HomeMy WebLinkAboutBuilding Permit #728 - 187 CORTLAND DRIVE 6/24/2009BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO:, ✓Qt'
Date Issued:
IMPORTANT:
LOCATION 187 Cd+rtic
PROPERTY OWNER NVet
must
Print
Date Received
all items on this
v Print
MAP NO: JSIC. PARCEL: 31 ZONING DISTRICT:, Historic District yes
Machine Shop Village yes
TYPE OF IMPROVEMENT
PROPOSED USE
Res' tial
Non- Residential
g
One fa
`
Addition -
Two or more family
Industrial
Alteration
No. of units:
Commercial
Repair, replacement
Assessory Bldg
Others:
Demolition
Other
,septic - Well
Floodplain Wetlands
Watershed District
V1/ater/
UtbUKIF I IUN OF WORD( TO RE PREFORMED:
OWNER: Name:
Address: I 1 S- 66 Yee y
CONTRACTOR Name:TA -1-& 4-1
Address:
Please Type or Print Clearly)
e)" m -tins L L. C
UC
Phone: 4 7R -&7-
2T( -b$7-ZAI r'
Supervisor's Construction License: C3 `," / Exp.. Date:
Home Improvement License:
Date:
ARCHITECT/ENGINEER Phone:
�--� -Address: -' Reg. No.
FEE SCHEDULE: BOLDING PERMIT: $12.00 P R $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ �g b x os x )Z. FEE: 4. t y J U0
1 , � � u� S �t33Z �e �1a + I Q� � �h� 1 u�
Check No.:_ _--5"zzT Receipt No.:
NOTE: Persons contracting with unregistered c tractors do not have access to the guaran u d
gnature of Agent/Owner Signature of contractcw
Location ro rX'- 11" !/r
No. 7,1Z Date C� ' (�
TOWN OF NORTH ANDOVER
L
Certificate of Occupancy $
Building/Frame /Frame Permit Fee $
s�CHuse 9
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # 22
22) bl _
Building Inspector
tans Submit Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewe
Tanning/Massage/Body Art
Swimming Pools
Well
Tobacco Sales
Food Packaging/Sales
Private (septic tank, etc.
Permanent Dumpster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
.PLANNING & DEVELOPMENT
COMMENTS �. "C l4. qO $
CONSERVATION Reviewed on d Signature V #-V-�
zzz
COMMENTS G�
J
HEALTH Reviewed on Signature
COMMENTS
4.
Zoning Board of Appeals: Variance, Petition No:..,.. Zoning Decision/receipt submitted yes
Planning Board Decision: N ).A Comments
Conservation Decision: Z Z ~ h Comments
> � -�-off .
Water & Sewer Connection/Si nature & Da ` Drivewa Permit
DPW Town Engineer: Signature:
Located 384 Osgood -Street
FIRE DEPARTMENT Temp Dump r on site yes no
Located at 124 Main Street
Fire Department signature/date d
COMMENTS
Dimension
1
Number of Stories: Total square feet of floor area, based on Exterior dimensions. 2 qN
Total land area, sq. ft.: .Z
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No X
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA — For department use
❑ Notified for pickup - Date
Doc.Building Penn it Revised 2008
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
❑ Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
❑ Floor Plan Or Proposed Interior Work
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
❑ Building Permit Application
❑ Certified Surveyed Plot Plan
❑ .Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (if Applicable)
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Copy of Contract
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submitted with the building application
Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2008
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