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Home My WebLink AboutBuilding Permit #159 - 219 MAIN STREET 8/29/2006 I TOWN OF NORTH ANDOVER !� p►O R TF/ APPLICATION FOR PLAN EXAMINATION 0"U"o 06 �a '6To 0 APPR®%/ED o - Permit NO: Date Received Date Issued: ssgcHus��Ay IMPORTANT: Applicant must complete all items on this page LOCATION 1`1 jV `V • ,I ��f1 rint PROPERTY OWNER ^ i V Print MAP NO.: 30 PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑New Building ❑ One family ❑ Addition ❑Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Repair, replacement ❑ Assessory Bldg ❑ Commercial ❑ Demolition ❑ Moving(relocation) ❑ Other ❑ Others: ❑ Foundation only D S RIPTION F WORK TO• BE PREFORMED p ( I •u 1_ _ ( - � Q yAn Ak_\ k r_C� - aeA e �' pcky& tcwoAtS4 r06AA aAa KJJ- MAA. a 00rx Wntification Please Type or Print Clearly) 1 OWNER: Name: I /4 91 Ile Phone: q70: S ' �l Z7 Address: Z g CONTRACTOR Name: �QJJ Phone: 1'F 1 1' q4o Address: ' Kurk*4VIIaLLl�_ taLiff_KCe_ ( l��3 Supervisor's Construction License: �S ((.Q'F a 3 Exp. Date: a 1 Home Improvement License: 3 '� Exp. Date: ( / (0 /0-:F pzkrvkl� PU-6111" ARCHITECT/ENGINEER'k)pc,GIA EAci &e@..i"ty,o Name: Phone: � � 34 1 ' MOO Address: 13 CCLAMfl Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ %44 '149 FEE:$ Check No.: �-� Receipt No.: Page W4 TYPE OF SEWERAGE DISPOSAL Swimming Pools 11r,/ Tanning/Massage/Body Art ❑ Public Sewer �i�' Well r] Tobacco Sales ❑ Food Packaging/Sales ❑ Permanent Dumpster on Site ❑ Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the gu F ranty fund Signature of Agent/Owner 4 Signature of contractor Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS f DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer connection/Signature& Date Driveway Permit Temp Dumpster on site yesno_ Fire Department signature/date Building Setback(ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area,based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA—(For department use) I III I Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan2006 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 Addition Or Decks ❑ Building Permit Application ❑ 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) 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 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:BPFORM05 PAPP 4 nf4 LocationC�,q MG{fj ST— No. S I Date Z� O �oRTM TOWN OF NORTH ANDOVER ` Certificate of Occupancy $ . i s °mob+„� ` • cMusEtl� Building/Frame Permit Fee $ f Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 19529 Building Inspector