HomeMy WebLinkAboutBuilding Permit #459 - 236 JOHNSON STREET 12/12/2006Permit NO: J
Date Issued: Z92 yl:m
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
I IMPORTANT: Applicant must complete all items on this oaize
LOCATION -3G /`�SU�'Y -Sr- / // -
Print
PROPERTY OWNER A�Ae� 10�w/g 3,01? �'/�--U
I / Print
MAP NO.: -1 .-1' PARCEL:
TYPE AND USE OF BUILDING
ZONING DISTRICT:
HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
❑ Addition
❑ Alteration
oD16ne family
❑ Two or more family
No. of units:
❑ Industrial
❑ Repair, replacement
'I Demolition
❑ Assessory Bldg
❑ Commercial
❑ Moving (relocation)
❑ Other
❑ Others:
❑ Foundation only
llL✓ )L,KIF I IVJN UP WORK TO BE PREFORMED
0Ue clzd oo/
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r/(f60 126.0 r
Identification Please Type or Print Clearly)
OWNER: Name:
Address: C226 —.,1 o h NSA -CT Al A-Ie)04e A
CONTRACTOR Name: A57- w$GS h V
Phone:
Address:�G�/4$'iY/<51�
rlA
Supervisor's Construction License: Exp. Date: 6/ f/4 if
Home Improvement License: las.3x,"� Exp. Date:
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE. BULDING P4WIT: $12.00 PFJW000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost :$ /Vt; pOD FEE:$
Check No.: 4- Receipt No.: 1 /4
Page IoP4
TYPE OF SEWERAGE DISPOSAL
Tanning/Massage/Body Art ❑
Swimming Pools ❑
Public Sewer ❑
❑
Tobacco Sales ❑
Food Packaging/Sales ❑
Well
❑
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 guaranty fund
Signature of Agent/Owner !•A ,ignature 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
PLANNING & DEVELOPMENT
COMMENTS
DATE REJECTED
CONSERVATION11
COMMENTS
DATE REJECTED
1
HEALTH ❑
V,
COMMENTS
❑
DATE APPROVED
DATE APPROVED
DATE APPROVED
V- FIRE DEPARTMENT - Temp Dumpster on site yes no
Fire Department signature/date /„s _ z �� . _ /4—jam— e-., 6
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer connection/Signature & Date Driveway Permit
Building Setback (ft.)
Dimension
Front Yard Side Yard Rear Yard
Required
Provided Require
Provides Required
Provided-
rovided
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. I:
1V V 1 EN and DA 1'A — Wor department use
Page 3 u1'4
Doc: INSPECTIONAL SER
Created ! MC. tan '006
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
Page 4 of 4
Location����
No. Date
NORTH TOWN OF NORTH ANDOVER
f D
t Certificate of Occupancy $
s'••1° • E<� Building/Frame Permit Fee $
sC14
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #���
19869 -�(2
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CS # 022680
HIC# 103358
ro ool _
A. J. Walsh A Sons
55 Pleasant Street
North Andover, MA 01845
# of
Proposal Submitted To: Job Name Job #
Address Job Location I
978-688-6737
or
1-866-AJWALSH
Date /` ` a G Date of Plans
Phone # Fax # I Architect
We hereby submit specifications and estimates for:
We propose hereby to furnish material and labor — complete in accordance with the above specificatiofor the sum
with pa�96n` dto be made as follows:
Dollars
Any alteration or deviation from above specifications involving extra costs will be
executed only upon written order, and will become an extra charge over and
Respectfully
submitted (�jf
above the estimate. All agreements contingent upon strikes, accidents, or delays
beyond our control.
/
Note — this be
proposal may withdrawn by us if not accepted within days.
Scceptance of Vropowd
The above prices, specifications and conditions are satisfactory and arer
hereby accepted. You are authorized to do the work as specified. Signature
Payments will be made as outlined above.
Date of Acceptance Signature