HomeMy WebLinkAboutBuilding Permit #630 - 24 PERLEY ROAD 4/10/2006NONT1r
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TOWN OF NORTH ANDOVER
APPLICATION FOR PL;,kN EXAMINATION
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Permit \'O,410-3-0 Date Received:= (�
Date Issued: &115,k
EMPORTANT: Applicant 111LISt C0111pICte aII items oil this
LOCATION_--� L/
PROPERTY OWNER
NL1P NO.: 3 _PARCEL:
TYPE. AND 11SF. OF Run,nINC.
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1'yint _
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5— Print
ZONING DISTRICT:
I-IIQTr"Dld" 1ATC9M1&"r1 V;c140 n
TYPE OI- IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
Addition
-. Alteration
One family,
- Two or more family
No. of units: _
_: Industrial
I
`, Commercial
Repair.. replacement
--j Demolition _
_ Assessor), Bldg________---
Moving (relocation)
Other
_. Others:
Foundation only
i
1xir i ik.jiv yr V "AN 1 v t5L rKrt UKNtt=,U
ea A01V4 14A CJ 14�p`4-ee
Identification Please Type or Print Clearly)
OWNER: Name:---! �'-� G ��t4.X5 Phone J6;���7� 1(-1
Signature o
Address. �-/� �r'v� /q—✓
CONTRACTOR Name:
ne�.g7�1
Address: f L(---_ ULAtti. efl -5 ? Imo, A
Supervisor's Construction License: 6 - P(c Exp. Date:d — f -o�
I.
IIonle lnlpro�enlent I IMISC:Y r
/ & d 5 % Exp. Date:: / 3 6— 7_
T
ARCI-I ITL:C'L,F.NGINEF, Rvarve: Phone:
Address:
g. No.
FEE SCHEDULE: BULMN'G PERM/T.• .S/ll.11ll PER S1000.00 OF THE TOTAL E'.STI,,IL i TED COST BASED O:?
5125. 00 PER S. F.
Total Project Cost :$ lDoe x10.00 FEE:$
Check No.: Receipt No.: ��
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 ,
:j Building Permit Application
Debris Removal Form
\ orkers Comp Affidavit
u Photo Copy Of H.I.C. And;'Or C.S.L. Licenses
J Copy of Contract
u Floor Plan Or Proposed Interior Work
Addition Or Decks
u Building Pen -nit Application
u Form U
u Surveyed Plot Plan
u Debris Removal Form
Workers Comp Affidavit
u Photo Copy of H.I.C. And C.S.L. Licenses
u Copy Of Contract
u Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic
—Calculations (1f Applicable)
u Mass check Energy Compliance Report (If Applicable)
New Construction (Single and Two Family)
u Building Permit Application
u Form U
Certified Proposed Plot Plan
u Photo of H.I.C. And C.S.L. Licenses
Workers Comp Affidavit
u Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic
Calculations (If Applicable)
Copy of Contract
j Mass check Fnergy Compliance Report
In all cases if a i ariance or special permit %v as required the Toy%n Clerks oft ice 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 H ith the building application
Doc: 1\SPEC HONA . SP.R% ICES DEPARTME\T:BrPOR1105
TYPE OF SEW ARGE DISPOSAL.
Public Sewer
well
I Prirate (septic tank, e
Tail niassage-Body .art
Tobacco Sales
Permanent Dumpsster_on Site
Swimmim, Pools
— Food Packa--in(Sales
NOTE: Persons c'on/rueln ullJ1rC'�l.1'/P/'C'(%C'111111'(/C'/llrl' (I(1 110/ I/(11'C' /!CC'C'.1'J' /0 1IfC'
Sigrtature oC;Xgent/Owner Signattu•e of' C ontractor
-. —� Stam ed Plans �!
Plans Submitted _I Plans Waived I� Certified Plot Plan p
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - l.! FORM
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION
COMMENTS
HEALTH
C'OYIMENTS
Zoning Board of Appeals: Variance, Petition No:
DATE REJECTED
❑ ❑
❑Water Shed Special Permit
Site Plan Special Permit
❑ Other
DATE APPROVED
DATE. REJECTED DATE APPROVED
❑ ❑
DATE REJECTED
D.
Zoning Decision:'reccipt submitted yes
t
Planning Board Decision: --------------Continents
Conservation Uccision:_---C'ommcnts
�\ ater &, Sewer connection signature &, date
Temp Dempster on site yesno_ Fire Department sillnaturedate
Building, Permit Approved and Issued by:
I
DATE APPROVED
Buildin, Setback (ft.) ------
-Front Yard j Side Yard Rear Yard
Required Provided j Required Provides Required j Provided
DIMENSION
Number of Stories: Total spare feet of floor area, based on Exterior dimensions._
Total land area. sq.
! L
1.1 I R; N'. J I'*,!.,, I A] :J:11 (11?
190195
Building Inspector
r
i�lelzl Le-(�7 fl'
Location e;l�
No.
Date
TOWN OF NORTH ANDOVER
41
Certificate. of occupancy $
Mus
Building/Frame Permit Fee $
440
—
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #-7//
190195
Building Inspector
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Board of Building Regulations and Standards
N HOME IMPROVEMENT CONTRACTOR
+Registration: , 126059
Expiration: 4/13/2006
Type: individual
RALPH A. RIZZO.
t RALPH RIZZO
14 VERNON ST. _ $
i BRADFORD, MA 01835```�``�
Administrator
;
BOARD OF BUILDING REGULATIONS
,rt License: CONSTRUCTION SUPERVISOR s
j t•, Number: CS 071946
Birthdate: 02/04/1970
Expires: 02/04/2008 Tr. no: 18793
Restricted: 00 t
} RALPH A RIZZO e�
14 VERNON ST
BRADFORD, MP, 01835 Commissioner
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