HomeMy WebLinkAboutBuilding Permit #633 - 25 COLGATE DRIVE 4/10/2006f MONTM
. 1
TOWN OF :NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
�SSACHu5E1
I
Permit ti0:_.e4 Date Received:
Date Issued: Z? 7
131PORTANT: Applicant 111LISt complete all 1tenIS oil th1S Da2C 1
LOCATION__4 _5� CG (te q to
I •- I'rntl i'
PROPERTY OWNER /1�
IPrint
Mf1P N'O.: = /_/, PARCEL: _ 3 �e
ZONING DISTRICT:
TYPF. AND IIRV nF RI III nuvr_
TIDE OF INIPROVENIENT
aaaV a vamat. 110711111...
PROPOSED USE
! Y LIN <J
Residential
Non- Residential 1
New Building
Addition
Iteration
'-"One family
- Two or more family
No. of units:
:_: Industrial
L' Commercial
I
Repair, replacement
_i Demolition
Assessory Bldg-=—�_ --
Moving (relocation)
Other
=, Others:
- Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
/L•C (� C �. r h
Identification Please Type or Print Clearl
OWNER: Name: /��� � � Z S-
.2
Address:_ S Cv CT P`. /J
CONTRACTOR Name:_ ,rte _4 ,. 1_fe e-'�c-4
Address:
Supervisor's Construction License: Exp. Date:
one:
ane:
Mollie I111prokenlent License: / .Z / S� Exp. nate:
I
1RC1I171:C' h: I .NC►1NF;1';R Name: Phone:
Address:
Rep. No.
FEE SCHEDULE: BC'LDL\'G PERMIT.- Sl11.110 PER S1000.0 OF THE TOTAL EST1,41.4 TED COST BASED OA
.S1? S. 00 PER S.F.
Total Project Cost :$ j 200 . OCA x10.00 FEE:$
Check No.:_ -j r Receipt No.:g� C�._
n, --
Location C^ e -
No. Date
T/-/
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
CHUS
Foundation Permit Fee $
Other Permit Fee
TOTAL
Check #
\ZS Building Inspector
TYPE OF SEW ARGE DISPOSAL
Public Sewer
well
Private (septic tank, etc.
Tanning/Alassage Body Art
Tobacco Sales
i
Permancnt Dumpster on Site
Swimming Pools
- I Food Packaging Sales
NOTE: Pet -sons contracting'.,' with unre istereil contractors (ho not have aec,ess /U the ("llarall/t' fillm
Signature. ot' Agent/Owner . Signature of Contractor
Plans Submitted ❑ Plans Waived l Certified Plot Plan.,tamped Plans
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
'
JCONSERVATION
COMMENTS
HEALTH
COMMENTS
Zoning Board of Appeals: Variance, Petition No:
Zoning Dccision,'receipt submitted yes
Planning Board Decision:
Conservation Decision:
�k ater &, Sewer connection signature K. date
DATE REJECTED DATE APPROVED
❑ ❑
[]Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
DATE REJECTED DATE APPROVED
❑ ❑
DATE REJECTED DATE APPROVED
Comments
Comments
Temp Dumpster rni site yes__no__ Fire Department si-tiature'date
Building Permit ,approved and Issued by:
Building Setback (ft.)
F----Froiit Yard Side Yard Rear Yard
Requircd I Provided
RcqLlii-cd Provided ]Llircd Providcs
DIMENSION
Number of Stories:
Total land area. sq. ft.:
Total square feet of floor area, based on Exterior diniensions.—_,—
;N:); I .i Ill 1 :;1,:, 'v I('1 :-, 1;; i G I Mi 1 W! ( ;R V
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
u Debris Removal Form
• Workers Comp Affidavit
• Photo Copy Of H.I.C. And/Or C.S.L. Licenses
u Copy of Contract
❑ Floor Plan Or Proposed Interior Work
Addition Or Decks
❑ Building Pen -nit Application
❑ Form U
❑ Surveyed Plot Plan
❑ Debris Removal Form
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
Calculations (If Applicable)
,jFloor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic
❑ Mass check Energy Compliance Report (If Applicable)
New Construction (Single and Two Family)
❑ Building Permit Application
❑ Form U
• Certified Proposed Plot Plan
Li 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
Calculations (If Applicable) Hydraulic
Copy of Contract
j Mass check Fnel•gy Compliance Report
In all cases if a iariance or special permit was required the To%%n Clerks off -ice must stamp
Appeals that the appeal period is over. The applicant must the decision from the Board ofthen get this recorded at the Registry of Deeds.
of recording must be submitted H ith the building application
One copy and Proof
Doc: ►\s",(110\.1L SER% ICES DEP.IRT%11:\T:BPr0R%l05
6771 �omvircoozurea/ a� /aa--
Board,of Building lieguions and 5taudqtl'r, ti
hOMEIMCRA t 1Tl2
Registration 122153
Di r 0 7,/26/2005.
-r jtt-
Type -D�:A
JOHNBERTHOPCOJSTRUCT40N
John BYerthoid t � ,� ✓�
43 SICKLE FANCY L-N�
-.EM-'NH 03079 µ'��✓
Admigistr eLoe ; -
Page No. of Pages
PROPOSAL
�0 - 110 MA Lic. # 122153
BERTHOLD CONSTRUCTION I.L.C. FL Lic.
# 1yr38
Widow Painting (603) 339-1465 Siding and Soffit
Carpentry
• Doors •Renovations
Fully Insured • Over 15 years Experience • Free Estimate
PROPOSAL SUBMITTED TO
PHONE
DATE
STREET
JOB NAME
CIN; STATE AND ZIP CODE
�JCB.LOCATION
i
We hereby submit specifications and estimates for:
r
1
k
WE PROPOSE hereby to furnish material and labor—complete in accordance with above specifications, for the sum of:
r
_
%/ �, •r - / y yam, — dollars
Payment to be made'as follows:
All material is guaranteed to be as specified. All work to be completed in a Authorized
workmanlike manner according to standard practices. Any alteration or Signature:
deviation from above specifications involving extra costs will be executed only'''r
upon written orders, and will become an extra charge over and above the
estimate. All agreements contingent upon strikes, accidents or delays beyond Note: This proposal may be
our control. withdrawn by us if not accepted within days.
ACCEPTANCE OF PROPOSAL—The above prices, specifications
and conditions are satisfactory and are hereby accepted. You are authorized
to do the work as specified. Payment will be made as outlined above.
Date of Acceptance: ,'t Signature: / l / % l 1'/ / 1 •� % %
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COL G19 T6- 04 lYC.
HEREBY CERTIFY TO THE TITLE INSUROR AND
THE BANK THAT THS DWELLING IS LOCATED ON
W LOT AS SHOWN AND THAT IT DOES CONFORM
W TAE 7vv" OF No. "000vG2 ZONING REGULArlONS
'CARDING SETBACKS FROM STREETS k LOr LINES.'
' FURTHER CERTIFY THAT THIS DWELLING IS NOT
CA TED IN E FE ERALAFLOOD HAZARD AM AS
'O lrm ON F CO PANEL i 2.Soo q 8
X03 C :?. 0,97Y 3
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.L'l�HE
iS FOR MORTGAGE PURPOSES, - NOT FOR
MARY DL'FERYJjkrlON,. BOUNDARY INFORMATION
CEN FROM KXMfING RECORDS.
PL O T PLAN
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MEIIRIJIACK ENGINEERING SERVICES
66 PARK STREET
ANDOVER, MASSACHUSETTS 01810
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