HomeMy WebLinkAboutBuilding Permit #681 - 265 GRANVILLE LANE 4/26/2006pORTF1
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Permit NO: /
Date Issued:
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received: 2 fo
I IMPORTANT: Applicant must complete all items on this page
LOCATION ;2,6 -5 � ��'� ► �-t-�-y"
y,� Print
PROPERTY OWNER /�"/ flR/a
Print
MAP NO.: �b PARCEL: ZONING DISTRICT:
TYPE AND ITSE OF BUILDING
HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT
PROPOSED USE
Reside al
Non- Residential
❑ New Building
❑ Addition
❑ Al ration
ne family
❑ Two or more family
No. of units:
❑ Industrial
epair, replacement
❑ Demolition
❑ Assessory Bldg
❑ Commercial
❑ Moving (relocation)
❑ Other
❑ Others:
❑ Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
Identification Please Type or Print Clearly)
OWNER: Name: Mf4 z/6 (S1 A UP( ruo Phone: 977 UFC -7Z66
Address: 2(-o S�►2-AAJbVIUUC- Z -ti
CONTRACTOR Name:r>'! F3 FR. i (<- ti Phone:ct7� S7LI-- 7 Z Z v
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License: % 2- / I4Ic l Exp. Date:
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT: $10.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTB SED ON $115.00 PER S.F.
Total Project Cost :$ 4/200 x10.00=FEE:$ e—
Check No.:Receipt No.: J
Page I of 4
Location h l /Z u4
No. Date
l
r►ORTM TOWN OF NORTH ANDOVER
• OL
9
Certificate of Occupancy $
Eta Building/Frame Permit Fee $
�GMus !
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # f
1 5 4 Building Inspector
It
TYPE OF SEWARGE DISPOSAL
Tanning/Massage/Body Art 11Swimming
Pools ❑
Public Sewer F1
Well ❑
Tobacco Sales ❑
Food Packaging/Sales ❑
Private (septic tank, etc. ❑
Permanent Dumpster on Site ❑
Electric Meter location to
project
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner Signature of Contracto %
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT ❑
COMMENTS
CONSERVATION11
COMMENTS
HEALTH
COMMENTS
Zoning Board of Appeals: Variance, Petition No:
Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
DATE REJECTED
C
❑ Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
DATE REJECTED
DATE REJECTED
Q
Comments
Comments
Q
I
DATE APPROVED
DATE APPROVED
DATE APPROVED
Water & Sewer connection signature & date
Temp Dumpster on site yes_24—no_ Fire Department signature/date
Building Permit Approved and Issued by: l
Page 2 of 4
Building Setback (ft.)
Front Yard
Side Yard
Rear Yard
Required
Provided
Required
Provides
Required
Provided
DIMENSION
Number of Stories:
Total land area, sq. ft.:
Total square feet of floor area, based on Exterior dimensions.
NUI LS and DATA — (For department use)
Page 3 of 4
Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM05
Created 1MC. Jan.2006
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:QPFORM05
Page 4 of 4
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