HomeMy WebLinkAboutBuilding Permit #682 - 265 GRANVILLE LANE 4/26/2006tIORTH
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Permit NO:�
Date Issued:
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received:
0
IMPORTANT: Applicant must complete all items on this page
LOCATION 97 g�9 — 7 Z �° l/J� �/�� �1
�—/ Print
PROPERTY OWNER d U1�y C e.) l LL --
Print
MAP NO.: PARCEL:
TVP' ANP ITCF. nF RITIVDING
ZONING DISTRICT:
HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ Addition
❑ A eration
❑ One 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
DVir— S INC SiAou GC_cs: art _)AIS,11 /II jE LLz r4E?l`l q
Z4fwCLE_'
Identification Please Type or Print Clearly)
OWNER: Name: U(�'/ (:�ILLIGOrl) Phone:52 l 69- 4!7?C
Address: 8 U ki 10 n/ S�
CONTRACTOR Name: LA.t-r1eC2-7 I`Oor— irJ� Phone: 57a
Address: • OQ ,Onl S -c—
Supervisor's Construction License:
Exp. Date:
Home Improvement License: % 2 j � I Exp. Date: 0616 9
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT. $10.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost :$ �'I`��iC�. x10.00=FEE:$
Check No.: Q N � Receipt No.:
Page Iof4
Location 6w ("m 0Y7 j r—
Na Z -Date �/2� 41
�oRTN TOWN OF NORTH ANDOVER
F � R
A
i
Certificate of Occupancy $
Building/Frame Permit Fee $
s�CHUS
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # C
Building Inspector
TYPE OF SEWARGE DISPOSAL
Art ❑
Swimming Pools ❑
Public Sewer F1Tanning/Massage/Body
Well F1Tobacco
Sales ElFood
Packaging/Sales 11
Private (septic tank, etc. ❑
Permanent Dumpster on Site ❑
Electric Meter location to
project
NOTE:
rersons conrracrrng wrtu unregtsterea contractors do not have access to the guaranty fund
Signature of Agent/Owner
Plans Submitted ❑
Plans Waived ❑
Signature of Contractor
Certified Plot Plan ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
Zoning Board of Appeals: Variance, Petition No:
Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Water & Sewer connection signature & date
DATE REJECTED
❑ ❑
❑Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
Stamped Plans ❑
DATE APPROVED
DATE REJECTED DATE APPROVED
❑ ❑
DATE REJECTED
El
Comments
Comments
DATE APPROVED
Temp Dumpster on site yes bio_ Fire Department signature/date
Building Permit Approved and Issued by: t
{ �1
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.:
NUIbJ ana UAIA—Icor
Page 3 of 4
Total square feet of floor area, based on Exterior dimensions.
Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM05
Created JMC. 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 DEPARTMENTMITORM05
Page 4 of 4
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