HomeMy WebLinkAboutBuilding Permit #610 - 27 BUCKLIN ROAD 4/16/2008BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit N0: Date Received
Date Issued:
' PS
IMPORTANT: Applicant must complete all items on this
Ti
n't
5. LOCATION
New Building
PROPERTYOVVNE!R.'
Addition
MAP
PARCEL DISTRICT;Histo-777777
.NO46
ZONING ric Dist
Commercial
Repair, replacement
O'tt�ec 16••�y0
3'� h�:s�'•_ "'"• a OL
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�A p�RAr I•PP ��(�%
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
One family
Addition
Two or more family
Industrial
Alteration
No. of units:
Commercial
Repair, replacement
Assessory Bldg
Others:
Demolition
Other
Septic Well z -
`" Floodplain -_- Wetlands
Watershed District
.
4
OWNER: Name:
Address:
UtZIUKIF I IUN Ur VVUKK I U BE PREFORMED:
�7
pep /r- C' (f
ARCHITECT/ENGINEER ' "� ` �� Phone:
Address: Reg. No.
FEE SCHEDULE. BULDING PERMIT. $12.00 PEAR$10000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PEERRiS..F.
Total Project Cost: $�FEE: Y
Check No.:-%q� Receipt No.:��
NOTE: Persons contracd/ith unregistered contractors do not have access to the guaranty fund
SOC -6
I
Location r� 0 r s
No. L Date V-16. D
1
NORTH TOWN OF NORTH ANDOVER
O L
p
Certificate of Occupancy
Building/Frame Permit Fee $g
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
Building Inspector
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer
Tanning/Massage/Body Art
Swimming Pools
Well
Tobacco Sales
Food Packaging/Sales
Private (septic tank, etc.
Permanent Dumpster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEAL'H Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Comments
Conservation Decision: Comm
Water & Sewer Con nection/Si-qnature & Date Driveway Permit
DPW Town Engineer: Signature:
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
Doe -Building Permit Revised 2008
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 -Q 4ode"C-
❑ Photo Copy Of HF_ I C_ And/Or C.S.L. Licenses
❑ Copy of Contract
❑ Floor Plan Or Proposed Interior Work
o Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
❑ Building Permit Application
❑ Certified Surveyed Plot Plan
o 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)
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
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)
o Copy of Contract - -
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
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:BPFORM07
Revised 2.2008
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GAUDETTE AND SONS ROOFING
"Over 50 years of Quality Work at a Reasonable Price"
978-807-5934
PROPOSAL
Name_ f i 41'5� lb 06CI' )�C,05C Job Name
Address / iL.L An Address YIV
Phone q7i2
We hereby agree to perform work andel provide materials as specified as follows;
-) �7d2+ice �o t. P � 7�it� tC�n �ti►.
L,f, Mf 6-11, et, rZ� / 4t/
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and sons agrees to furnish labor and materials as specified above for LCL'
Paymen as follows: t �� Z/LVl / Z ✓� L%J2 L
11 work and materials are prded as d c abo4. Any changIteratiods, or additional
w s all be renegotiated. Parties agree to above specifications by signing and dating below:
r Date 1 e w—A ? Date LI11 o?
AfOs i(- C& 11� 36 ��4 &/d
NORTH ANDOVER BUILDING DEPARTMENT
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance ith the provision of MGL c 40 S 54, a condition of Building Permit
at: 2 -? /Al is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
c11,S150A.
Also, note Permits are required under Fire Prevention laws Chapter 148 Section
10A.
The debris will be disposed of in:
l
of'acility)
Signat re of Permit Applicant
q11j1C17-9?
Date