HomeMy WebLinkAboutBuilding Permit #96 - 316 JOHNSON STREET 8/9/2006Pennit NO:
Date Issued:41--- Z
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
DateReceived 9-
0
I IMPORTANT: AvDlicant must complete all items on this page I
LOCATIONJ 4' 4 n
A , , Print
PROPERTY
Print
MAP NO.: PARCEL:
TYPE N USE OF BUIL ING
ZONING DISTRICT:
HISTORIC DISTRICT YES 0
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
0 New Building
E�One family
F1 A4fition
11 Two or more family
0 Industrial
[tAteration
No. of units:
��<epair, replacement
0 Assessory Bldg
11 Commercial
0 Demolition
[I Moving (relocation)
L1 Other
0 Others:
[I Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
Please Type or Print Clearly)
OWNER: Name:
Address: 2 / w" —,)a A t7,4 0 -7 "qW—
CONTRACTOR Name:
Address:
Supervisor's Construction License: o,6 � 9-o 3 Exp
Home Improvement License:_ � 2-0 S '� 0 Exp
ARCHITECT/ENGINEER Name: Phone:
Address:
Reg. No
Date:
Date:
FEE SCHEDULE. BULDING PER 0 PER $1000.00 OF THE TOTAL ESTIMA TED COST BASED ON $125.00 PER S.F.
Total Project Cost S A3 MOW,—FEES 16,0
11,6 /;�- 00
Check No.:--JY7t Receipt No.: A.193 --7--
Page I of 4
TYPE OF SEWERAGE DISPOSAL
Tanning/Massage/Body Art
Swimming Pools
Public Sewer 1�
Well
I Tobacco Sales
Food Packaging/Sales El
Permanent Dumpster on Site
Private (septic tank, etc.
Electric Meter location to
project
N OT E: Persons contracting with ut ister contractors do not have access to ;thegu;aanty
-tit u I&vr
Signature of Agent/Owner Signature of contra
r]
Plans Submitted 0 Plans, Waive/ El Certified Plot Plan El Stamped Plans El
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED
PLANNING & DEVELOPMENT 11
101
[]Water Shed Special Permit
11 Site Plan Special Permit
11 Other
COMMENTS
DATE APPROVED
DATEREJECTED DATE APPROVED
CONSERVATION F1 n
COMMENTS
DATE REJECTED DAT;f
PROVED
HEALTH 9 OIL
COMMENTS
Zoning Board of Appeals: Variance, Petition No:
Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer connection/Si2nature & Date Driveway Permit
Temp Dumpster on site� 'ye's'—no� Fire Department signature/date
Building Setback (ft.)
Front Yard
Side Yard
Rear Yard
Required
Provided
Reguir�e�dProvides
Required
Provided
I
+
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
NOTES and DATA — (For department use)
ffz -
Doc: INSPECTIONAL SERVICES DEPARTM ENT: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
u Building Permit Application
a Workers Comp, Affidavit
u Photo Copy Of H.I.C. And/Or C.S.L. Licenses
u Copy of Contract
u Floor Plan Or Proposed Interior Work
Addition Or Decks
u Building Permit Application
u Surveyed Plot Plan
u 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 (If Applicable)
u Mass check Energy Compliance Report (If Applicable)
New Construction (Single and Two Family)
a Building Permit Application
o Certified Proposed Plot Plan
a Photo of H.I.C. And C.S.L. Licenses
u Workers Comp Affidavit
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
u Copy of Contract
u 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:BPFORM05
N op. 4 of 4
Location
A-56 Y7
No.
Date
TOWN OF NORTH ANDOVER
0.
Certificate of Occupancy $
Building/Frame Permit Fee $ k
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #5AL—
�337
.1 Building Inspector
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ACOR-0, CERTIFICATE OF LIABILITY INSURANCE 1 03120/2006
RODUCER (978) 687-8304 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
UGONE-JOHNSON INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
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MEADOWVIEW CONSTRUCTION LLC
DAVID WEST
80 HAVERHILL RD. r4—, --,. �; �
TOPSFIELD, MA 01983 , Administrator
4�
License or Nostration valid for individul use only
before the "phration date. If found return to:
Board of Building Regulations and Standards
One Ashburton Place Rm 1301
Boston, Ma. 02108
Not valid without signature
TIM Co..0—wakA
BOARD OF BUILDd
License: CONSTRUCTION SUPERVISOR
Number: CS 069803
Birthdate: 08/22/`1970
Expires: 08/22/2006 Tr. no: 1635.0
rl Restricted: 00
DAVID 0 WEST
80 HAVERHILL ST
i TOPSFIELD, MA 01982
Commissioner
92,
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 120560
Expiration: 1/30/2008
Type: Ltd Liability Corporation
MEADOWVIEW CONSTRUCTION LLC
DAVID WEST
80 HAVERHILL RD. r4—, --,. �; �
TOPSFIELD, MA 01983 , Administrator
4�
License or Nostration valid for individul use only
before the "phration date. If found return to:
Board of Building Regulations and Standards
One Ashburton Place Rm 1301
Boston, Ma. 02108
Not valid without signature
TIM Co..0—wakA
BOARD OF BUILDd
License: CONSTRUCTION SUPERVISOR
Number: CS 069803
Birthdate: 08/22/`1970
Expires: 08/22/2006 Tr. no: 1635.0
rl Restricted: 00
DAVID 0 WEST
80 HAVERHILL ST
i TOPSFIELD, MA 01982
Commissioner