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Home My WebLink AboutBuilding Permit #197 - 373 RALEIGH TAVERN LANE 5/1/2018 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION o`N�°T a o p Permit NO: Date Received + +� 04 Date Issued: �9SSgcHuSE��y IMPORTANT: Applicant must complete all items on this page LOCATION 373 Print PROPERTY OWNER /_/ 4A G% U L Print MAP NO.: j D 7 1t PARCEL: j;I �L. ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑New Building ❑One family ❑ Addition ❑Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Repair, replacement ❑ Assessory Bldg ❑ Commercial ❑ Demolition ❑ Moving(relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIP;ION OF WORK TO BE PREFO ED Identification Please Type or Print Clearly) OWNER: Name: A4 r{J S 1- /= h',b.,ci e_' U Z- I_= Phone: 979 Address: 3 7 /?A L A' L A A,F CONTRACTOR Name: AA 9 R I O Re a SSF L Phone: 6 a 3 Address: 4 ILL /?JP 4V,/,A/,Q N A M, l , Supervisor's Construction License: 4& 9 L// Exp. Date: �`/ 3/ �0 7 Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED C ST BASED ON$125.00 PER S.F. Total Project Cost :$ 04, Oo FEE:$ 1�_ G Check No.: C }— Receipt No.: �S6 Page lora TYPE OF SEWERAGE DISPOSAL Swimming Pools ❑ Tanning/Massage/Body Art Public Sewer Tobacco Sales ❑ Food Packaging/Sales ❑ Well Permanent Dumpster on Site 11 Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guarantyJund 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance, Petition No: d Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer connection/Signature& Date Driveway Permit Temp Dumpster on site yes noFire Department signature/date Building Setback (ft.) Front Yard Side Yard Rear Yard I RequiredProvided Required Provides Required Provided 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) Pale 3 ol'4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created 1VIC,J:m.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 pp Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of BuildingPlans One To Be Returned to Include Sprinkler Plan And ( ) P 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 I Doc:INSPECTIONAL SERVICES DF.PART3IF.N'r:11PFORN105 III Parr.$of a ` FORTH Town of 4Andover L o = L A rt dover, Mass., J*At-,# eo COCMICHE WICK ADRATED p �C) S BOARD OF HEALTH PERMIT ' T D Food/Kitchen Septic System 1, BUILDING INSPECTOR THIS CERTIFIES THAT.........A.A.!.�..r...................... ar��.. ..1...3................................. i""""' Foundation has permission to erect........................................ buildings on34;...... t h7.`(....Tg.09sm....e*^A.... Rough to be occupied as..........CAOWA002. .... . .4 ..f.�.......................................................... .... Chimney provided that the person accepting this permit shall in every respect conform,to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings In the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTR TS Rough . ... . . .. .. .. . .......... ....................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Bumer Street No. SEE REVERSE SIDE Smoke Det. � �""__�� a�✓��aavcu,�u�ael,�� , lie am rraa� BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR �t 4� 066941 Number: CS Birthdate: 05/3111952 a Expires:„05,'3112007 Tr.no: 12650 H ;action- Restricted: 00 MARIO ROUSSEL PO BOX 936 W INDHAM, NH 03087 Commissioner Location 0 �CAr�✓1 /�y ��"' No. Date NORTh TOWN OF NORTH ANDOVER • O s4 -0- I Certificate of Occupancy $ E Building/Frame Permit Fee $ Mus AC Foundation Permit Fee $ Other Permit Fee $ TOTAL $ f Check # '! 9582 Building Inspector