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HomeMy WebLinkAboutBuilding Permit #180-14 - 39 HIGH STREET 8/27/2013 BUILDING PERMIT TOWN OF NORTH ANDOVER s c APPLICATION FOR PLAN EXAMINATION } Permit NO: O N Date Received bA4rso Date Issued: Ly-, 7 l �SSwcyE� IMPORTANT:Applicant must complete all items on this page LOCATION N 5 v\ <,-, �Vy-ve"e__ PROPERTY OWNER 1`�C Print �C %fi'\ Ar�1 � r,f LLQ LLC Print MAP NO: _PARCEOW1 ZONING DISTRICT: Historic District yes no Machine Shop Village TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial X Alteration No. of units: xCommercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer T���a\� /Hol Cv3E curt N i �Q� ��fii Iury S Identification Please Type or Print Clearly) OWNER: Name: o g.rH J ZJwE 2 MILLS LI-C Phone: — Address: C o 1'�C LLC. I' Iva Ir o �". 'DJi m N o 0 CONTRACTOR Name: C1�� ���„�, (�;•�StY.:t,�� Da it&,Phone: x;17 — (,-I y 55717 Address: Supervisor's Construction License: CS - c S*,(,'4 to Exp. Date: G o3 / 2of+f Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:512.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $_ yU FEE: $_(-,17—' Check No.:— 3�:j./ Receipt No.: G'7 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty f 1d ignature of Agent/Owner Signature of contractor • r � i TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print._ PROPERTY OWNER - Pririf` ,r 100 Year Old Structure yes no MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 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 0 Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund ;Signature of Agent/Owner Sigature of contractor Plans Submitted 0 Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ Plans Waived❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE-:0Y SEW-ERAGEDISPOSAU 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 DATEAPPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS .CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes • Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW'Tow;. Engineer: Signature: Located 384 Osgood Street FIRE-DEPARTMI:_NT - Temp Dumpster on site yes no Located*at 124 Mair Street Fire Departmer`t•si§nature/date t u S :; COMMENTS . 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 NOTES and DATA— For department use I ® Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The fol(.wwing is-a list of the required forms to be filled out for the appropriate.permit to be obtained. Roofil�g, Siding, Interior Rehabilitation Permits uBuilding Permit Application u Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses u Copy of Contract u Floor Plan Or Proposed Interior Work u Engineering Affidavits for Engineered products NOTE: All dumpster.permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building pp Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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) o Building Permit Application o Certified Proposed Plot Plan a Photo of H.I.C. And C.S.L. Licenses u Workers Comp Affidavit L3 Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract u Mass check Energy Compliance Report u Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cans if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apw al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Building Permit Revised 2012 . Location ZG /�`1�� G.. No. Date 7 ArF . - TOWN OF NORTH ANDOVER Certificate of Occupancy $-42?�'` Building/Frame Permit Fee $_ri/Z Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Z— Check# lA 26781 Builcrioinspector i Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost $ 42,640.00 m $ - $ 511.68 Plumbing Fee $ 63.96 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 63.96 Total fees collected $ 739.60 39 High Street - Converse 180-14 on 8/27/13 40 Cubicle Stations RT SS'AC1111`'Et CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 180-14 on 8/27/2013 Date: August 30, 2013 THIS CERTIFIES THAT THE BUILDING LOCATED ON 39 High Street MAY BE OCCUPIED AS 40 Cubicle Stations - Converse_IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: RCG NA Mills, LLC 39 High Street North Andover, MA 01845 Bui ding Ins ector Fee: PrePaid Receipt: 26781 Check : 65996 r '1 NORTH i. -c . . ve' . o - No. Iq ver, Mass, r�7 COCNICHIWICK U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System L� THIS CERTIFIES THAT XC. r ... . ............................ BUILDING INSPECTOR . 11:11 /� Foundation has permission to erect .......................... buildings onr7/��. � '�'��'s`. ......... .... . Rough -� to be occupied as .......... �....��.��:Q,�............. .5....... ... .rfi .......................................... Chimne provided that the person accepting this permit shall in every respect conform to the terms of the application �inal on file in 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 F1, Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS �ugh Bk, Service ............ ...... . ../.. ....................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE EVERSE SI q�q - (as GENERAL BUILDING NOTES/CHECKLIST-NOT LIMITED TO ITEMS BELOW f / POST ALL LOT NUMBERS,ADDRESS, AND PERMIT(COPY OK)..or no inspections INSPECTIONS: (Minimum) Excavation , Footing, Foundation, Frame, Insulation, Final. FOOTINGS: Continuous Full 2x4 Keyway Continuous strip footings for interior columns FOUNDATION: Rebar as required Anchor bolts or straps Damproofing Foundation drain-pipe/stone/fabric filter/cover and outlet connection. FRAME:Fireblock-over girts/plates between floor joist Penetrations for plumbing, heat, elec, etc. Walls at stair stringers. Windbrace corners and center bearing partitions. Size ridge to provide full bearing at rafter cuts. Hip and Valley rafters-watch bearing at walls. Ridge&Hip-Provide proper connections. Cathedral roof rafters provide proper connections and use"Hurricane Clips"tie to plate. Stair stringers-watch cuts and heal support. Joist hangers-fully nailed w/hanger nails. Sill plates 2-2X6(1 PT)w/sill seal. Girls-solid brick or steel plate bearing at foundations '/"air space at sides in foundation pockets. Lateral bracing at ends. Certified calculations. required for Beams/LVL's Trusses. Solid bearing support for Headers/Beams etc. Check headroom clearances-stairways, under beams Attic Access. (min.22x30 w/3' headroom above). Crawl space access. (min. 18x24). Bath exhaust fans to have metal duct to exterior(not in soffit). Firecode S/R wood frame of"0"clearance fireplaces&stoves Window Schedule or Every Habitable Room Must Have: Natural light equal to 8%of floor area. %of required glazing shall be openable. Bedrooms required min.20x24 egress window or door. Vent attic spaces-"proper vent", soffit and required ridge vents. Firecode under stairs if used for storage FIREPLACES: Separate permit required. Inspections at Footing-Smoke Chamber- Finish Smooth parging, clean joints, 8"solid @ combust. DECKS: Lag to house, provide flashing. s Rails min. 36" high, Baluster max space 4" on center. Over 8'above grade, use 6x6 posts w/lateral bracing. Lag all.posts and rails. Pier footings down 48", Conc. pad at stair base. FINISH: Handrails returned to wall/newall post. Guardrails required alongside open cellar stairs. Exterior grading complete. Certificate or occupancy required prior to occupying structure. Temporary Stairs required for inspection. Re-inspection fee- $30.00(Be Ready). Certificate of occupancy required prior to occupying structure. I r 1 NORTH ' E c . . ve" . iq T No. .. * - �o _ _ . ver, Mass, J �� C0CNIC.2WICK �1. A�OATED J"Pg5 S U BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System AfX� DU � BUILDING INSPECTOR THIS CERTIFIES THAT .....l..Y.�?:^7.4 �&' �! /� •••L � �.... .... ....................... . . . .................................... � �. �Mv�`,s.�� Foundation ff / J C has permission to erect.......................... buildings on .. . .. ................. .......................................... Rough to be occupied as . �t,�C Q,?.• C 1F s ........ ....... ................. .............................................p............. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough .�� . Service ...... .......... /. ....................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE EVE SE SI E 7 ® 712/18/12 (MM/DD/YYYY) A�o CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the.policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements). PRODUCER CONTACT NAME: Connolly Insurance Agency, Inc PHONE FAX N 85 Main Street E-MAIL ADDRESS: North Easton, MA 02356 INSURER(S) AFFORDING COVERAGE NAIC# INSURERA: Travelers INSURED INSURERB:AIM Mutual Insurance Companies Chapman Construction/Design INSURER C: Company LLC INSURER D: 84 Winchester Street INSURER E: Newton, MA 02461 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVID POLICY NUMBER MMIDDIY MM/DD/YYYY LIMITS A GENERAL LIABILITY CO-077OM990 1/1/13 1/1/14 EACH OCCURRENCE $ 1,000,000 DAMAGE X COMMERCIAL GENERAL LIABILITY PREMSETOEaocccu encs $ 1,000,000 CLAIMS-MADE Fx1 OCCUR MED EXP(Arty one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OPAGG $ 2,000,000 POLICY PRD LOC �{ $ A AUTOMOBILE LIABILITY AO-810-4216L138 1/1/13 1/1/14 COMBWd r,)INGLELIMIT $ 1,000,000 000000 X ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Per accident A X UMBRELLA LIAB X OCCUR CUP5681B087 1/1/13 1/1/14 EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED X RETENTION$ 10,000 $ B WORKERS COMPENSATION MCC 2000394012013 1/1/13 1/1/14 X I WC STATU- 01TH- R AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTNE Y/N N/A E.L.EACH ACCI DENT $ 1,000,000 OFFICE RIME MBER EXCL UD ED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yyes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is regri red) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Sample AUTHORIZED REPRESENTATIVE Richard P. Connolly ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The AC ORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.govldia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print legibly Name(Business/Organization/Individual): Chapman Construction/Design Address: 84 Winchester Street City Newton State MA Zip: 02461 Phone 617-630-8408 Are you an employer?Check the appropriate box: Type of project(required): lam a employer with S� 4. ❑ I am a general contractor and I 6.. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7.,�Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required-] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing,all work right of exemption per MGL I LE]Plumbing repairs or additions myself.[No workers'comp. e. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' c3113p.insurance required.] 110 Other *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information' t Homeowners who submit this affidavit indicating they an doing all work and then hire outside contractors must submit a new affidavit indicating such. tcontracmrs that check this bolt must attached an additional sheet showing the name of the sub-contractors and thea workers'comp.policy information. /am an employer that is providing workers'compensation insurance.for my employees.. Below is the policy and job site information Insurance Company Name: A.I.M. Mutual insurance Company Policy#or Self-ins. Lie..# MCC-2000394012013 Expiration Date: ate: 01/01/2014 .Job Site Address: 3�=r t1S�, SA- _City Non / nCUVf(f State V/I Zip: d (V LI Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL e.. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.,00 and/or one- year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250,00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. /da hereb rti under tpenalties of perjury that the information provided above is true and corre Z Signatures Date Phone# 617-63U--T408 Oficial use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health Z.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• Department of Code Enforcement Debris Disposal Affidavit In accordance with the provisions of GL,c. 40, sec. 564, a condition of permit# is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defingd by GL,c. 111, sec. 150A. The debris will, or has been disposed of at: Location of Facility Locatioh,bf action/jobsite (Street Address) c5d 26 / Signature Wapplicaat,66ntractor date 8/26/2013 84 Winchester Street -54 Construction/ Newton,MA 02461-1720 Design 617.630.8408 phone 617.630.8409 fax www.chap-con.com To whom it may concern, I, Richard Elliott, hereby authorize Robert Lowre to pick up/process all Town of North Andover permits under my name and license number CS-058646. Sincerely, Richard Elliott Massachusetts -Department of Public Safety J Board of Building Regulations and Standards Construction Supervisor License: CS-058646I Is �� RICHARD L ELLJOtiv 75 DEER HOLLOWRAYNHAM MA-D27 `J.•�..- �� . �� '+��� Expiration Commissioner 06/03/2014 CITY OF BOSTON LIC. O B1781=� BOARD OF EXAMINERS MAYOR THOMAS M.MENINOLS 5z7iJ ' f TICSi- { RI ARS E�.'�LI Is Y Lf E WQ UNDER PRUVISICOMM SOF THEA 4 O H!8AMEND. { SES. CIQ1 0/ ?D_ b11 BOARD OF EXAMINERS ALEXANDER H MACLEOD A'A TF SCOTT DARLING IA P„ PATRICK TRACY i TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page vJ � PIT _ L(ACATRIONS PRNPER�TI( ug,U11 ERS �� H� TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 0 One family 0 Ajdition ❑Two or more family 0 Industrial Iteration No. of units: Commercial 0 Repair, replacement 0 Assessory Bldg ❑ Others: 0 Demolition 0 Other ,flSe tie ®1Nell Rai dila n� ❑V1/etlands r0x„ Wate shame_dDist pct . P r ,., ^t> p - sus_ i't' � �'� x c x�'T��WaterlSewer�� 'Ms - �., .....�� DESCRIPTION OF WOR O BE PERFORMED: \0 0 00—V `-IVC) <,—t Q >1,c P 15 fi�l•e�-e, � � �` � e. A,IJ .� I e c fr, l`iol7 �`o �: c ,Yfn "ioyJeC' 'tea \-1dvg,,k g "��V )S FevmI't aJReAb, 211116`12, entification PQveR Type or Print Clearly) OWNER: Name: �G Qofvy % MALS LLC Phone: 6/7 -6X- LLC, 6X 83 Address: C O RcC3" (-� V�`�\lp s-t-�e�.+- Sv fi\00 . F -mak?•- �,. ,. .-e. ��". 5 '"+ '^.x�' � � C.,®NTRACT®R4NameF ���� � f: %`s �'��:� - '�.�. -s ;,a~� .'s,�'-,•,�'x � -� �,�,' ,- ''-r:" ,�.q Su ervisor�sConstructionLicense� E4x�p Date F � P �� _ ` H ome 1�mprou a entLicense :� � ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ..... 6'10 " FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund .:....... .. .. ._,. ,r::�::s:_���,::,;::S� nature.;.of_Contractorss:::s:���-����rw:.� ,::.:;::.,.. Signature_ of.Agent/O.caner:::..:_:.:::-.::._:...,..�.,::.;.:.,... .:.:........ _..9 Plan- Si ihrnittari F-1 Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑