HomeMy WebLinkAboutBuilding Permit #836 - 39 MAIN STREET 6/22/2006Of NORTH 7ti
9 TOWN OF NORTH ANDOVER
o, APPLICATION FOR PLAN EXAMINATION
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Permit NO: Date Received:
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION
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Print
PROPERTY OWNER G sIe-�� e -Q/' /S 0/!
IV
Print
MAP NO.: I PARCEL: ZONING DISTRICT:
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uTCTnurf nICTRIC'T VES ❑
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TYPE OF IMPROVEMENT
- - -
PROPOSED USE
---
Residential
Non- Residential
❑ New Building
❑ Addition
❑ Alteration
❑ One family
❑ Two or more family
No. of units:
❑ Industrial
❑ Repair, replacement
❑ Demolition
❑ Assessory Bldg
ommercial
❑ Moving (relocation)
❑ Others:
❑ Foundation only
nRCC`Q1PT1nN OF WORK TO BE
PREFORMED
Identification Please Type or Print Clearly)
OWNER: Name: 2e 5 le-
U6--
-
Address: ,/��� sr ii�/j /�/��e✓G/
CONTRACTOR
w
971
W .u4571 4&1;1- y?g-.P2-/
Address:Supervisor's Construction Construction License: j!�)& Exp. Date: a
Home Improvement License: 2�2 J' Exp. Date:
ARCHITECT/ENGINEER ��i/',l &,.-ACe-? Name: Phone
Address:
Reg. No
j'e"y f - q75-``.; 3'�7,? d� IV L
FEE SCHEDULE: BULDING PERMIT: 510.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost :$ (pow) L x10.00=FEE:$
Check No.: �� _Receipt No.:
Page W4
TYPE OF SEWARGE DISPOSAL /
Tanning/Massage/Body Art ❑
Swimming
Pools El
g
Public Sewer �9/
Well ❑
Tobacco Sales ❑
Food Packaging/Sales ❑
❑
Permanent Dumpster on Site ElPrivate
(septic tank, etc.
Electric Meter location to
project
NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund
Signature of Agent/Owner Signature of Contractor
Plans Submitted Plans Waived ❑ Certified Plot Plan �i Stamped Plans
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION
L `
COMMENTS
HEALTH-
COMMENTS
t
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
DATE REJECTED
DATE REJECTED
El
Comments
Comments
Temp Dumpster on site yes—no— Fire Department signature/date
Building Permit Approved and Issued by:
Pape 2 uF4
11
DATE APPROVED
DATE APPROVED
DATE APPROVED
Building Setback (ft.)
Front Yard Side Yard
Rear Yard
Required Provided Required
Provides
Required
Provided
DIMENNION
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
NOTES and DATA — (For department use)
Page 3 of 4
Doc: INSPECTIONAL SERVICES DEPARTMEN"r:13PFORM05
Crented JMC. Jan.'_o%
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
d. Surveyed Plot Plan
d Workers Comp Affidavit
ql Photo Copy of H.I.C. And C.S.L. Licenses
❑�J 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
Dor. INSPECTIONAL SERVICES DEPARTMENTMFOR1105
Page 4 of 4
Location 47�1-
No. P-3 (a Date
40RT#q
TOWN OF NORTH ANDOVER
.1
0
Certificate of Occupancy
$
CHU
Building/Frame Permit Fee
$
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
$
Check # 3 o ��—
Building Inspector
Twomey & Legare Contracting, Inc.
PO Box 366
North Andover, Ma 01845
3
Name / Address
Lesley Carlson
Main ST.
No. Andover Ma. 01845
Estimate
Date
Estimate #
6/22/2006
15
Project
Description
Qty
Rate
Total
ADD NEW DECK ON BACK OF BUILDING. SEE PLAN AND
PLOT PLAN .
11,600.00
11,600.00
Total $11,600.00
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