HomeMy WebLinkAboutBuilding Permit #647 - 41 LYMAN ROAD 4/13/2006Of NORTH
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9SSACHUSES
Permit NO: ,
Date Issued: &L6
LOCATION
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received:
IMPORTANT: ADDlicant must complete all items on this one
PROPERTY OWNER 10 e-
MAP NO.: PARCEL:
TVPF AND ITRF, OF RITTIBING
ZONING DISTRICT:
141STORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ Addition
oWAlteration
,'One family
❑ Two or more family
No. of units:
❑ Industrial
❑ Repair, replacement
❑ Demolition
❑ Assessory Bldg
❑ Commercial
❑ Moving (relocation)
❑ Other
❑ Others:
❑ Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
J
Identification Please Type or Print Clearly)
OWNER: Name:
ature
Address:
-rO AAn
I
CONTRACTOR Name:
S
Supervisor's Construction License: 0 91 eFFT Exp. Date:
Home Improvement License: 03 q zJ Exp. Date: 101 iq Z®D 1
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT. $10.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost :$6 act x10.00=FEE:$ qO
Check No.: ��� �� Receipt No.:
Page 1 of 4
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
o 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
o 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 Permit Application
❑ Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
Li 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
Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM05
Page 4 of 4
TYPE OF SEWARGE DISPOSAL
Public Sewer ❑
Well ❑
Private (septic tank, etc. ❑
Tanning/Massage/Body Art ❑
Tobacco Sales ❑
Permanent Dumpster on Site ❑
Swimming Pools ❑
Food Packaging/Sales ❑
Electric Meter location to
project
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner Signature of Contractor L44,
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION
COMMENTS
t
°. HEALTH
G
COMMENTS
Zoning Board of Appeals: Variance, Petition No:
Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Water & Sewer connection signature & date
DATE REJECTED DATE APPROVED
❑ ❑
[]Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
DATE REJECTED
DATE REJECTED
Comments
_Comments
Temp Dumpster on site yes—no— Fire Department signature/date
Building Permit Approved and Issued by:
Page 2 of 4
DATE APPROVED
DATE APPROVED
Building Setback
Front Yard Side Yard Rear Yard
Required Provided Required Provides RequiredFProvided
DIMENSION
Number of Stories:
Total land area, sq. ft.:
iN%JIGJAlIULHIA—
Page 3 of 4
SERVICES
:reated JMC. Jan.2006
Total square feet of floor area, based on Exterior dimensions.
4
Location--�/z
No. Date
A
TOWN OF NORTH ANDOVIER
4L
Certificate of Occupancy $
A,10 Building/Frame Permit Fee $ 414
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
19-11-13
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