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HomeMy WebLinkAboutBuilding Permit #581 - 440 GREAT POND ROAD 3/20/2006 f NORiM 1 0 4,�■o r. 4'O p TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ,'s CHUSEt Permit NO: Date Received: 9 , 2-0 a0 Date Issued: ° [IMPORTANT: Applicant must complete all items on this page 12 LOCATION � � p O _ Print PROPERTY OWNER l pia I rent NIAP NO.: ` - PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential " New Building 190ne family Addition C Two or more family C Industrial Alteration No. of units: C Repair, replacement C Assessory Bldg C Commercial C_l Demolition Moving(relocation) 0 Other C Others: -i Foundation onlv DESCRIPTION OF WORK TO BE PREFORMED Ile Identification Please Type or Print Clearly) OWNER: Name: �� . 9 411' Phone: Si ature a-7�slab �2.1f Address: GAS .4- CC � a� /`irr 7 ✓ 3 r/��t0?G bd CONTRACTOR Name: Phone:,7�/��.� � C . ,r Address: r Supervisor's Construction License:e97 /p Exp. Date: M Home Improvement License: A� f/ Exp. Date: / b ARCI-11TEC'T+NGINEER ic��y�-/ ��i b re Name: Phone: 2Jf- 7J'Y S2/b Address: 2/ zf—W' 5/ ,S f 5 � ��"/ /�. Reg. No. -- FEE SCHEDULE:BOLDING PERMIT. 410.00 PER$1000.00 OF THE TOTAL ESTLNATED COST BASED ON 512.5.00 PER S.F. Q Total Project Cost _ =FEE $ Check No.: x10.00= Receipt No.:- 3� 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 ❑ Debris Removal Form ❑ 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 ❑ Form U ❑ Surveyed Plot Plan ❑ Debris Removal Form ❑ 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 ❑ Form U ❑ 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 Doc:INSPECTIONAL 5ER1 ICES DF.I.1RTVIEV'f.BPFORNIUS TYPE OF SEWARGE DISPOSAL — Swimming* Pools Tanning/Massagei Body Art Public Sewer Well Tobacco Sales — Food Packaging/Sales '- Permanent Dumpster on Site Private(septic tank,etc. i_..', NOTE: Persons contracting with unregistered contractors du not have access to the guarajhtj;fhuhd 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 ❑ ❑ c COMMENTS "Zoning Board of Appeals: Variance, Petition No: Zoning Decision receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments S� Water&Sewer connection signature&date Temp Dumpster on site yes no Fire Department signature/date Building Permit Approved and Issued by: ti i i Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided DIMENSION Number of Stories: Total sq care feet of floor area, based on Fxterior dimensions. Total land area, sq. ft.: NO'I'F.S and DATA—Wor department use) f I I I)nc:INSITC1'IGN.-LSr.RVI LSI%L1'.\i\I .il.N'IJ)I'hOliVNIS -- ('rr.ucl Location No. J ` Date ' ►ORTIy TOWN OF NORTH ANDOVER F A 9 Certificate of Occupancy $ ` s��N�s t� Building/Frame Permit Fee $ U Foundation Permit Fee $ Other Permit Fee $ TOTAL $ nn s� Check # c9 os- 1 ©038 '`Building Inspector