HomeMy WebLinkAboutBuilding Permit #472 - 470 CHESTNUT STREET 12/19/2006Permit NO:
Date Issued:
TOWN OF NORTH ANDOVER
NORT1y
APPLICATION FOR PLAN EXAMINATION of s,•o • '�a
Date Received t"y` �`�'6t�'s^•
IMPORTANT: Applicant must complete all items on this page I
LOCATION 1117r �'�%�ST/� �%T s% 1 -ye • )' 1V�DO ✓ERZ ,/'S'C/
Print Print
PROPERTY OWNER kV l L 0
Print
MAPNO.:O7�} 9- C PARCEL: 1f ZONING DISTRICT:
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT
PROPOSED USE
Avlz- 40MI724,e6"� /
Phone: 779- &OC! -2366
Residential
Non- Residential
❑ New Building
0 Addition
Alteration
ane family
0 Two or more ,family
No. of units:
❑ Industrial
0 Repair, replacement
0 Demolition
❑ Assessory Bldg
0 Commercial
❑ Moving relocation
❑ Other
❑ Others:
❑ Foundation only
CRIPTION OF WORK TO BE PREFORMED
Identification Please Type or Print Clearly)
OWNER:
Name:
Avlz- 40MI724,e6"� /
Phone: 779- &OC! -2366
Address:
2170
Ct/FSTNCJr- ,fir. /-W- 4'-gD0yf-2
MA 0/8-L/S
CONTRACTOR Name: Phone:
Address: _
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE. BOLDING PERMIT. • SI2.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125 00 PER SF.
Total Project Cost :$ <✓f FEE:$ Igo,,
Check No.: 5-0 Receipt No.:
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Location),51--
No. Date 157-1f—az;
'" TOWN OF NORTH ANDOVER
certificate of Occupancy $ _
cwusEt� Building/Frame Permit Fee $ �c�d
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
19886
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TYPE OF SEWERAGE DISPOSA
Art E]g
Swimming Pools El
Public Sewer
Well ❑
Tobacco Sales ❑
Food Packaging/Sales ❑
❑
Permanent Dumpster on Site ❑
Private (septic tank, etc.
Electric Meter location to
project
Persons contraciw
ntractors do not have access to the guaranty fund
Signature of Agent/Owner Signature of contractor
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 ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
CONSERVATION ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH ❑ ❑
COMMENTS
FIRE DEPARTMENT - Temp Dumpster on site
Lire Department signature/date
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
0
Building Setback
Front Yard Side Yard Rear Yard
Required Provided 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
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Doc: INSPECTIONAL SER
Created IMC. Jan. 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
a Floor Plan Or Proposed Interior Work
Addition Or Decks
❑ Building Permit Application
❑ Surveyed Plot Plan
❑ Workers Comp Affidavit
a 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
❑ 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 DEPARTMENTMFORM05
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