HomeMy WebLinkAboutBuilding Permit #5-2 - 48 Kingston Street 1/18/2007Permit NO:
Date Issued: k,(2
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
L IMPORTANT: Applicant must complete all items on this Daae
LOCA
PROPERTY OWNER
Print
MAP NO.: PARCEL:
TYPE AND USE OF BUILDING
ZONING DISTRICT:
HISTORIC DISTRICT VF..R n
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ Addition
RAJI"t'eration
❑ One family
❑ Two or more'family
No. of units:
❑ Industrial
❑ Repair, replacement
❑ Demolition
❑ Assessory Bldg
❑ Commercial
❑ Moving relocation
❑ Other
❑ Others:
❑ Foundation only
DESCRIPTION Or WORK TO BE P
/1 1 _ ► 1 ,
Identification Plbase Type or Print
OWNER: Name: Phone:
Address: J
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.• $12.00 PER $1000.00 OF, TAL ESTIMATED COST BASED ON $125.00 PER S F.
Total Project Cost :$ C, I` — AFEE:$!�-
e
Check No.: % % % Receipt No.: 15'1 /
Page I of 4
TYPE OF SEWERAGE DISPOSAL
Tanning/Massage/Body Art ❑
Swimming Pools El❑
Public Sewer
❑
11
Tobacco Sales
Food Packaging/Sales 11Well
El
Permanent Dumpster on Site �
Permanent
Private (septic tank, etc.
Meter location to
project
NOTE: Persons contractin ith un gistere contraictors do not have access to the guarantyfund
Signature of Agent/Owner Signature of contractor
Plans Submitted ❑ P ' s aived iied Plot Plan ❑ Stamped Plans
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT ❑
COMMENTS
CONSERVATION
COMMENTS
DATE REJECTED
0
DATE REJECTED
❑ ❑
DATE APPROVED
DATE APPROVED
a DATE REJECTED DATE APPROVED
HEALTH
I
COMMENTS
❑ ❑
FIRE DEPARTMENT - Temp Dumpster on site yes no
Fire Department signature/date
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer Connection/Sienature & Date Driveway Permit
Fe -
Building Setback (ft.)
Front Yard Side Yard Rear Yard
Required Provided Re uired Provides Required Provided
F
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
A V I VN anu llA 1 A— (vor department use
Page 3 of 4
Created JMC. 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
❑ Floor Plan Or Proposed Interior Work
Addition Or Decks
❑ Building Permit Application
❑ 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
❑ 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 DEPARTMENTMFORMOS
Page 4 of 4
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Location L�� t •M f-//0
No. Date
NORTH TOWN OF NORTH ANDOVER
F 9
i
Certificate of Occupancy $
CHU Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
L
Check # �/
19941
Building Inspector