HomeMy WebLinkAboutBuilding Permit #689 - 48 MEADOWOOD ROAD 4/27/200604 HORIN
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Permit NO:
Date Issued:
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received: /_/_ a 7.0 6
11 -a7 -o(
IMPORTANT: Applicant rnust complete all items on this pa,,e
LOCAION _.
PROPERTY OWNEI
;IAP NO.:
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ZONING DISTRIC"I':
PARCEL:
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TYPE OF IMPROVEMENT
-----
PROPOSED USE
Residential
Non- Residential
_ New Building
XOne family
Addition
C Two or more family
:. Industrial
Alteration
No. of units:
_, epair replacemen
_ Assessory Bldg
;- Commercial
Demolition
ti1oving (relocation)
'_'Other
-. Others:
-! Foundation only
DESCRIPTION OF \VOKK IU BE FKLPUKMt U
Identification Please Type or Print Clearly)
OWNER: Name: ���/ / C /4 4GhP S Phone:
'nn signature
Address: u {'Y 4?4q oey 0 / o`
q -7's -54A-5-7
CONTRACTOR Name: �1--l-E� Phone: =_
Address: �J y
Supervisor's Construction License:
Home Improvement Liccnse:. k2(2 �S0i3
�RCI-IITE CT; FNGfV.N.FI,R
:address:
Exp. Date:
Exp. Date:
ti.1111e: Phone:
eg. No
FEE SCHEDULE: BGLDE G PERMIT:.S10.00 PER 51000.00 OF THE TOTAL EST1,1111TED COST BASED ON
S 11.5.00 PER S. F.
Total Project Cost x10.00 FEE:$ '
Check No.:�a�� i(O _Receipt No. -i3_
TYPE OF SEWARGE DISPOSAL
Public Sewer
Well
Private (septic tank, etc.
Tanning/Massage Body Aa
Tobacco Sales
Permanent Dumpster on Site
Swinuning Pools
- I
- Food Packaging, Sales
NOTE: Persons contracting with unregistered contruc•tory du not huve access to the quurunty jltnd
Si nahtre of Agent/Owner_ � 'COKCEg�4C Sighalure of Contractor
Plans Submitted ❑ Plans Waived ❑ Certified;.Plot Plan I-) Stamped Plans �!
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U F6RN1
PLANNING & DEVELOPMENT
COMMENTS
DATE REJECTED DATE APPROVED
❑
❑ Water Shed Special Permit
Site Plan Special Permit
❑ Other -
DATE REJECTED DATEAPPROVED
CONSERVATION ` ' ❑ ` - �] ,`
COMMENTS
z
DATE REJECTED' DATE APPROVED
HEALTH
� COMMENTS
C
Zoning Board ofAppcals: Variance. Petition No:
7_onim, Decision, receipt submitted yes
Pkinninu Board Decision: Comments
Consc►'vatlon Decision:
c ommcnts
beater & Sewer connection signature & date
Temp Dumpster on site yes__no-C Fire Department signature -'date
Building Permit ,approved and Issued by:
Building Setback (ft.)
Front Yard
Side Yard
Rear Yard
DUNIENSION
NUmber of Stories:
Total land area, sq. M.:
Total square feet of floor area.. based on Exterior dimensions.
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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
J Building Permit Application
o 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
j 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
j 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
IIs :III cases if a Variance or special permit was required the Town Clerks office must stamp the decision from (he Board of
ant must then get this recorded at the Registry of keds. One copy, and proof 11
Appeals that the appeal period is over. The applic
of recording must be submitted with the building application
Doc: I\SPECTIONAL SER% ICES nEPARTNE'NT:111"FOR\I05
Location
No. / 4 Date `l
NOItT►j TOWN OF NORTH ANDOVER
G
Certificate of Occupancy . $
'�'°'•••° ''<�'
Building/Frame /Frame Permit Fee $
9
Foundation Permit Fee $
Other Permit Fee $
TOTAL
Check # /O�.I�j
19160 Building Inspect&r
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NORTH ANDOVER BUILDING DEPARTMENT
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
at: is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
C 11, S 150 A.
Also, note Permits are required under Fire Prevention laws Chapter 148 Section
10A.
The debris will be disposed of in:
(2— 2FFN (I)OOD S U—)O tZCesr6'(Z
Fire Department Sign off:
Dumpster Permit
(Location of Facility)
ignature of Permit Applicant
It=- -7- 6 G
Date
-AT-HOME
Installed
Siding and Windows
3200 COBB GALLERLI pr,.YY #20
ALTANTA, GA 30339 Administrator
617—
"d
-
Board of Building Regulations andStandards
HOME IMPROVEMENT CONTRACTOR
893
apiration;8t3.i2006
plernerd Card
THE Home
Depot. AI-fi6T6&,Ssrvi�
WUNROEUN
3200 COBB GALLERLI pr,.YY #20
ALTANTA, GA 30339 Administrator
,#ROM : KIMBLY FAX NO. : 6033629679 Apr. 11 2006 10:19PM P4
f u VMr. tiw.rxU V wme.n l t.UN'tlLALA
Sold. Furnished and installed by:
,� Date: y 7 THD At -Home Service, Inc-
Branch
nc.
BranchNtimr. r
dlbJa The Name Depot At -Home Serrias
.��, �� � }ASA Gmenwood Street, Worcester, MA 01607
N� Job ll: �� 3 Toll Free (11M) 657.5182; Fax, 508-75b-2859
Branch Number.
F.&.1 ID N 75.20840 ME lac N C 024 t N 12g�3 `
M 16477
CT Lie N 565522; MA lioasa latpeov
lttallatioa Address % ql II 0/
sn
�;ly State Zp
Home Address:
(if different from lnstallarion Address)
E-mail Address (Io receive updates and Promotions from The Home Depot):_
Pw' Info ort I/WGYou ("Purchaser"), the owners of the property located at the above insiallation address, offer to
contract ZU materials as
w1 orae epee U.S,A., Ire. ("Home Depot") to furnish, deliver
no orated (rein by ree for the felt nee andmade a P hereof,
allation Of
described on the attachad Spec Sheet Il:
Home Depot reserves the ripen to caacd this contract if, upon re-iuspection of the job, Home Depot detcrminea that it
cannot perform its obligations due to a structural problem with ft bone, pricirig errors or kteause work required to
complete the Job was not included in the Spec Shed or Contract.
DEPOSIT PAYMENT OPTIONS
(Srjb as to fund v<rificarion aedlor coedit Wrov.l.)
City
State Zip
1. Check, Casbwo CbI or US 1'usul ;;Cmw Mua q nide
CONTRACT AMOUNT S']"7_v/..� - (M.dePayabletoTMHomaOcpee)-
a / 2. Crodil Cald• 49dlor 9111V PaYn "ofbmw-L'trdr One Fklv�r
*LESS DEPOSIT $ O V,» MasteYCaYd D>zova Ame�icusfsaproa
BALANCE DUE / Q/ /tic Horm Impcovomew LOU o F1owu Ikp�t Cced�t
ON COAxPLMON Acawat C $tt+Nna Aemant ( lura st IID ox1.Yy
lvliaimum 2S9a of Contract Alh011at due upon execution AsaI Credit; 1s3 (HIL k ILDCC ONLY)
f this coa[rrct. Aceta- �Eq. �'gfir.
I
7R�c A �e uES
mdicatc Payment Method For
Nsme at tt vtl�ry m cud', ---^
BALANCE DUE ON COMPLETION. By mylaur r, tsdoW, F/tYe aQICe to allow Home 1hpM Io cbaryc 1ha above
icietemed io[tbedapoa� io�r+tod' .
1 Daft
c' Idot t SiQaatuto
HIL or 0DCC thorWtion 0040
i Fined P cat
t8 # m� �
satit facto letion of tba work. Purchaser will execute a Cotnp(ntion Canificatc
Purchaser agrees that, immediately uPon rY comp
pay any balance due, Purchaser also agrees to , ointly and severally obligated and liable he
andtat r attachmen �tg any futaaeAng agrectnetu, co d the
com
pl
et
e agreement
were pa a andagy
his of be atnrndtd or tu bed ttnless in wl�rititrg in a separare agreement signed by both parties.
Q to reel' moi" f N01NIC�ETOPURC�ASIP �/ �N Y�_y
Do ao( riga eerie contract before you read IL You are entttled to a completely d0ed lc°t+y of the k contract PrO (blb ho e n .ear
it to protect yoar rlghu- Do bot asyp a Com��lIetba Cerlka tt before this project i r to ihca- P p �n �e
contractors ft>ao rreeqquesting or accepting a Cotnpktiao Certifkate signed by the Owner prior to rhe acturl a ompktbo of the work w 1
be performed underibt coateset.
You may csnccl this traus■ctron at arty time prior to mktor�ht of the t0ir'd bastac*s day alter the date of this culkw2cc See Nolke of
Cancellation for as tsplauxtien of th s reghi• There Witt be a aervks chart equal to ZSR' of the mud'aet an ottat if dw lob it
cancelled by Purchaser AFTER thr. third business day -
BY MYJOUR SIGNATURE BELOW, UWE AGREE TO CIE BOUND BY THE TERMS
THF NIOTICE OF IS CANCELLATION.OWLL lK+E
ftF.CEIPT OF A COPY OFTHIS CONTRACT AND Two COMPLETED Q. Ni
By MY SIGN.aTUkE BEWIA', VWL UNDIMSTAND THAT THE wGREC'MENT IS SUAJICT T<) REVIEW OF M1
1i AN
CREDIT HISTORY AND IIP'% AUTHORIZE HOME DEPOT TO VERIFY AND REvIE`A' MY/OUR CREDIT kEC•PRD wires AN
INDEPENDENT CWN
AND RELEASE THEM FROM RE AREAh1�BLANKSP CES.ILITY ){ �trrM
INADVERTENT OSIGN THISCONTitACI
SUBMITTED BY_ Datc:
ACCEPTED BY;Date: 7 f t L r I
Date:
Hovicevbci �i.Jt
hOTICT.: AUAITIO VwL 7EIL�SS, ('PPI MONS AI»> N'AIi1N."rTiEb ARg STATED ON THT, RY.VVRSY. SIDE AND ARE I'ART Or 1195 CONI RAC1'
Wpiis - aiaoc6 rale Yelloa - Clat•�c+ Piok-Sols ('gpeulun�
12 -&os GSC
FROM : KIMBLY
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Apr. 11 2006 10:17PM P1
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