HomeMy WebLinkAboutBuilding Permit #718 - 49 CROSSBOW LANE 5/4/2007 (3)BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
-�? �'`"�,�•- a �L
o Vol
TYPE OF IMPROVEMENT
PROPOSED USE
A
Residential
Non- Residential
❑ New Building
❑ One family
OWNER: Name:
❑ Addition
❑ Two or more family
❑ Industrial
,StAteration
No. of units:
❑ Commercial
❑ Others:
❑ Repair, replacement
❑ Assessory Bldg
❑ Demolition
❑ Other
. -
•, I❑ WeII
Vet lands,
s#rSeptic
11 �ct s
Q Water/Sea>�er
UtbUK11' I IUN OF WUKK TO BE PREFORMED:
A
Please Typ( r Print Clearly)
Identification
OWNER: Name:
Phone:
Address:
,
QNTRACTOR Nlarm e� "
6
Phase
x
w,
w
Address:
n
. -
Stajienrisor`s Coni#�ulctior� License:
Exp. Dade;
r
s-,
Horne I Provemen l iperise
Exp. Dated
.:
ARCHITECT/ENGINEER
'f
Phone:
Address:
Reg. No.
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $a5 oc
- FEE: $ ZOO
Check No.:
Receipt No.: ':g "J 0 l
NOTE: Persons contracting with unregiste ontractors do not have access the guaranty fund
-�, ..
Signa#ure of Agent/c�wner � ` ,`5i ature of contractor
Date...
?k ............
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies thatU ',-A,- � So �o^ A�5be-A &�- � c,3 7D�Oo
............................................................................................... 4 ...........................
has permission to perform Se',P.Y.� ......
. ... . ............ ............................................................
wiling in the building of.....
�P- ......................................................................
a'A ........................0-.. .n) ................................................ . North Andover,
F* � EM . .. ' .11
Fee... +'........ Lic. No2q6.o..MO 4.
ELECTRICAL INSPECTOR h
r I /
Check it 'to n"�� V
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑
Tanning/Massage/Body Art ❑
Swimming Pools ❑
Well ❑
Tobacco Sales ❑
Food Packaging/Sales ❑
Private (septic tank, etc. ❑
Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT ❑
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
❑D
DATE REJECTED
DATE REJECTED
DATE APPROVED
DATE APPROVED
DATE REJECTED. DATE APPROVED
❑ ❑
ZoningrBoard of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
i
Planning Board Decision:
Conservation Decision:
Water & Sewer Connectio
Located at 384 Osgood Street
Comments
Comm
FIRE DEPARTMENT: `Temp Dumpster oar sat. eyes no`
Located at 14 Main Street -
Fire Department,,signatureldate
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
NOTES and DATA — For department use
❑ Notified for pickup - Date
..........................................................................................._.........................--...........................__.........._................................................_..................-..................................................................................................................__.......................................
Doc.Building Permit Revised 2007
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
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
❑ Building Permit Application
U Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
o 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)
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
o 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
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
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:BPFORM07
Revised 2.2007
John Millburg, Project Developer
Emailzjonm@Sun1 776.com,Cell: 781-264-4762
300 Brickstone Squ�re, Suite 201, Andover, MA 01810 1
1.855.SUN.1776 m www.SUN1776.com