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Home My WebLink AboutBuilding Permit #67 - 54 CEDAR LANE 8/2/2006TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION o� No oT 6 qti o Permit NO: Date Received +� i r o �* q «<«e t Date Issued: �.qs RArno SgCHUSE IMPORTANT: Applicant must complete all items on this Daae LOCA ' ^ Print PROPERTY OWNER_ I� 1/% �� / n Print MAP NO.: �t�Y k PARCEL: f -1� ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC". DISTRICT VF,S fl TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ Addition ❑ Alteration ❑ One family ❑ Two or more family No. of units: ❑ Industrial ❑ Repair, replacement ❑ Demolition ❑ Assessory Bldg ❑ Commercial ❑ Moving (relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE ® d Identification Please Type or Print Clearly) s OWNER: Name: D K'(f-V 1 Address: CONTRACTOR Name: Address: i Phone: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No 14 FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost :$x12.00=FEE:$ 30 Check No.:Receipt No.: Page l of 4 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION O� N%.110 6 0 Permit NO:te Date Received Date Issued: S ICHU`�E IMPORTANT: Applicant must complete all items on this Dage LOCATION QC - Print PROPERTY OWNER fSIAe_ Kk' Print MAP NO.JQqk__PARCEL:_J(__ZONING DISTRICT: TVPF AND 1TCF OF RITII.DINC LTfCTl1Dirl-'nrerrT)r!'rm tma - TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ Addition ❑ Alteration ❑ One family ❑ Two or more family No. of units: ❑ Industrial ❑ Commercial ❑ Repair, replacement ❑ Demolition ❑ Assessory Bldg ❑ Moving (relocation) ❑ Other ❑ Others: ❑ Foundation only 1_1 Vl\1t I IkJiN Vr vv OWNER Address: i v nr, rtcr,r tuvlr,li Identification Please Type or Print Clearly) el CONTRACTOR Name: 1-\vtiC_V\s3 v1 Supervisor's Construction License: Exp. Date. - Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE: BULDINC PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost :$ �,56 x12.00=FEE:$ Check No.: S� Receipt No.: Page I of 4 Location No. (10-0 6-1 Date X 1-7 Mus FboL Check # TOWN OF NORTH ANDOVER, Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ 'LS TOTAL $ too— I 93b6 Building Inspector TYPE OF SEWERAGE DISPOSAL Tanning/Massage/Body Art ❑ Swimming Pools El❑ Public Sewer ❑ ❑ Tobacco Sales Food Packaging/Sales ❑ Well Dumpster on Site El Private (septic tank, etc. ❑ Electric Meter location to proj ect NOTE: Persons contractina4vilk unregistered contractors do not have access to the guaranty juna Signature of Agent/Owner)11- Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT DATE REJECTED ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other DATE APPROVED COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ 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 Temp Dumpster on site yes _no/,,,, -, o ,, Fire Department signature/date TYPE OF SEWERAGE DISPOSAL Tanning/Massage/Body Art ❑ Swimming Pools ❑ Public Sewer ❑ ❑ ❑ Tobacco Sales Food Packaging/Sales ❑ Well Permanent Dumpster on Site ❑ Private (septic tank, etc. ❑ Electric Meter location to project NOTE: Persons contractin unregistered contractors do not have access to the guaranty Juna 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 PLANNING & DEVELOPMENT COMMENTS DATE REJECTED DATE APPROVED ❑ ❑ []Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ f COMMENTS A' HEALTH COMMENTS DATE REJECTED DATE APPROVED ❑ ❑ 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 Temp Dumpster on site yes_no1� Fire Department signature/date Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total land area, sq. ft.: NOTES and DATA — (For denartment use) Total square feet of floor area, based on Exterior dimensions. 1�j 6LA) a, y) 6C4 L V"k A�L 0 vq- za�� Page 3 of 4 Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC. Jan.2006 r- Building Setback Front Yard Side Yard Rear Yard Required Provided Re uired Provides Required Provided / 7 Dimension Number of Stories: Total land area, sq. ft.: NOTES and DATA — (For devartment use) Total square feet of floor area, based on Exterior dimensions. 11' t YVI.ow M -a- i 1 e wt U W� (� U V7— Page 3 of 4 Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created IMC. Jm.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 DEPARTMENT:BPFORM05 Pnoe 4 of 4 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 DEPARTMENT:BPFORM05 Pave 4 of 4 ANCHOR ROOFING & REPAIR 16 Sixth Ave Haverhill, MAO] 830 978-374-3714 2, A � PROPOSAL SUBMITTED TO: io T S'+ f --- Page No. of Pages DESCRIPTION OF JOB ARCHITECT DATE OF PLANS JOB ADDRESS CITY STATE ZIP PHONE DATE F SUBMIT SPECIFICATIONS AND ESTIMAT/1E'S� FOR: / G'✓ i I' d�',�ll f e� Uc• �e b"f I -a -a le"; '74-16 ei'a eble"), e �! L( c� Gu /'7p KS• �'1' - / S�r:�.� Gr 1��c'✓rt'S' We hereby propose to furnish material and labor, complete in accordance with above specifications, for the ---e sum of dollars ($ �) tel with payment to be made as follows: Gf'71(7 All material is guaranteed to be as specified. All work is to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from specifications Authorized involving extra costs will be executed upon written orders, and will become an extra Signature charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary Note: This proposal may be withdrawn by us if not accepted insurance. Our workers are fully covered by Worker's Compensation Insurance. within days. Acceptance of Proposal - The above prices, specifications and condi- tions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Cinnati Irp