HomeMy WebLinkAboutBuilding Permit #660 - 545 WINTER STREET 4/18/2006Of
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TU«'N O1{ NORTH ANDOVER
APPLICATION
FOR PLAN EXAMINATION
SSACHUSE
Permit \0: % o Date Received: � ,�
Date Issucd:
i
- ---- IMPORTANT: Applicant I11LIS1 complete all items on this paoc --
LOCATION_�5
Prin
PROPERTY MN'NER V v i 4e,VL
NIAP NO.: P.ARCEL:___)q___, ZONING DISTRICT:
TYPE AND USE OF BUILDING
HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT
PROPOSED USE
j
j
Residential
Non- Residential
-: New Building
Addition
Alteration
-. One family
_ Two or more family
No. of units:
=: Industrial
L_' Commercial
I Repair, replacement
Demolition
_ Assessor), Bldg-------�
'Moving (relocation)
Other
= Others:
Fnundation only
DESCRIPTION OF WORK TO BE PREFORMED
OWNER
141 A A
Identification Please Tyne or Print Clearly)
lM
:
Address:
Name: Phone: 5249
Sien�ture
� r
CONTRACTOR Name:
:address:
Supervisor's Construction License:
Home llllproxelllent Liccllse:
IN
Exp. Date:
1RC'I I111.C' (: I N(iltil":I :R Nanle: Phone:
Address:
Reg. No.
Date:
FEE SCHEDULE: BULDUG PERMIT: S/0.00 PER 5100/1.00 OF THE TOTAL EST1;11ATED COST BASED OA
SI? i. 00 PER S.F.
Total Project Cost :$ p'Z�O0 x10.00 -FEE:$
Check No.: /L V Receipt No.:�
! TYPE OF SE\% ARGE DISPOSAL
I -
Public Sewer
\Vell
i Private (septic tank, etc.
i Tanning'hlassage Bode ,art
Tobacco Sales
j Permanent Dunlpster on Sitc
Swilllllllll`� Pools
- Food Packaging Sales
NOTE: Persona contracting
Signature.
unre,(giVered eontruc•t0l•.1' do not have acc•evv h) they rurrrauty jlmd
Signature. ol',koent,"Owner ' — Signature of Contractor—_ -.-
Plans Submitted r Plan7sW'v'a ived Certified Plot Plan Stamped Plans
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION
COMMENTS___ _
HEALTH
COMMENTS
Zoning Board of Appeals: Variance, Petition No:
DATE REJECTED DATE APPROVED
❑ ❑
[]Water Shed Special Permit
Site Plan Special Permit
❑ Other
DATE. REJECTED
11
DATE APPROVED
DATE REJECTED DATE APPROVED
n ❑
Zoning Dccisioll,'reccipt submitted yes -- --
I'lannim-, Board Decision: ------------Comments
Conservation Uccision:—.
\k'ater & Sewer coll"ectloll signature &. date
Comments
Temp DunlpStCr on Site yes_—no-- Fire Department si,nature'date — — -----------
Building. Permit ,approved and Issued by:
Building Setback (ft.) i
—Froilt Yard I Sidc Yard Rear Yard
Rcquired Providedi Providcs Required Provided
_J�C—C, I, —iro
DIMENSION
number of Stories:
Total land area. sq. fi.:
Total square feet of floor area. based on Exterior dimensions.__
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
❑ Debris Removal Form
❑ NVorkers Comp Affidavit
Photo Copy Of H.I.C. And, Or C.S.L. Licenses
u Copy of Contract
❑ Floor Plan Or Proposed Interior Work
Addition Or Decks
❑ 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
❑ 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
j Mass check Fnergy Compliance Report
In all cases if a 1a1-iancc or special permit was required the To�ln 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 cope and proof'
of recording must be submitted H ith the building application
DOC: i\sPecTIONAL sraz� ices nerARTNn:NT:erroRNw5
Location Or
No. Date
TOWN OF NORTH ANDOVER
-94 Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fees)qti) $ 430
TOTAL $
Check#
191124 Building Inspector