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Home My WebLink AboutBuilding Permit #477 - 55 MAIN STREET 12/22/2006TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO:--123-- Date Issued: Id �U r Date Received IMPORTANT: Applicant must complete all items on this S s MC&,A 5+ N. LOCATION Print PROPERTY OWNER a ^^ 9 " Print MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUH,DING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE I Non Residential 0 New Building ❑ Addition ❑ Alteration I 'epai , replacement ❑ Demolition ❑ Moving (relocation 0 One family ❑ Two or more'family No. of units: ❑ Assessory Bldg ❑ Other ❑ Foundation only I DESCRIPTION OF WORK TO BE PREFORMED na vk-k'� ^ Identification Please Type or Print Clearly) OWNER: Name: Address: 5J 111?,4 11 J ❑ Industrial ❑ Commercial ❑ Others: Phone: 9-,1 111. 6 Phone: CONTRACTOR Name: r' Address: Supervisor's Construction License: A/ (a _Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: 512.00 PER 51000.00 OF THE TOTAL ESTIMATED COST BASED ON 5125.00 PER IF Total Project Cost: JJ� • �� FEE:$ Check No.: lis Receipt No.: Page I of 4 TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ I Tanning/Massage/Body Art ❑ I Swimming Pools ❑ Well ❑ Tobacco Sales ❑ 1 Food Packaging/Sales ❑ E]Private (septic tank, etc. Permanent Dumpster on Site ❑ Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty jund Signature of Agent/Owner I � Signature of contractor Plans Submitted ❑ Plans Waived, ❑ Certi d Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS HEALTH ElDATE REJECTED DATE APPROVED - ❑ COMMENTS FIRE DEPARTMENT - Temp Dumpster on site Fire Department signature/date COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Conneetiinnic:nn.4— Building Setback (ft. Front Yard fired Provided Dimension Side Yard puired F Provides Rear Yard -I- Provided Number of Stories:__ Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: A7ATT� . - . - 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 o 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 Da: INSPECTIONAL SERVICES DEPARTMENT-MFORM05 Page 4 of 4 0. Location '� �'14i� S No. Date t NaRT� TOWN OF NORTH ANDOVER OL 9 Certificate of Occupancy $ res' °''cam Building/Frame /Frame Permit Fee $ Jb s�CHust 9 Foundation Permit Fee $ +-l` Other Permit Fee $ TOTAL $ Check # 19894 Building Inspector \, 5J , k a0�..C- ST 155 M-:, S� O 'jIi G k c� n g�'• l ` c � � 1 �l ,o n T 6 z • or E i° h Z H Z9 y C cm 0 m CIOC m 0 ca QC N 03 Z O Z O 5 Lo zo O w w a. I M as cm C3 Me O O 'E m m 0 CD CL � �•• Z O� �3 CD L cc O d o. �a c ca cc CD c Zm �..� V3 O C — C c M 0 W O U) U) ce W W U) o44 x x a Q W jZ U)a a p�y'' z L w o°G w w o -iL a�G opo cn cn or E i° h Z H Z9 y C cm 0 m CIOC m 0 ca QC N 03 Z O Z O 5 Lo zo O w w a. I M as cm C3 Me O O 'E m m 0 CD CL � �•• Z O� �3 CD L cc O d o. �a c ca cc CD c Zm �..� V3 O C — C c M 0 W O U) U) ce W W U)