HomeMy WebLinkAboutBuilding Permit #47 - 579 CHICKERING ROAD 7/16/2009Permit NO:
Date Issued: /
LOCATIO
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
IMPORTANT: Applicant must complete all items on this naize
F'AKLCL: LUNING Ulb I HILT: Historic District yes
Machine Shop Viilaae ves
m
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
One family
Addition
Two or more family
Industrial
Alteration
No. of units:
erci
Others:
e air re lacemen
Assessory Bldg
emolition
Other
Septic Well
Floodplain Wetlands
Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
or Print Clearly)
OWNER: Name:
Address:
CONTRACTOR Name:
W
Address: 1 CS(Q+Dn, MA 0 1060
Supervisor's Construction License: Exp. Date:
Home Improvement License:
ARCHITECT/ENGINEER
Phone:
Address: Reg. No.
FEE SCHEDULE. BOLDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $_ , 1f .�(� FEE: $�
Check. No.:( q 22-4 Receipt No.: a A� ,l
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner Aignature of contractor
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public SewerTanning/MassageBody
Art
g Swimmin Pools 7 '
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
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH
COMMENTS
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Y
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS
CTIONAL' SERVICES
Doc. INSPE
Revised 2.2008
Street
Doc.,
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 Affivit
❑ Photo Copy Of'1:-. 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
❑ Certified 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)
❑ 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
❑ 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 2.2008
� COMMENT. -
Location �� I C� Lk �-✓ti ��C _ t
No. ��� Date
Check # �-
� i
TOWN OF NORTH ANDOVER
ti
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
222��,
U Building Inspector
04127/2007 19:14 9786702880 BUONOPANE COOK
From Tonry Northwest Melon 13 JIu1 2009 09:56:05 AAI EDT
ACORQ CERTIFICATE OF LIABILITY INSURANCE
Tonry Northwest Insurance Agm y, Inc,
238 80ford Street
Lexinyltan, MA 02420
Coll am Mathews
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Groton, MA 01450
ONLY AND CONFERS NO
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INSURER A: Travelers
INSURERS: 'rft W?QW zirri>aIg'+ ir"
INSURM C:
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INSURER E:
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B&C FLOORING INC.
10 RUSTIC TRAEL
qROTON IMA 01450
Bill To
Kellee Twadcllc
125 Chickering RD
At.4�dn�ex
Invoice
Date Invoice #
7/12/20051 293
Ship To
P.O. No. Terms Project
Due on receipt
Item
Desvt tion
Quantity
Rates
Amount
TILE LABOR
supply knight tile for score arca
l.tiBtT
z.44
3,Zzg.21 T
ETEC LABOR
instalt pW* flooring in score arca also supply all
1,480
2.00
2.160,04
er�t�i�e
FLOOR PRFFAl2...
prepare floor to receive now plank floor nndte W and
1.080
1.00
1,080,00
kabor
Trs been a pleas working with you!
Sales Tax (5.0%) $161.46
Total $6.630.66
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