HomeMy WebLinkAboutBuilding Permit #802 - 7 OLYMPIC LANE 6/5/2007Permit NO: -
Date Issued:
LOCAT-101'
MAP
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
�. Date Received
RTANT: Applicant must
;omplete all items on this page
Q'tttED 16 •'N�
o m
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
One family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑ Se is El Well
❑Flt odplain etlan
❑ Watershs Diwiot
❑ Warr/Seer
i'
OWNER: Name;
Address:
CONTRACT a
DESCRIPTION OF WORK TO BE PREFORMED:
4-7
0-0 -� r
Identification Please Type or P
L'-- -9 mil bY." i C A
Supervisor's Cdnstrdtion License.;µ:
-int Clearly) Cf 8��j� ��
Phone �3
f. t k:. x
I P 11 e F..
;Exp Date:
Fyn r)nio�- - Y1'1 t F'
ARCHITECT/ENGINEER 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: $ U C/ FEE: $ 00
Check No.: 16 le Receipt No.: cQ OP 7
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Age_ntlC?_w_
ner Signature ofcontractor t
Ir"
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
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
DATE REJECTED
CONSERVATION
COMMENTS
DATE REJECTED
HEALTH
COMMENTS
DATE APPROVED
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
Located at 384 Osgood Street
FIRE' DEPARTM'EN , Te 3umpster ori._ste yes(/' ` no
Locatedat 124 Main Strutt`"„`
Fire Department"signature/date
COMMENTS
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
v
❑ 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
La Building Permit Application
v. Workers Comp Affidavit
�.❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o- 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)
L ,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 2.2007
Location 7 C-
No. v --- Date
TOWN OF NORTH ANDOVER
9
Certificate of Occupancy $
Building/Frame Permit Fee $
ncMus
Foundation Permit Fee $
Other Permit Fee $
TOTAL $`
Check # A/7/0
205/'/
Building Inspector
M
'77
STARR PAINTING 01�o ce.f(
BRYAN INTERIOR & EXTERIOR BRYAN
800-630-4948 HAVERHILL
Roofing * Gutters 374-4948
Pressure Washing * Textured Ceilings
FREE ESTIMATES * Registered Insured
I herewith submit Specifications and Estimate for: AA—p co /ZO t] 7 , a' /� �% 7! AK
f'
✓lie irJarnia�U����`�y a�'-�Qaciutde�
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration:' `1.4.4769
piration: 11/$/2008
ExTr# 124574
SfA:RR PAINTING`.
BkYANT RAYCRA6
12 GRAND AVE
"ERHIL!_, MA 01930 1
Administrator
I hereby propose to furnish and install the above
for the sum of x l
Payments to be made:
Date aF A0
Licen."'
before'
Board
One A!
Boston
per by first grade workmen. Contractor covered by
f`i agreed upon involving extra cost of labor and material
��mentioned in this contract. Agreements made with
I
)mplete in accordance with the above pecifications
Dollars ($ 6—)
AC66PTANCE OF ESTIMATE U
The foregoing terms, specifications and conditions are satisfactory, and the same are hereby accepted and agreed to,
and hereby authorize you to /94i4e_sad9- .
Date �'� �Signed _
This Contract is void 10 days from
signed and returned to bidder.
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