HomeMy WebLinkAboutBuilding Permit #500 - 7 SOUTH CROSS ROAD 1/10/2007Permit NO: 4r) d()
Date Issued:—/—
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received (% d
I IMPORTANT: Avvlicant must complete all items on this vase I
LOCATION SOtl,, C,"-1055
PROPERTY OWN
Print
MAP NO.:
TYPE AND USE OF BUILDING
ZONING DISTRICT:
HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ Addition
T"Alteration
lirbne 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 PREFORMED
Koor 5C,_ -6,J a,C-,4- in,+ (.
// , -;, .c /
Identification Please Tyke or Print Clearly)
OWNER: Name Phone:
7 Cess
Address:— �.� � -
CONTRACTOR Name:
7/
Supervisor's Construction License: C S 0 3 a 170 Exp. Date: o i
Home Improvement License: n 0� l Exp. Date:
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE. BULDING PERMIT.• SI2.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON S125.00 PER SF.
Total Project Cost :$ S-00— FEE:$ id
LL� «g a
Check No.: �.� 0 �O f Receipt No.:
Page I of 4
NOTE: Persons contra'etins with unregistered contractors do not have access to the guailaa
Signature of Agent/Owner Si , ature of contract
Plans Submitted r]ans Waived F1 Certified Plot Plan El Stamped Plans
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT ❑
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
DATE REJECTED
u
DATE APPROVED
DATE REJECTED DATE APPROVED
❑ Ti
IN
DATE REJECTED DATE APPROVED
FIRE DEPARTMENT - Temp Dumpster on site
Fire Department signature/date
COMMENTS
I
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
TYPE OF SEWERAGE DISPOSAL
Art ❑
Swimming Pools ❑
Public Sewer ElTanning/Massage/Body
Well ElTobacco
Sales ElFood
Packaging/Sales El
Permanent Dumpster on Site ElPrivate
(septic tank, etc.
Electric Meter location to
project
NOTE: Persons contra'etins with unregistered contractors do not have access to the guailaa
Signature of Agent/Owner Si , ature of contract
Plans Submitted r]ans Waived F1 Certified Plot Plan El Stamped Plans
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT ❑
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
DATE REJECTED
u
DATE APPROVED
DATE REJECTED DATE APPROVED
❑ Ti
IN
DATE REJECTED DATE APPROVED
FIRE DEPARTMENT - Temp Dumpster on site
Fire Department signature/date
COMMENTS
I
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
Building Setback (ft.
Front Yard Side Yard Rear Yard
Require 4Provided Re uired Provides Required Provided
/ /
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
NOTES and DATA — (For department use)
Cz5L
Page 3 of 4
Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM05
Crated JMC. Jan.2006
L
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 DEPARTMENTMFORMOS
Page 4 of 4
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Location -� j0v4 G/I orS
No. 1400 Date /d o-
MpRTM TOWN OF NORTH ANDOVER
o. • p
9
a ; : Certificate of Occupancy $
s�CMUs t�' Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ J
Check #.-VGl
19926
V Building Inspector