HomeMy WebLinkAboutBuilding Permit #640 - 767 JOHNSON STREET 4/11/2006Location
No. r /10 Date
v
F 0 TOWN OF NORTH ANDOVER
0
0.- Z
Certificate of Occupancy
$
CHU
Building/Frame Permit Fee
$
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
$
Check #lS 3
191 U6
Building
Inspector
OF NORTH 9
a
o 41 1 p TOWN OF NORTH ANDOVER
«• -'. ,' •' APPLICATION FOR PLAN EXAMINATION
y �O+ire° ��•(°�
AC US
Permit NO: v Date Received:
Date Issued: Alk&
I IMPORTANT: Applicant must complete all items on this Daae
LOCATION 76701 P'�d J rec t ,
T t
PROPERTY OWNER �I UPrint j � �j Cil} a 5 el)16)' D)/ClwJ q
_ Print
MAP NO'S' ] PARCEL:,, I- _ZONING DISTRICT:
TYPE AND USE OF BUILDING
HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ Addition
AAlteration
>(One 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 /� eh dale / �> 7`c� �i, — . /tit.✓ :2)�;2�7 Aooi�
) j J
C Q�s hCG Q'H tl „ G OlrT,,76,r
Identification' ' Please Type or Print Clearly)
OWNER: Name:
Signature
Address: a Z ' ALe 5#Uc-�
CONTRACTOR-Name:Phone
Address:— 7 4 �fOh ���t -
Supervisor's Construction License: CJ (!7775V Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE. BULDING PERMIT. $10.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost :$- Z6,)�a0 Od xI0.00=FEE:$
Q,
Check No.: /5-.3/ Receipt No.: 1
Page Iof4
TYPE OF SEWARGE DISPOSAL Swimming Pools El
Tanning/Massage/Body Art Ll
Public Sewer
Well
Tobacco Sales El Food Packaging/Sales 11� ❑
Permanent Dumpster on Site ❑
Private (septic tank, etc. F1 Electric Meter location to
proj ect
NOTE: Persons contracting with unregister d contractors do not have access to the guaranty fund
�J :l
Signature of Agent/Owner" Signature of Contractor
Plans Submitted ❑ Plans Waived . ❑ Certified Plot Plan ❑ Stamped Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
DATE REJECTED
❑ ❑
❑Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
DATE APPROVED
DATE REJECTED DATE APPROVED
CONSERVATION
COMMENTS
HEALTH
COMMENTS
DATE REJECTED DATE APPROVED
❑ ❑ /'/7
Zoning Board of Appeals: Variance, Petition No:
Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer connection signature & date
Temp Dumpster on site yes X no_ Fire Department signature/date Gy/ %/—v
Building Permit Approved and Issued by:
Page 2 of 4
t
Building Setback (ft.)
Front Yard
Side Yard
Rear Yard
Required
Provided
Required
Provides
Required Provided
DIMENSION
Number of Stories:
Total land area, sq. ft.:
NOTES and DATA — (For department use)
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
❑ 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 DEPARTMENT:BPFORM05
Page 4 of 4
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