HomeMy WebLinkAboutBuilding Permit #92 - 85 FLAGSHIP DRIVE 8/8/2006TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
MY j�G tjO PH 12-- 19
Pennit NO: Date Received
Date Issued:
V
IMPORTANT: Applicant must complete all items on this p
LOCA
PROPERTY
Print
MAP NO.: PARCEL:
ril Qu 1'%U n1rT" nrvf�-
ZONING DISTRICT:
MPftTnR1C, DISTRICT YES 0
000tr 6
`6 0
'I IN
0
0
10 A
Residential
k
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
0 New Building
[] One family
0 Addition
0 Two or more family
11 Industrial
':K -Alteration
No. of units:
0 Assessory Bldg
0 Repair, replacement
AConiniercial
11 Demolition
0 Moving (relocation)
D Other
11 Others:
0 Foundation only
I
I
DESCRIPTION OF WORK TO BE PREFORMED
72,,-AzoL1=&2 ::�gxL4-1,nu- lIvAr- -
Identification Please Type or Print Clearly)
OWNER: Name: (f 11961'1VW&- Z�G Phone: 9-�?- 6 9'3- 751,5Y
Address: ZO
CONTRACTOR Name:— KISH- Phone:
Address: /1) 7 Aobl )13
Supervisor's Construction License: Z61 Exp. Date: 16Lo
Home Improvement License: A )1A Exp. Date: ti.liq
ARCHITECT/ENGINEEK�V- e I-rcgra- P As -w-, Name: Phone: -x�667 - 3137
Address:,7,3Z- C#61 -SCA Reg. No.
FEE SCHEDULE. BULDINGPERMIT.- $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Proje . �ct Cost:$ 301, CW - xl2.00=FEE:$ q45�,Q —
Check No.:- Receipt No.:
Page I of 4
Location
No. q Date C)
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ 360
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
'Z/-/- q -
Check# I Vw
Building Inspector
TYPE OF SEWERAGE DISPOSAL
Tanning/Massage/Body Art n
Swimming Pools
Public Sewer F1
Well - 11
Tobacco Sales
F -o@ �ac�Wging/$afF� -'11'
- 1. 1
Permanent Dumpster on Site
Private (septic tank, etc.
Electric Meter location to
proj ect
INU'I'E: Persons contracti i unregi e contractors do not have access to the guarantyfund
Signature of Agent/Owne= --..Signature of contractor-X'Z,'�,'-�"A
Plans Submitted PlansWaived '�r Certified Plot Plan D Stamped Pla�ns
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
I
COMMENTS
CONSERVATION
COMMENTS
I
14,EALTH
QOMMENTS
Zoning Board of Appeals: Variance, Petition
Zoning Decision/receipt submitted yes
Planning Board Decision:. -
Conservation Decision:
Water & Sewer connection/Signature & Dal
I
Temp Dumpster on site yes�no— Fir
)� <,-� -ra-, �, �r- (-e,
DATE REJECTED DATE APPROVED
F1 1-1
[]Water Shed Special Permit
El Site Plan Special Permit
11 Other
DATE REJECTED
F1
DATE REJECTED
F]
Comments
DATE APPROVED
F1
I
DATE APPROVED
El
Building Setback (ft.)
Front Yard
Side Yard
Rear Yard
Require
L+
Provided
Requireq_j_
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 dwartment use)
N
Doc: INSPECTIONAL SERVICES DEPARTMENT: BPFORM05
C=ted JMC. Jan.2006
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be
obtained.
Ro I ofing, Siding, Interior Rehabilitation Permits
u Building Permit Application
Lj Workers Comp Affidavit
• Photo Copy Of H.I.C. And/Or C.S.L. Licenses
• Copy of Contract
ci 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
ci Copy Of Contract
L3 Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
u Mass check Energy Compliance Report (If Applicable)
New Construction (Single and Two Family)
Lj Building Permit Application
Li Certified Proposed Plot Plan
u 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
Pa Pe 4 of 4