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Home My WebLink AboutBuilding Permit #720 - 9 SALEM STREET 9/6/2008BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: pv Date Issued: 4011 P- 8 IMPORTANT: Applicant must Date Received all items on this LOCATION S6? /c/22 PROPERTY OWNER l Ifo rttG1 111 oc,6i- f'7,1 d �1 �n Z &�- s Print PARCEL: ZONING DISTRICT: Historic District _ Machine Shop Vi yes no yes . no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Others: Repair, replacement Assessory Bldg Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: cJ✓/%10 Gln /�'-Y-oa� G�-/� roa � �lea� Identification Please Type or Print Clearly) 2 OWNER: Name: ori �/y�°i / �°",/ Phone: Address: % , �C'y c�oi .iuitc�o�' CONTRACTOR NameD- d Uhh Phone: G i3 3 3,1L Address: 20 4 /t7 Supervisor's Construction License: Exp. Date: Home Improvement License: �� `'�`{l°' Exp. Date:�� ARCHITECT/ENGINEER Phone: Address: Reg. No FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED N $125.00 PER S.F. d� Total Project Cost: $ 023 6 UU FEE: $ Check No.: & Receipt No.: NOTE: Persons lontracting with unregistered contractors do not have access to the guaranty fund nature of Agent/Owner 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 CONSERVATION COMMENTS HEALTH 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 DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT Temp Dumpster on site yes no Located at 124 Main Street 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 MGL Chapter 166 Section 2 1 A —F and G min.$100-$1000 fine NOTES and DATA — For department use ❑ Notified for pickup - Date i Doc.Building Permit Revised 2008 No 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 ❑ 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 E O EM4 H O z p O w aco vp Cf)w O U Og Ga w U w O ca w. O W �� w cn w U d w w W a wto v 0 co o 8 cn O o cn O z 8 O M v a 2 O O MO V Z d O y o � O cm COD O 'a O— h CD m m L- 0 CD I.- = 4r CD O Ogoi R o a CL tmQ c o .0-0c C ev CO Cos C Z CD Q CL V y c C C c CLCO3 0 O' y H m 3 �m ' H W N :mo CLU CD H m 0 aca coa y O • cc O G HG Q y m C = O C.'=' p � W C m r0+ O -00 w =25 ui •N r O C °C •E m dt ca c h m c C.3.3 o CODCLa _ Ca m� J ` N Cp Coo 8 O M v a 2 O O MO V Z d O y o � O cm COD O 'a O— h CD m m L- 0 CD I.- = 4r CD O Ogoi R o a CL tmQ c o .0-0c C ev CO Cos C Z CD Q CL V y c C C c CLCO3 0 Massachusetts - [hpurtincnt of Public Safeo .rEVELBoard of Building- Rc�„ulations and Standards Construction Supervisor Specialty License License: CS SL 99358 Restricted to: RF,WS DAVID CASTRICONE 31 COURT STREET 2 �• NORTH ANDOVER, MA 01845 Expiration: 12/16/2011 ( nunis.i ncr Tr#: 99358 tiu rax DGlVC.t —... - ---- ACORD,, CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDDIY" 4/15/20D8 PRODUCER Phone: 508-651-7700 Fax: 508-653-8089 Eastern Insurance Group LLC -Commercial Lines 233 West Central Street Natick MA 01760 THIS CERTIFICATE IS ISSUED AS A MATTER.OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED David Castricone Roofing & Siding Inc 200 Sutton St Suite 226 North Andover MA 01845 INSURERA:The Insurance Cc of State PA INSURERS: Citation InSUranCe 40274 INSURERC INSURERD: INSU RER E: COVERA�� E POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. OTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE RMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. /NSR DD7. EM TYPE OF INSURANCE POLICY NUMBER Pp LIE EFFECTIVE POMMFDDrM ACEEMXPIRATION LIMITS GENERAL LIABILITY EACHOCCURRENCE $ PREMISES Eeomironre $ COMMERaAL GENERAL LIABILITY MED EXP(Anyone lean) $ CLAIMS MADE n OCCUR PERSONAL& ADV INJURY $ GENERAL AGGREGATE $ GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OPAGG S POLICY PR4 JFCT 1-1 LOC B AUTOMOBILEWABIUTY 07MM13BTNKT 8/1/2007 8/1/2008 COMBINED SINGLE UMIT g (Es ecddent) ANY AUTO ALL OWNED AUTOS BODILYINJURY $ 250000 SCHEDULED AUTOS (Pe Peron) j{ HIREDAUTOS BODILYINJURY $ 500000 x NON-ONNEDAUTOS (Perm)ddent) PROPERTY DAMAGE $ 100000 (Pet aWdant) GARAGEUABILITY AUTO ONLY -EA ACCIDENT $ OTHERTHAN EAACC $ ANYAUTO AUTO ONLY: AGG S D(CEMUMBRELLALIANLRY EACH OCCURRENCE $ AGGREGATE $ OCCUR 0 CLAIMS MADE S $ DEDUCTIBLE $ RETENTION $ TATU- OTH- WCSIM A WORKERSCOMPENIIATIONAND WC7222278 9/23/2007 9/23/2008 R E.L.EACHAOUDENT $ 100, DOD EMPLOYERS'LIABILRY E.L. DISEASE -EA EMPLOYEE $ 100, 0O ANY PROPRIETCRIPARTNERIEXECUTIVE OFFICERIMEMBEREXCLUDED? E.L. DISEASE -POLICY LIMIT $ Ifyyes desalbeunder SPEGNIAL PROVISIONS belay OTHER 1 7 DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES/ EXCLUSIONSADDED BY ENDORSEMENT I SPECIAL PROVISIONS Town of North Andover Att: Joseph Lidick 123 Main St North Andover MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SIiALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ACORD25(2001106) ,ry ' �`" pACORD RD,N CERTIFICATE OF LIABILITY INSURANCE ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS GERTIFI ATE MAY BE ISSUED OR 04/108/2008' PRODUCER (800)333-7234 FAX Eastern Insurance Group LLC 233 West Central Street Natick, MA 01760 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED SyTHE POLICIES BELOW, INSURERS AFFORDING COVERAGE NAIC # INSURED David Castricone Roofing & Siding'Inc 200 Sutton St Suite ZZ6 North Andover, MA 01845 INSURERA: Aspen Specialty POLICY EFFECTIVE INSURER B: I LIMITS INSURER C: INSURER D: GLOO131901 INSURER E: 09/06/2008 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE POR THE POLICY PERIOD IN ICATED, NOTWITHSTANDIN ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS GERTIFI ATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSION AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. tNSR Aob,t TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRAT N I LIMITS GENERAL LIABILITY GLOO131901 09/06/2007 09/06/2008 EACH OCCURRENCE $ 11000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 501000 CLAIMS MADE I OCCUR MED EXP IAnv ono peroon) m A PERSONAL A ADV INJURY S 1,000,000 GENERALAGGRE ATE $ Z 000,000 GEN'L AOOREGATE LIMIT APPLIES PER: PRODUCTS - COM PIOP AGO d j 000 , 00 POLICY CT DCLOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S ANY AUTO (Ea accldenr) ALL OWNED AUTO$ BODILY INJURY SCHEDULED AUTOS (Por person) HIRED AUTOS BODILY INJURY $ NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE S (Paraoadem) GARAGE LIABILITY AUTO ONLY . EA A CCIDENT S OTHER THAN ACC 9 ANY AUTO AUTO ONLY. AGO $ EXCESS(VMBRELLALIABILITY EACH OrCURREN.E $ OCCUR CLAIMS MADE AGGREGATE & $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND C STAT - OTH- EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ANY PROPRIEYORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? E L. DISEASE - EA MPLOYE $ IIB8, damfibe under E L. DISEASE • Pp ICY LIMIT 5 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCAIIONB / VEHICLES / FXCLUSIONS DDED BY ENDORSEMENT I SPECIAL PROVISIONS Roof to be Completed at North Andover Fire Station, Main St North Andover MA OWN OF NOTH ANDOVER NAMED AS ADDITIONAL INSURED $MOULD ANY OF THE ABOVE DESCRIBED POLICIES 85I CANCELLED BEFORE THF EXPIRATION DATE THEREOF, THE ISSUING INSURER 14LL ENDEAVOR TO MAIL TOWN OF NORTH ANDOVER 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE FOLDER NAMED TO THE LEFT, JOSEPH LIDICK BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE N OBLIGATION OR LIABILITY 120 MAIN ST OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRPSENTATIVEB, N ANDOVER, MA 01845 AUTHORIZED REPRESENTATIVE ACORD 25 (2001108) U V ,-I OA�ORD CORPORATION 1986 Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 DEBRIS DISPOSAL FORM XaakrH 04 O L ` .., coc Nlc�II WN11 1\ lot SACNl15�� In accordance with the provisions of MGL c 40 s 54, and a condition of. Building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, sl 50a. The debris will be disposed of in /at: Facility location Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector, A) A PAVED CASTRICONE CASTRICONE R00FINGA SIDING INC.. ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 200 SUTTON STREET, SUITE 226, NO. ANDOVER, MA 01845 In Norah Andover 978-683-3420 InBoxford -978-887-6147 InHawrhX978-374-7314, Uwe the owner(s) of the premises mentioned below, hereby contract with and authorize. you as contractor, to furnish all necessary,, materials labor and workmanship, to install, construct and place the:improvements according to the following specifications terms and on premises below described: e 1 11 Owner's Name.... .A ... A42.41.dr .. arw 1. .1 ....... T�ephone 1.1 Job Address ........ SJ.64.1 ....... ::3 . ............... ......... ........... City.... #....} .......... .......... Stlite....14A ....... . S pectficoigns: ........................................... ili't**r'i*pexisting "s*'h*i*n***g*l*c*'&'**w*"* .......dPP**I*Y--e*w* ...drip ***edge ***t*o*"all edges �.*'*,**?",*v****A**1*4*'-,, ................ ..................... ........................................................................................................................................................................... rice n shield .-2�pply I _/,,_feet ice and water shield membrane to bottom edges of house. 3feeti and ie brane In valleys and bottom edges of any unheated areas of house.. ......................................................... e�Apply felt papa adrlsyment 4offistall ridge vent to. t.:*i ..... jo..45W&Wd.. ............ ....... Oct shingles with a Yese warranty Xer9of using ...................... ...................... .. .... ; ................................................ ....... .......................................................................................... ............. /Counterflasb chimney. *4qvew nt pipe flashing. Aegal disposal of all debris. ................... .. F ................. ............................................. . .................... .................................... .................. Area(s) to be worked on:..... .................................................. .............................. .. ....... ........................................................................... .................. ................... ..................................... .......... I ................................. I ......... ................................................................. ...................................................... ...... ......................................................... ............... . ... ... ................................................................... .................................................. :r.* Roof board replacement if necessary @ /,g /sheet or kAftot ......... . . . . . . . ......... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....... . . . . . . . ........ . . . . . . . . ........................ . . . . . . . . . . ..... . ia Warranty as specifi�o Y ni� Two Year.Workmansbip Warranty (Not Transferable) AUnufactuier's W Irv- .nufa LIP The contractor agrees to perform the work and fittritish the materials specified above for the SUM f F_'Y:77Z�3 . ....... Payable.1 ............................ on'................. I Payable-, .......................... on................... I ............... Balance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability while job is in operation: Contractor is not responsible for any damage to the interior of property, including pro-odsting conditions (i.e. water stains, crumbling plaster, exposed nails) or conditions resulting from application of materials specified above (i.e. objects coining loose from walls, crumbling plaster, exposed nails, dust in aide or other living spaces). items in attic may need to be covered by homeowner. All materials are property of contractor. Any dumpster placed V contractor is for his use only. Upon completion of above work, all undersigned agree to execute and deliver to contractor, their joint note in accordance with his (their) above obligation as requestedby contractor. Upon refusal to do so, contractor may at its option declare the -entire contract price or so muclias then remains unpaid, immediately due and payable. It is agreed that, if permitted by law, contractor sha . 11 be paid by the owner(s) all reasonable costs, attorney fees and expenses, in addition to the amount due and unpaid, that shall be incurred in enforcing the term and conditions of the contract and/or any lien in connection herewith. It is further agreed that this contract may be assigned by contractor, and also that the obligations hereof shall bind and apply to their heirs, successors or estates of the parties; The undersigned warrint(s) that be is (they are) the owners(s) of the above mentioned premins'and that legal tide thereto -stands of record in hip (their) mur*s).Thcrt are noreprescut6tions, guaranties or warranties, except such as maybe herein incorporated, if any, nor any agreemenwcollateral hereto, nor is die contract dependent upon orsubject toany .conditions not I herein stated. Any subsequent agmemerit in reference hereto shall be binding only if in writing and signed by. all parties. All Home Improvement Contractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to- Director, Home Improvement Contractor Registration, One Ashburton Place, Room 1301, Boston, MA 01108 Tel. 617-727-9598 Any and all necessary construction -related permits shall beobtained by the Contractor. Any. Owner who secures his own construttion- related permit or deals with unregistered contractors is excluded from the.;Guaranty Fund provisions. of MGL c. 142A. Approximatestarting date of work. .......... .......... .............. .......... Completion date........:. . ....................................... Receipt of a copy of this contact is hereby acknowledged, and it is fijrthe,r acknowledged by the undersigned that the foregoing provisions have:been read and the contents thereof understood and that no�ep not herein contained shall t�e _ragreerawt__ binding upon the parties and thatallofth eag-reements; and understandings of said parties are contained herein. DO NOT SIGN THIS CONTRACT.IF THERE ARE ANY, BLANK SPACES Owner has three business days to cancel this contract andincur no penalty (see notice of cancellation). IN WITNESS WHEREOF, the parties have hereunto signed their names this.. day o ...... 20.... Accepted: Signed ......»: ... » ....».:: .............»... Owner ...:....:::.............»...»........»:.._.........». Owner David Castricone, President The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass gov/dia mpensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): _DAV t b C S T ted W Ai E, kOO f' i N b„ t S 1 D! N Cs T 1J C Address: nZl&J7- Qi 51744,E„T City/State/Zip: R. Aar i 11 Jp rz t -1A Q 1 Zq s Phone #: J)? 613 3 Y.,.0 Are you an employer? Check the appropriate box: 1. Rr I am a employer with 8 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.t required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. _❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition. 10. ❑ Electrical repairs or additions 11. ❑ Plurnbmng repairs or additions 12. o repa� 13. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: —FkE NSt1 gAMC C.D QF S-Tp,n. -?A Policy # or Self -ins. Lic. #: VV C. Z aaa M B Expiration Date: C4,316% Job Site Address: gJa,&_,i✓1 U 7/�e f City/State/Zip: ��✓ i'/i l[ t' ` . Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under pains and penalties of perjury that the information provided above is true and correct. Signature: Date: /J—/,o R Phone #: W L i 3 qA 0 use City or Town: area, to or .town official Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Location 1 No. Date 140R701 TOWN OF NORTH ANDOVER �L 9 Certificate of Occupancy $ cHuS Building/Frame /Frame Permit Fee $ � s�t 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # 21216 Building Inspector