HomeMy WebLinkAboutBuilding Permit #768 - 99 BEAR HILL ROAD 5/28/2010BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATIO
Permit NO: / W-0 Date Received
Date Issued:-
IMPO/RTANT: Applicant must complete all items on this pate
LOCATION?9 EPW-�,
Print
PROPERTY OWNER C 01Vq 7710N
Print
MAP 210 PARCEL: ZONING DISTRICT: Historic District yes
Machine Shod Villaae ves
2v t1Lov ib'6ryO\
of
no
no
TYPE OF IMPROVEMENT
PROPOSED USE
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Residential
Non- Residential
New Building
One family
CONTRACTOR
Addition
Two or more family
Industrial
Alteration
No. of units:
Commercial
Repair, replacement
Assessory Bldg
Others:
Demolition
Other
Septic Well
Floodplain Wetlands
Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
Identification Please
OWNER: Name
or Print Clearly)
917 F- i6ff7 - 3 7 71$`
Address: -72
7-30i4f
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CONTRACTOR
Name:
Phone:
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License:,
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: $ OD a FEE: $
Check No.: �? -rO�K Receipt No.: ??2/,P'
NOTE: Persons contracting u re is red ontractors do not have access to the guaranty fund
Signature d Agent/Ow r ignature of contractor
Location /q
No. `�)A.4-- Date
Check #
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $`
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
c.
232{8
( Building Inspector
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
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION
COMMENTS
S fig'
42'�e� /o/
HE H
COMMENTS
Reviewed
DATE APPROVED
5110
�9�/ 9�
oor.
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
z Conservation Decision:
Comments
Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature: -
Locatea 3254 usgooa wreet
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 No
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
NOTES and DATA — For department use
❑ Notified for pickup - Date
Doc.Building Permit Revised 2010
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
v
;i
❑ 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: Building Permit Revised 2008
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RECEIVE®
AM 16 2010
NORTH ANDOVER
CONSERVAT!!1nl C(MWSSION
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1?.,
FOR R631STRY USE ONLY
P.F�9si.�
I HEREBY CERTIFY THAT
THIS PLAN CONFORMS TO THE
RULES AND REGULATIONS OF
THE REGISTERS OF DEEDS OF
MASSACHUSETTS.
id,5 m
REGISTERED LAND SURVEYOR
SCAB: I° - 600'
SIZE ��
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f, LAND
i
ER MASS.
Date: July 2,1984
MALTY CORPORATION
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