HomeMy WebLinkAboutBuilding Permit #638 - 99 HIGH STREET 4/11/2006NORTH
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Permit NO: 6929
Date Issued: z °—L/—erk
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received:
IMPORTANT: Applicant must complete all items on this pavze
LOCATION 1 6 tiT&ff
57•
Print
PROPERTY OWNER :ZA AC5 /Y1CC.o2Kriw=k l k�C � � AYA5(/QAV6-E41-0
Dr:r+
MAP NO.: ✓7 PARCEL:
ZONING DISTRICT:
1L1 OLI,5
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES 0
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ Addition
❑ Alteration
❑ One family
CVTwo or more family
No. of units: Z
❑ Industrial
IN/Repair, replacement
❑ Demolition
❑ Assessory Bldg
❑ Commercial
❑ Moving (relocation)
❑ Other
❑ Others:
❑ Foundation only
DESCRIPTION OF WORK TO BE PREFORMED-Q£7M612 < Z ff-7'G
Identification Please Type or Print Clearly)
CONTRACTOR Name:— Phone:
Address: Ci/Q A^J-G _
Supervisor's Construction License: (g6 03 A Exp. Date:
Home Improvement License:__ '7 Exp. Date: !7 , $
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT: $10.00 PER 11000.00 OF THE TOTAL ESTIMATED COST BASED $125.00 PER S.F.
Total Project Cost :$ 20. 600 ' ° x10.00=FEE:$
Check No.: Receipt No.:
Page I of 4
TYPE OF SEWARGE DISPOSAL
Tanning/Massage/Body Art ❑
Swimming Pools ❑
Public Sewer ❑
Well- F1❑
Tobacco Sales ❑
Food Packaging/Sales ❑
❑
Permanent Dumpster on Site
Private (septic tank, etc.
Electric Meter location to
proj ect
NOTE: Persons contracting with unregis tereA contractors do not have access to the guaranty fund
T c
Signature of Agent/Owner ASignature of Contractor
Plans Submitted ❑�Tans Waived Ll Certified Plot Plan ❑ VMped Plan El
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT ❑
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
Zoning Board of Appeals: Variance, Petition No:
C, Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
DATE REJECTED
51
❑Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
DATE REJECTED
El
DATE REJECTED
IN
Comments
Comments
Water & Sewer connection signature date
Temp Dumpster on site yes_no Fire Department signature/date
Building Permit Approved and Issued by:
Page 2 of 4
L01
DATE APPROVED
DATE APPROVED
DATE APPROVED
Building Setback (ft.)
Front Yard
Side Yard
Rear Yard
Required
Provided
Required
Provides
Required
Provided
DIMENSION
Number of Stories:
Total land area, sq. ft.:
NUIbJanuvAlA-
Created JMC. Jan.2006
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
Location—
No. /,,-, ? g /� Date
&0ItTo, TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
2 CHUS
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
19 1 L, 3
Building Inspectpr7
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