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Home My WebLink AboutBuilding Permit #318 - Millpond 10/20/2009 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION o�N:oT Permit NO: V _ Date Received ( 0 r2b41 j i _ _ Date Issued: 9 +,T.o.•'��y SSACHU`�� IMPORTANT: Applicant must complete all items on this page LOCATION e 5 Print PROPERTY OWNER !_ Print MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑New Building ❑ One family ❑ Addition ❑Two or more family ❑ Industrial ❑ A ation No. of units: epair, replacement ❑ Assessory Bldg ❑Commercial Demolition ❑ Moving(relocation) ❑Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED Identification Please Type or Print Clearly) �j /� OWNER: Name: 41rt J"CGC 214 0!31h A t Phone: Address: Gi l�r I VCJ YI rC /Vv P, R,4��f� �f � L -8'S/1J1 X dam . ' CONTRACTOR Name: �' Phone: Address: kL,(-4L4/L— -� - -A/f , Supervisor's Construction License: S (� " �� Exp. Date: �� z 00 Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. -� FEE SCHEDULE:BOLDING PERM/T.$12.00 PER$1000.00 OF THE TOTAL EST/MATED COST BASED N$125.00 PER S.F. Total Project Cost :$ ?®, OoO FEE:$ Check No.: 7`f�� Receipt No.: 2-7/ Page Iof4 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 DEPARTM1IEN'r:BPFORN105 Page 4 of 4 I I TYPE OF SEWERAGE DISPOSAL Tanning/Massage/Body Art ❑ Swimming Pools C. Public Sewer F Tobacco Sales J Food Packaging/Sales C Well r � Permanent Dumpster on Site Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons tracting with unregistered contractors dognoot have access to the guaranty fund ature of contractor Signature o'Agen caner _,f/'(Sign Plans Sub ' ed ❑ 4'Pla'n2sW�aived ❑ ertified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT Fl- COMMENTS COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS FIRE DEPARTMENT - Temp Dumpster on site yes no Fire Department signature/date COMMENTS Zoning Board of Appeals: Variance, Petition No: "Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer con nection/Sienature& Date Driveway Permit Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required 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 department use Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.1:m2006 r NORTH '9 Town of : Andover No. C, o doverf Mass.- �� ' Ld • OG al- o - CO CMICHEWICN RATED C2 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT-14.&A.440.1...... ........ .e.. .................. Foundation has permission to erect...........�........................... buildings.on..1 � Rough �. . ..1. i. .................. . g to be occupied as.....3�I ..........Qt.. �.+ r� � I .... �. Chimney provided that the person acce ing this permit shall in ve respect conform he terms of fhe a lication on file in J this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU ST TS Rough .......... .... ............................................................................. Service . ... .. .... . . BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENTUntil Inspected and Approved by the Building Inspector. Bumex Street No. SEE REVERSE SIDE Smoke Det. ` ` z 6 1 +QAm r r,_.1 b 1 p(J t i Y '•"! N N n N n �y DR � o , ; \\ t•1 g� � �. � .� �N /•gyp 1 ��. �� ` .at.bz 1, � '� � IT,'..`td=':•:.': _`�-'•��`•:.'sem lu '- t K � V^ � :•:.iii:. � -r.=z 3 / - g4 r -• 69 go KAY / f ;:� 9 =�. -� WATER HYDRANT ) es \ _.__.-___ =� _ Y •. (36 * ELECTRIC METER SHEDa3 - 0y 1 BUILDING NUMBER QP :o� `O�+db 4.1\ DR DRIVEWAY NUMBER Pleat Street �► �6 w .• • . . . .•.. . •r.. . •��E.r• �' �\X11/1• Irr1 • • � � . .. . _ �\V