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Home My WebLink AboutBuilding Permit #Exception - 0 Martin Ave Lot 36 10/11/2012 NOTy R BUILDING PERMIT oF�sL�o ,6-i TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION T 1 h T Permit N0: Date Received 1/ ��q PyA Oreo� Date Issued: SSS 9CHU5E� IMPORTANT:Applicant must complete all items on this page Print (A PROPERTY OWNER _ . . , , ,.. � , �c� ,�• � � lam_ Print 'MAP NO PARCEL: ZONING DISTRICT:`�� . � Historic.District yes . no Machine Shop Village 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 Repair, replacement Assessory Bldg Others: Demolition Other S.. tic Well Floodplain' Wetlands Watershed District' ater/Sewer DESCRIPTION OF WORK TO BE PREFOR ED: Identification Please Type or Print Clearly) -CM OWNER: Name: M to� k o Z u-% L-,,V R,�tr 21 Phone: 9-`�, / SSU Address-7D '�z� -N�� (,�� xky tk-a. 0 18A-- CONTRACTOR NameN, Phone Address: 70. . Supervisor's-:Constructiori,L,'icense :f : Exp:'1Date:__:: LHome Improvement License: Exp. Date: ARCHITECT/ENGINEER Ld;,-C� Phone: 9 -3C,7 1 Address.0,�e ,u u. p Reg. No. FEE SCHEDULE:BULDING ERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $_ 37� FEE: $ Check No.: Receipt No.: NOTE: Persons contracting Ivith zznregistered contractors do not have access to the guaranty fund Signature of Agpnt/Own Signature of contractor Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/BodyArtSwimmin g 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 PLANNING & DEVELOPMENT DATE REJECTED DATE APPROVED COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on Siqnature COMMENTS 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: FIRE DEPARTMENT -Temp Dumpster on site yes Located 3noos no' street Located at 124 MainStreet Fire Department signature/date COMMENTS I 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 2008 " 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 e Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cressection/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 DEPARTMENTMFORM07 Revised 2.2008