HomeMy WebLinkAboutBuilding Permit #Exception - 0 Ogunquit Road 1/20/2010 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:
IMPORTANT:Applicant must complete all items on this page
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I111Ai?NO: ROEL : _ZONIIGSTR1,TlNistoa is 3?asta�ct yes,
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Buildin One family)
dition wo or more family Industrial
Alteration No. of units: Commercial
Repair, replacement Assessory Bldg Others:
Demolition Other
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DESCRIPTION OF WORK TO BE PERFOED.
stru� on. YL R
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3 o sq -F
CD) OP-) ICA I C-.-CLC�e-, Lind -e
.Identification Please Type or Print Clearly) I ,
OWNER: Name: 1 Phone:�1�
Address: �7�7C7 PSC- jv21 "St �J - Y)6OYtK
77777
Cr�1TRAC7OFt Namey e 5'12 ?honea``� `�
Address `7 b
Super�asor'sonstructio� l:lceas � 1`xp Date �,Cl.l.O
"Honesrn:pa-ovaYaaent I.aeense : .,� 3 Etp Date_ 10
ARCH ITECT/ENGINEERIa I(i� _ ill t n s Phone:���(
Address: JPR )n ma Reg. No. 7(D5
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
R,=
Si nature of A ent/Owner -
9 a - 9 Signature of contractor ..
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
II
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed on
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3 WV 1�1
COMMENTS i' �
HEALTH Reviewed on Signature
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COMMENTS y ,�fl�-z - ,-z.S -3//9//
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
PlanningBoard Decision:
Comments
Conservation Decision: Comme
Water & Sewer Connection/sic
naturW� f��eZV
Drivewa Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
BRE'DEP.ART.MEKT -'Tern a ster Dn Usite.
P des �,no,
Lcated-,at 12 llain.Street'
Fire Departrhen#signature/bate
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 2008
i
Building Department
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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
I
o 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)
o 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
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New Construction (Single and Two Family)
Building Permit Application
0 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: Doc.Building Permit Revised 2008