HomeMy WebLinkAboutBuilding Permit #Exception - 100 COLGATE DRIVE 5/1/2018 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
2013 OCT 16 P;; 1 : 02
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION.._
PROPERTY OWNER �_ �e
Print 100 Year Old Structure yes Ano MAP NO: 7�'. PARCEL: ZONING DISTRICT HistoricDistrict yes Machine ShopVillage yes
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
❑ Septic ❑Well ❑ Floodplain u ❑Wetlands 0 Watershed District
❑Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
fic�L-� -Sut-o&
Iden ficatio�' Please Type or Print Clearly)
OWNER: Name: �ri Scr� u �SJi Som Phone:c17�
Address:
CONTRACTOR Name: __ Phone: _
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BOLDING 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 w'h unregistered contractors do not have access to the guaranty fund
_ r f
Signature of Agent/Owner ;� Sure of contractor
Plans Submittedxi Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
Plans Submitted-11 Plans Waived❑ Certified Plot Plan ❑ Stamped Plans ❑
"TWE-OFSEWERAGEDiSPDS 1-
Public Sewer ❑ Tanning/Massage/BodyArt ❑.. . .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: DATEAPPROVED
PLANNING'&DEVELOPMENT ❑ ❑
COMMENTS
.CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
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 Tow;,, Engineer: Signature:
Located 384 Osgood Street
FIRE D
`E .R
T
Teriip Dumpster on site yes no
Located at 124 Mair Street
Fire Departiner�t 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
EJ Notified for pickup - Date
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Doc.Building Permit Revised 2010
Building Department
--?he following is�a li'st of the required-forms to belilled 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
❑ 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)
o 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 cans if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the apw-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be subm.tted with the building application
Doc: Doc.Bui?ding Permit Revised 2012