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HomeMy WebLinkAboutBuilding Permit #Exception - 1004 SALEM STREET 10/3/2010 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION T� a' Print 'PROPERTY OVJNEReit'r_,&t&U M, y?— 4 `? Print MAP NO�D .� PARCELS 3/ ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ZOne family ❑Addition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other ){. ❑ Sc ® ell" yVa ershe`dDistrict - ``' 3 3 .� !* y DESCRIPTION OF WORK TO BE PERFORMED: - U el-- OHt iE.4f f.00F t Cir/,iJt 1,;S-fAIt AI�,Gy 400 f- CCr li Aro i�t3/tl,-T Lu_g ` S� a - a(547� 4 LS�• ��a& It�4.L/<. Fes; o Q OI GE E_.acIsS--+:fpt -�o L�44�c co'% QC S©�.c wljdouj., Identification Please Type or Print Clearly) OWNER: Name: Phonc Address: 10 6) 1 Au g4Q LtrLo< CONTRACTOR Name: ��9.M iem be gg &r t/ R q t e &z AZcs_Phone: Address: P6 JP o ZRE 2—.b ro4lb,-(ti— C Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: &O-i1j, ARCHITECT/ENGINEER Cu_ P � s- Phone: 9 3— Address: RAI c-� S� T���P�;�� U $�� Reg. No. FEE SCHEDULE:BULDING PERMIT.•$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contractiiyw with unregistered contractors do not have access to the guaranty fund j Signa_ure_ of Agent/0:. n.__r _.- _Signature=of contractor ;_ - _ ��j Building Department The following is a list of the required forms to be filled out for theappropriate ermit to be obtained. p 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 Ej Flo or/Crossection/E levation Plan Of Proposed Work With Sprinkler Plan And p p 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 DOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals hat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording lust be submitted with the building application Doc: Doc.Building permit Revised 2008mi ■ 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 ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on Sig naturex'l` 1,-l'.��_', /4' 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: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 124 Main Street Fire Department 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 I NOTES and DATA— For department use i ® Notified for pickup - Date Doc:.Building Permit Revised 2008