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HomeMy WebLinkAboutBuilding Permit #Exception - 114 STONECLEAVE ROAD 5/1/2018 NORTh BUILDING PERMIT OFtAao TOWN OF NORTH ANDOVER o? APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received1 -1 �4"�q,r,o•��.e� �SSACHUS�� Date Issued: IMPORTANT:Applicant must complete all items on this page 'LOCATION: Pnnt PROPERTY OWN1=R e i - Y Pnnf - . 11�AP Nfl PARCEL 20NINGUSTR-1CT �i�s#t�ic�3s#nct - yes R a lAllaclme Shop 1lllage . yes no . TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential NexuBuilding One family A�eratiorn more family Industrial No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other epti.c aNe11 Floodplain Iletlands .,§ 1atershed Dastnct wa er/SevUer , DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone(lians) Address: O.�ITRACTOR Name. - Phone -Addss tL3 - _ Sa{��rvisor'-s Gona3ruct�ora License 4 3;�` _ '� - app _'Da Horne Improvement License Z�.LI© ARCHITECT/ENGINEER V%/y C Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ Z-7Z •S-U ' FEE: $ O Check No.: Receipt No.: NOTE: Persons contwith u registered contractors do not have access to the guaranty fund Sign atfare of`Agent/Owna_ .Signa#ure of contractor= � , Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. t E 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 t NOTE: All dumpster permits require sign off from Fire Department prior to Issuance of Bldg Permit ` Addition Or Decks i ❑ Building Permit Application I G ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ± ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract i ❑ 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 I ❑ 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 i 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 E 1 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 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 Si nature COMMENTS n _� (-'�J 1nLz HEALTH Reviewed on Si nature-f COMMENTS �ni�;� �.� L, 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 DEPAR MENT Temp Durnpster on site= yes Located-4t 9-2a�am.Street :department.-sign tureloate COMMENTS = ff Dimension Number of Stories:_ Total square feet of floor area, based on Exterior dimensions. Total land area, sq, ft.: a t ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No_ DANGER ZONE LITERATURE: Yes No C\S MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) i i I ❑ Notified foris p kup - Date a Doc.Building Permit Revised 2008 r- Jl/ MAX. COVER 1000 GALLON MONOLITHIC 4 PUMP CHAMBER 12" 8. ' - 1500 GALLON 2"SCH 40 PVC MONOLITHIC 48"EFFECTIVE LENGTH FORCE MAIN SEPTIC TANK 52"TOTAL LENGTH I ---92 SIDE VIEW 0 0 0 o o 0 0`` ✓°� EXISTING 4 BEDROOM DWELLING #114 BENCHMARK:1 SPIKE IN TREE SILL ELEV 97.35 ELEV.96.45(ASSUMED DATUM l O1� 100'WELL OFS 94 EXISTING WELL EDGE OF LAWN 94 .4a LOT 14 STONECLEAVE ROAD o ASSESSORS MAP 104B,LOT 138 43,571± SQ.FT.