HomeMy WebLinkAboutBuilding Permit #Exception - 119 MAIN STREET 5/1/2018 NORT11
BUILDING PERMIT OFttLso /6 6'
TOWN OF NORTH ANDOVER O
APPLICATION FOR PLAN EXAMINATION N.
Date Received / b ATEV�Q¢'
Permit NO: acwus��
Date Issued: '
IMpORTANT:Applicant must complete all items on this page
LOCATION 119
Print
PRO.PERT*
Y.Oj/UNER
Print
MAP.210:. . .'>. PARCEL:. ZONING DISTRICT; -Historic Disttict. yes. no .
Machhe Shop.Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
El Two or more family ❑ Industrial
0Addition
Alteration No. of units: IA Commercial
El Bldg ❑ Others:
❑ Repair, replacement
❑ Demolition ❑ Other
D.Septic V1/ell Li Floodplain ❑Wetlands Water
❑NVater/.Sewer. = _
r DESCRIPTION OF WORK TO BE PERFORMED:
cn.►�S ,.c-fir {ale C����P� S .�/e w �l cbcY tai
MAPLE LEAF CONSTRUCTIOP
COMPANY INC.
—T—
Identification Please Type or Print Clearly) BILL FRANCOEUR
OWNER: Name:F - mases �.,�C Phone. PROJECT MANAG
ESTIMATOR
Address: h a o 3
5 CONGRESS ST.
ODNTRACTOR Name: NASHUA, Nx
L03062
603 882-7498
. A� . FAX 603 595-8688
Aticlress: �����`�� �— FAX
Supervisor's_Construction License: <'S 5�,�..,� Exp:; bate:..,s.I2
H6hj6..lmprovement License:
Exp. Date::
ARCHITECT/ENGINEER Phone: Lemk c4 Ar ;keds ���- A5'-1 -14 35A
Address:B89 MNIt s e441_S A��� Reg. No. 4 y 9 Ca
FEL SCHEDULE.BULDING PERMIT.-$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COSTBASED ON
$925.00 PER S.F.
Total Project Cost: $--2t, $CC:> e CCS FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting4w' egis r d co tractors do not have access to the guaranty fund
Signature of Agent/Owner Signature of contractor.&a�
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Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/MassageBodyArt ❑ Swimming Pools ❑
Well ❑ ❑
Tobacco Sales Food Packaging/Sales ❑
Private(septic tank,etc. ❑ET
on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF e U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ dvbr
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH� Reviewed on� Signa ureZ
Z==:,:::4,,
COMMENTSZ/�
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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
D-PW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp-Dumpster on site yes no
Located at 124 Mairi Street Fire Departsneh#signature/da#e_
COMMENTS..
i
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
II I
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
II
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$10041000 fine
NOTES and DATA— For department use
I
M
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® Notified for pickup - Date
Doc.Building Permit Revised 2010/0ctober
i
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
❑ Co of
Contract
act
❑ 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 Ener Compliance Report Energy p p rt (If Applicable)
❑ Engineering Affidavits for Engineered products
MOTE: 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
DoE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Xn 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:Building Permit Revised 2008