HomeMy WebLinkAboutBuilding Permit #Exception - 120 WINDKIST FARM ROAD 5/1/2018 BUILDING PERMIT o`"°orN gtiv
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
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Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION
t
vont,
PROPERTY OWNERf _
'Pnhit
MAP NO: PARCEL,�j ZONING:DJSTR1CT Historic District yes no
'Machine Shop Villageyes no
TYPE OF IMPROVEMENT PROPOSED USE
Res' Non- Residential
New Buildin : One famil
Zition Two or more family Industrial
Alteration No. of units: Commercial
Repair, replacement Assessory Bldg Others:
tion Other
Septiid Well F(oodplafn Wetlands 'Watershed District
ater./Sewer
DESC TION OF WOR .TO 135 PREF4RMED:
A el 24: G
I
dentification P ase Type or Print Clearly)
OWNER: Name:r.4 , C j � `" Phone:Q09,R1
Address:
CONTRACTOR Name4-
n ' Mone:
Address;
14
Supervisor's ConstructionLicense:r Expo .Date.
Home l nprovement:License: Exp,. .Date
ARCHITECT/ENGINEER
Q Phone: �Y - 77-0'/0
Address: �r � �rt�� SIP ��'! `! 1/ —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: $ FEE: $
Check No.: Receipt No.:
NOTE: Persons contractin y-egistered contractors do not have acce to the gran fund
I nature of A ent/Own r � nattare of cop. ctor
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
i
COMMENTS
I
DATE REJECTED DATE APPROVED
CONSERVATION
r
COMMENTS
DATE REJECTED DATE APPROVED
i
/HEALTH �7
COMMENTS 75Vs74-,::,112 i—A
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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
Located at 384 Osgood Street
F�Rf DEPARTMENT - Ternp 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.: ia :`Ze=
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
I
❑ Notified for pickup - Date
Doc.Building Permit Revised 2007
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
o Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
L3 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
o Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
Li 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)
xi Building Permit Application
❑ Certified Proposed an
❑ Yhoto of H.I.C. A C.S. . Licenses-
orkers Comp Affidavit
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And,
Hydraulic Calculations (If Applicable)
Li Copy of Contract
,a ass 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:JNSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2007