HomeMy WebLinkAboutBuilding Permit #801 - 125 DALE STREET 6/9/2010 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO:
Date Received
041kre D
Date issued: E' IT S CHU
IMPORTANT: Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building One family7)
Addition -'Tw—o-orrn-ore family Industrial
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Al No. of units: Commercial
< e air, re lacement
Assessory Bldg Others:
Demolition Other
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DESCRIPTION OF WORK TO BE PREFORMED:
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Identification Please Type or Print Clearly)
OWNER: Name:. gr'll t-v-4,,Y,7- Phone- 9Y-7- 975-0
Address:- Aw 49 a114,-IL
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.:eW i en e;
ARCHITECT/ENGINEER All 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: $ '9 ' &C
FEE: $
Check No.: Receipt No.: r7)t--5 r%17 -Z
NOTE: Persons contracting1w'th unregistered contractors do not have access to the guarant.17fund
e:df contractor
tianatur
Sig- -it-64of-Agent/b n er -
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Location ,a Z�e f -e _ 5:-, --
k No. Date
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,,ORT,y T®tr=rN OF NORTH ANDOVER
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Certificate of occupancy $
CMUs<� Building/Frame Permit Fee $
Foundation Permit Fee $
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Other Permit Fee $
TOTAL $
Check # `
232b3
Building Inspector
Jun 04 10 01 : 31p NORTH ANDOVER 9786889542 p. 2
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWtRAGE DISPOSAL
Public Sewer Tanning/Massage/Body Ari Swinuning 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 Signature
COMMENTS
I
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decisionlreceipt submitted yes
I
Planning Board Decision:' Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
Locate�L_.384 Os ood Street
F E:DE ART�IEiNT Temp Duma, steron yes : xao
Located-at 124.N41n.Street .
�:irp,n�riarmptat cic�natriiweitrtate
w Jun 04 10 01 : 31p NORTH ANDOVER 9786889542 p, 3
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 2 1 A—F and G min.$100-$1000 fine
NOTES.and DATA— For department use
i
❑ Notified for pickup - Date
Doc.Bailding Permit Revised 2010
Jun 04 10 01 : 31p NORTH ANDOVER 9786889542 p. 4
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
❑ 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
a Certified Surveyed Plot Plan
o Workers Comp Affidavit
o Photo Copy of H.I.C. And C.S.L. Licenses
a 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
u 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
o 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:Building Permit Revised 2008