HomeMy WebLinkAboutBuilding Permit #Exception - 134 MABLIN AVENUE 5/1/2018 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received b-F CJM
Date Issued:
IMPORTANT:Applicant must complete all items on this page
` LOCATION
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PROPERTY OWNER CJ2L —,l f
Print
MAP NO: PARCEL: ZONING DISTRICyes no
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f �J I age yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential lential
ilding One family
_Addition Two or more famil _al
Alteration No. of units: ----— —e;ommercial
Repair, replacement Assessory Bldg Others:
Demolition Other
Septic Well Floodplain Wetlands 'Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
Identification Please Type or Print Clearly) fL
OWNER: Name:• EJVII���� �/� ���'I�iS / Phone: ��-?9Tp�
Address:
CONTRACTOR Narne; 6 Phone: L "
Address: /3 4
Supervisor's Construction.License:_ r Exp. Date:
Home Improvement License; Exp. Date;
ARCHITECT/ENGINEERQ�� — .SSSS Phone:92P 6
Address: ��� e Reg. No.
FEE SCHEDULE:BULDING�ERMIT:$12.00 PE $1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregiste contractors do not have access to the guaranty fund
;iSgnature of Agent/Owner = 'Signature of contractor
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
❑ 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
❑ 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
❑ 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
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: Doc.Building Permit Revised 2008