HomeMy WebLinkAboutBuilding Permit #Exception - 136 BRIDLE PATH 5/1/2018 (3) OTT q�
BUILDING PERMIT NORTF� qti
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TOWN OF NORTH ANDOVER
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APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received p°AA7ED►�`4y
�SSACHUSE�
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION
Print
PROPERTY OWNER
Print
MAP NO: PARCEL ZONING DISTRICT: Historic District yes o
Machine Shop Village yes
TYPE OF IMPROVE Y PROPOSED USE
7 Residential Non- Residential
New Building One family
Addition Two or more family Industrial
Alteration No. of units: Commercial
Repair, replacement Assessory Bldg Others:
Demolition Other
Septic Well Floodplain Wetlands Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
C h s/ZC f Ote*
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Identification Please Type or Print Clearly)
OWNER: Name: fr2s�/L� � f1'!r>•r% �,►G%/�7i Phone: �
Address: 3 'I-7iein6c 4 1-2d ,k,-e [J30 qC?()g
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CONTRACTOR Name: 0% ;2� a r bti Phone: Ct it ID
Address: S i7�t�rrC- 1 - c'' L$'t
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Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BOLDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ FEE: $
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Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access fund
Signature of Agent/Owner Signature of contractor
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public SewerTanning/MassageBody 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 Signature
COMMENTS
HEALTH Reviewed on i'_ Sinature,
COMMENTS v
e
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 DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS
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Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
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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
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❑ Notified for pickup Date
Doc.Building Permit Revised 2008
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Building Department
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The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, , id nig-nterior Rehabilitation Permits
-�o Building Permit Application
a Workers Comp Affidavit
Photo Co Of H.I.C. And/Or C.S.L. Licenses
� Copy ,
Copy of Contract
� fl 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
P P P 9
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) '
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❑ 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 PIn 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2008
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