HomeMy WebLinkAboutBuilding Permit #Exception - 138 HIGH STREET 5/1/2018 r
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received 11
Date Issued:
IMPORTANT:Applicant must complete all items on this page
.LOCATION Prin
PROPERTYOWNER \A—Z���5 `��i"f��s` Cr
Pnnt'. 1o0'YearOldStructure yes`:. no
-:
MAP NQ: PARCEL:" �ZONING DISaTRICT: Histone Qistnct yes no,
Machine Shop Village yes; nos'
TYPE OF IMPROVEMENT PROPOSED_ USE
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
❑ S:eptie: ❑Well$. El Floodplain, D Wetlands. ElWa'- shedT)istrict
Ij Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
"T-6
Identificat•on Pl e T e or Print Clearl )
OWNER: Name: _t 4J r-- Phone:
Address: /Volf�i
CONj ,'RACTORe Name: _ s_:T - - Phone:
Address:
Supervisor's Consfruetion License: Exp. Date .
Home Improveriaent License'.' " Exp: Gate
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BOLDING 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 contracti with unr 'stere co ctors do not have access to the guarantyfund
.81gnaturEn'd. gent/Ow „r".TM Sig nature of contractor .
Plans Submitted ❑ ans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
Building Department
The folowing is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofivg, 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 apo-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submAted with the building application
Doc: Doc.Buiifiing permit Revised 2012
I
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
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TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Swimming Pools ❑
Tanning/MassageBodyArt ❑
Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ I
Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑
i
1
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 Signature
COMMENTS
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 To-vv;! Engineer: Signature:
Located 384 Osgood Street
FIRE�DEPARTf�EN Temp Dumpster on site yes no
Located at 124 Mair,.Street
Fire Depairtinerit,signature/date
s
COMMENTS
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 chop requires apprroval 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
® Notified for pickup - Date
Doc.Building Permit Revised 2010