HomeMy WebLinkAboutBuilding Permit #Exception - 14 Longwood Avenue 5/1/2018 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
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Permit NO: Date Received
Date Issued:
IMPORTANT:Applicant must complete all items on this page
L®CATIO.N�
PROPERTY ®.WNER
Pnnt 100�Year•Old Structu[e no. ,
IMAP NOc _►PARCEL;_ - ZQNINGdDI T4RIG a Histone;®istnct yes ono➢
MachlrietSfiop Village eyes nom
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 _
❑ Septic. 1Nell - .. Flootl'plamr 01Netlands r I•. Pi.VV tershed'Dlstrlctj -i
_ .
—s .
DESCRIPTION OF WORK TO BE PERFORMED:
Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address:
{CONTRAC 50R`IN_ame.�� _-a r- - -
Phone
Stapervlsors Construction`License
}
I Honie4mpro�ement`Lieense-�_
ARCHITECT/ENGINEER 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: $ FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of AgentiOwner" 3 SI nature of'.contra for '-
r�i I-1 Plnnc Wnhipri n f Prtified Plot Plan ❑ Stamped Plans ❑
Building Department
The fol;owing 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 cans 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.Building Permit Revised 2012
Plans Submitted-F] PlansWaived-11 Certified Plot Plan ❑ Stamped Plans ❑
-T
.. YPE_OF.SEWERAC�EDISP.OSAL - i
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.A_PPROVED
PLANNING & DEVELOPMENT" ❑ ❑
COMMENTS
-CONSERVATION Reviewed on Siqnature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
z
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 Toiv;s Engineer: Signature:
Located 384 Osgood Street
FIREDEPAWM:C-WTemp Dempster on site yes no
Located-at 124 Main Street
-Fire'Depar merit sigriatu'relelate
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 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
r
B Notified for pickup - Date
Doe.Building Permit Revised 2010
Location A/ f+ o 1,11-a irvIA �l�F
No. ? Date �O
o - TOWN OF NORTH ANDOVER
v
. - Certificate of Occupancy $ X60
Building/Frame Permit Fee
Foundation Permit Fee $
Other Permit Fee $
� r TOTAL $2 00
n
Check#
26977
`�I Building Inspector