HomeMy WebLinkAboutBuilding Permit #705 - 174 JOHNSON STREET 5/13/2010Permit NO: 0
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received 1; 05 % y
v �t�.cv 16* ryO\
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il
Date Issued: ��ACH
IMPORTANT: Applicant must complete all items on this pace
LOCATION
Print
PROPERTY OWNER Sw'C.kV,,J k
Print
MAP 210 PARCEL: ZONING DISTRICT: Historic District yes
Machine Shop Village yes
no
no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
it
Addition
Two or more family
Industrial
Alteration
No. of units:
Commercial
Others:
Repair, replacement
Assessory Bldg
Demolition
Other
Septic Well
Floodplain Wetlands
Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
Identification Please Type or Print Clearly) ;
OWNER: Name: Phone:
AdrirP-,c-
CONTRACTOR Name: *L J -
Address: ato Jk. -ts, 6 t"' 0
Supervisor's Construction License:
Home Improvement License;
Exp. Date:
. Date:
ARCHITECT/ENGINEER Phone:
Address:
Reg. No.
z3
FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ -2-0� hq-U FEE: $ 9YO
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have accesstot a my fund
Signature of Agent/Owner Signature of contractor
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer
Tanning/Ivlassage/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
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION
COMMENTS
A
HEALTH
11
COMMENTS
DATE REJECTED DATE APPROVED
Reviewed on Signature
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Os000d Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS
Dimension
Number of Stories
Total land area, sq. ft.:
Total square feet of floor area, based on Exterior dimensions.
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
No
NOTES and DATA — (For department use
❑ Notified for pickup - Date
........ _... __.......................................... _...................... __................................................... .... __.._._........... __................................................. _._....... _... _............................................................................... _....................................... ...... ... _.... _...._._.......................................................
..._...._..........................
Doc.Building Permit Revised 2010
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: Building Permit Revised 2008
Location'7(A n Jo, -7 xd
No. Date ' v
MaRT►, TOWN OF NORTH ANDOVER
Of t`•e ,•,yG
Certificate of Occupancy $
,SSACHUSEt Building/Frame Permit Fee $ l
Foundation Permit Fee $ �—
Other Permit Fee $
TOTAL $
Check # ` � H
9.
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Building Inspector
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