HomeMy WebLinkAboutBuilding Permit #Exception - 1782 SALEM STREET 4/13/2011 L
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO:
Date Received ,
4—
Date Issued:
IMPORTANT:Applicant must complete all items on this pLge
LOCATION Yr ��� z�
Print
PROPERTY OWNER
Print
MAP NO: 106P PARCEL: IY8 ZONING DISTRICT: Historic District yes no
Machine hop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE Non- Residential
Residential
❑ New Building ❑ One family
El Addition 11 Two or more family El Industrial
El Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
-
❑ 11 Other Demolition - � _ -
��. - -❑Flood'laiii 03W�t1anc1s3 [7}�.
WaershdlDisfrict�
p -
Septi.ca ❑'Well a _
®Water/Sewers.
DESCRIPTION OF WORK TO BE PERFORMED: 9�cac,�1
ar �� ori
6, P-C
(Identification lease Type or rint Clearly) n--
OWNER: Name: J
Phone: �£f - 3—,?r2f
Address: -2
CONTRACTOR Name: Phone:
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
'iY s�� FEE: $
Total Project Cost: $
Check No.: Receipt No.-
NOTE: have access to the uarano fund
NOTE: Persons contracting with unregiste d contractors do no g
Y
5i nature of A ent/Ovyn _:� - -
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/13ody 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
r PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION Reviewed on Si
i - 9nature
COMMENTS
FHEALTHReviewed on /` l� Si natureS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water& Sewer Connection 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
L
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
® Notified for pickup - Date
I
Doc:.Building Permit Revised 2008mi
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 Calculationslicable If Applicable)
pp )
❑ Mass check Energy Compliance Report (If Applicable)
❑ Engineering Affidavits for Engineered products
DOTE: 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
OTE: All dumpster permits require sign tiff from Fire Department prior to issuance of Bldg .Permit
all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
at the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
ust be submitted with the building application
Doc: Doc.Building Permit Revised 2008mi
PROPOSED INSIDE
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SERVICE POOL PROPOSED 18'X78'
COMPOSITE,/W000
DECK
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PROPOSED STAIRS
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GRADE
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/PROPOSED INSIDE ,
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ELECTRIC T4
SERVICE POOL j
PROPOSED 16'X16'
COMPOSITE/WOOD
DECK
PROPOSED STAIRS
DOWN TO E)GSTING
GRADE
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