HomeMy WebLinkAboutBuilding Permit #Exception - 180 BERRY STREET 5/1/2018 L
NORTH
BUILDING PERMIT 0� ��ED ,bgtio
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION _
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Date Received Q°RTEU rQ�4y
Permit NO: �SSgcHuS�R
Date Issued:
IMPORTANT:Applicant must complete all items on this page
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LOCATION i
Print
PROP V
ERTY OIlNER
Print
PARCEL: ZONING'DISTRICT: Historic District ' . yes. no
MAP 2.10`_ — Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
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[X New Building
pKOne family
❑Addition ❑Two or more family ❑ Industrial
El Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
[IDemolition ❑ Other
' Septic Well" ❑ Floodplain ❑Wetlands ❑ Watershed District:
Ij Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
C0/'15-TT2u0-T
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Identification Please Type or Print Clearly)
OWNER: Name: K� s N� oar .�i�PE 9Tr�S [eGc - Cert��,os� Phone:
Address: ��.� �3ox ic�� t!A rv� rr���so3�3yY
CONTRACTOR Name: Phone'-.-
(4
hone:
Address: �a Bo Y-
7
1 (� (4R�^^ P'ro i-r��c S hi- if
Ex Date:.
supervisor's Construction License: %�3 p
Home Improvement License: Exp. Date::
4-
ARCHITECT/ENGINEER Phone:
Address: 5^7% / �r/�.�lf �si .lnl� Reg. No.
FEE,SCHE®ULE: BULDING PERMIT:$12.00 PER
0 PER$1000-00 OF THE
S,F. Z T TA ESTIMATED COST BASED ON
Total Project Cost: $ 3�`l ` FEE: $ /
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner Signature of contractor
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Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
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 APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION Reviewed on
Signature
COMMENTS
HEALTH Reviewed on P Si nature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
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conservation Decision: " Comments
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Water& Sewer Connection/Si nature& Da Driveway Permit �pP'
DPW Town Engineer: Signature:
Located 384 Osgood Street
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FIRE DEPARTMENT - Temp Du pst
Located at 124 Main Street
Fire Department signature/date; l�
COMMENTS. :
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Dimension f
Totals care feet of floor area, based on Exterior dimensions.
Number of Stories:_.— q '
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.$1 oo-$1000 fine
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NOTES and DATA— For de artrrnent use
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® Notified for pickup- Date
Doc.Building Permit Revised 201010ctober
r'
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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
MOTE: 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
o
Flo or/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
Mew 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 r• Permit
p r permits require sign ou£= ifo�n Fire Department prior to issuance of Bldg P
Yn 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
Doe:Building Permit Revised 2008