HomeMy WebLinkAboutBuilding Permit #968-15 - 184 CARLTON LANE 5/27/2015 (3)BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATI
Permit No#: Date Received
Date Issued:
ED
7,
I IMT'ORTANT: A-pDlicant must comDlete all items on this Daae I
LOCATION
PROPERTY OWNER �Azz-s-/ &A6gnd
I Print 100 Year Structure
MAP Iq PARCEL: ZONING DISTR'ICT: Historic District
Machine Shop Village
yes no
yes no
no
yes. D
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
0 New Building
0 One family
El Addition
El Two or more family
0 Industrial
0 Alteration
No. of units:
0 Commercial
0 Repair, replacement
El Assessory Bldg
0 Others:
D Demolition
El Other
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OWNER: Name:
Address:
Contractor Name:
Em'ail:
Address:
DESCRIPTION OF WORK TO BE PERFORMED:
Please Type or Print Clearly
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Phone: �f)da ,
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Supervisor's Construction License: Exp.- Date:
Home Improvement License: E -^P. Date:
ARCHITECTIENGI NEER Phone:
Address: Reg. No
FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASED ON $125.00 PER S.F.
Total Project Cost: $_Iqt 060 FEE:
Check No.: !3
.ko Receipt No.:
NOTE: Persons contracting with unregistefed contractors do not have access to the guarantyfun
LocationlAq i 4)?�
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2
Check #A36c>.
TOWN OF NORTHANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $Ak ^101
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
�—Building Inspector
Plans Submitted 0 Plans Waived 11 Certified Plot Plan [I Stamped Plans 11
TYPE OF SEWERAGE DISPOSAL
Public Sevver
Tanning/Massage/Body Art
Swimming Pools El
Well
Tobacco Sales El
Food Packaging/Sales
Private (septic tmk, etc.
Permanent Dumpster on Site El
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On Signature.
COMMEN-TS
CONSERVATION Reviewed on
COMMENTS
iHEALTH
Reviewed
I Signature
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Zoning Board of Appeals: Variance, Petition No: Zoning Decisionlreceipt submitted yes
PlaSning Board Decision: Comments
Co;servation Decision: Comments
Water & Sewer ConnectionlSignature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood 6treet
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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
MGL Chapter 166 Section 21A—F and G rnin.$100-$1000 fine
NOTES and DATA — (For department use)
M
AO
64
LJ Notified for pickup Call Email
Date Time Contact Name
Doc.Building Permit Revised 2014
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
46 Copy of Contract
Floor Plan Or Proposed Interior Work
Engineering Affidavits for Engineered products
E: 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
4L Copy Of Contract
.4. Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (if Applicable)
4. Mass check Energy Compliance Report (if Applicable)
,4. Engineering Affidavits for Engineered products
10TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
�6 Building Permit Application
4. Certified Proposed Plot Plan
Photo of H.I.C. And C.S.L. Licenses
Workers Comp Affidavit
rwo Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Copy of Contract
2012 IECC Energy code
Engineering Affidavits for Engineered products
IOTE: 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
Doe: Building Permit Revised 2014