HomeMy WebLinkAboutBuilding Permit #Exception - 190 BERRY STREET 5/1/2018 L
BUILDING PERMIT NORTH
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TOWN OF NORTH ANDOVER o «-
APPLICATION FOR PLAN EXAMINATION
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Permit NO: Date Received �SSACHus��Ry
Date Issued:
IMPOgRTANT:Applicant must complete all items on this page
LOCATION I C
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PROPERTY.OWNER Ksf�1�S C7AY : 4eb (� —P1 sS
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MAP 210. PARCEL: ZONING DISTRICT:_ Histone Distrct ' . yes. no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
P�,New Building E�One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
d Septic . J�Well- ❑ Floodplain Ij Wetlands D 1Na.ersf_ed District.
Water/Sewer
DESCRIPTION OF WORK TO BE'PERFORMED:
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Identification Please Type or Print Clearly)
OWNER: Name: KzN6s oto PRoPtRrs[F s LLX� - TONY Phone:
Address: t'o 3ox i�� 1IAniPTo- P-4LG.s lv1-1 a38gY
CONTRACTOR Name: 610-'71'c1'sA Phone: 4nn3 5/1/_6a54 ,.
-Address:
Supervisor's Construction License: S �1 3 Ezp: Date;
Home.Improvement License:.. Exp. Date:.
ARCHITECT/ENGINEER Phone:
Address: 5 79 ,5� i(/d.Pr1fc-',6 gL v� S�/�sd�.�r l�� Reg. No.
FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON
$125.00 PER S.F. 7'152 sr- x lZS 3 Y$ o00
Total Project Cost: $ '000' FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors,do not have access to file guars ty fund
Signature of Agent/Owne Signature of contracto
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer Tanning/Massage/BodyArt ❑ Swimming Pools ❑
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Well:- ;/�( v' 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
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- 'CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Si natures
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COMMENTS
Zoning Board of Appeals: Variance Petition No: Zoning Decision/receipt submitted yes
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Planning Board Decision: Comments
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Conservation Decision: . Comments
Water & Sewer Connection/Signature& Dae � Driveway Permit
JDPW Town Engineer: Signature: W:-
Lgjaated
384 Osgood street
FIRE DEPARTMENT - Temp Durppster on yes no �
Located at 124 Main Street
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Fire Department signature/date OL
COMMENTS --=—=--
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of defer 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
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��� ® Notified for pickup - Date
Doc.Building Permit Revised 2010/October
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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 g, 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
nAffidavits for Engineered products
N OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
ci 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 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
roust be submitted with the building application
Doe:Building Permit Revised 2008