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Home My WebLink AboutBuilding Permit #Exception - 20 BRIDGES LANE 8/13/2009 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: t IMPORTANT: Applicant must complete all items on this page tAt L_OCATIO' PROPI=RTY OWNER J� - - s " Print " MA;P NO 4 PARCEL ZONING;D1STRiCT _ " Historic District - es rjo r � y. 70achlne Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One famii Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacem Assessory Bldg Others: Demolition Other Sepfic` , Well 4 Floodplain, VVetlards Watershed District DESCRI TION O WORK TO E PERFORi> M- Id of cation Pled se'Type or Print Clearly) OWNER: Name: Phone:9 — Address: - CONTRCTOR' Narnet'� Phone -r - r ;� 4.. K4 Supervisor s Construction License l=xp Da#e .Horaie;lmprovement License._ /f1: - _- - _.Exp Date � �r�.� ^=a�� ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT-$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty.fund Si nature of Agent/ n��rf Signatui e of con ac 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 i DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature �,OMMENTS HEALTH Reviewed on 1 Si natur COMMENTS �, (� c� �1 1 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Sic nature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 OsgoodStreet 11RE tEPAE<NT F Temp rDum ` Aster on site Locatecat 124,MamfStreet Fire Departrnentsagnature/date -^ wK..i 3 , hCOM1VIENT.S" r ` _ 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 Doc:.Buildino,Permit Revised 2008 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 o Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products EMOTE: 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 '561(' �� . ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ mss check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products MOTE: 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 o 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) Li Copy of Contract u . Mass check Energy Compliance Report u 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: Doc.Building Permit Revised 2008 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION {continued) Property Address: �._ 13Qt Owner: R\� fl�t L..V �'. i Ov, e.L tt Date of Inspection: S (f c � 1`1y��7 SKETCH OF SEWAGE DISPOSAL SYSTEM:- include YSTEM:include ties to at (east two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) • i I I I I I I i uv�SC 1 n) kA.) 51 Z-•e �Y c�1� 3 '.Z .S�/GT lNut -C � 13` Q IST. tjox F: l i" i 1 (r.vi..d 04/)S/471 Y.p. 1 �r 10