HomeMy WebLinkAboutBuilding Permit #799-16 - 20 GREAT LAKE LANE 1/11/2016NORTIi
BUILDING PERMIT oF�t�eo -6'�ti
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION *
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Permit No#: Jb Date Received Tela °°Rwreo "` ty�
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
[(One family
❑ Addition'
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
'❑ Other
❑Septic ❑Well
, 11 Floodplain ❑Wetlands
❑ Watershed District
XWater/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
5,F R s-t"el76 FI
Identification - Please Type or Print Clearly
OWNER: Name: i kZ LLC Phone:y-
Address: 4 9%, k qmp- ,. Lj-i +2 201,
Contractor
Address:_q A'4r-14 9*m4 StA 2161 r .1 ��ja rj1j4Y
Supervisor's -Construction License: ,5" Exp_
Home Improvement Licenser Exp.
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: $ j oo . c.)zp
Check No.: 153 Receipt No.: 0
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Sianature of Aaent/Owner 'i /Signature of contractor
Location �alllr-
No.
�/ Date !
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $7Z�'
Other Permit Fee $
TOTAL $ "'
Check #� '
n �•} Building Inspector
Plans Submitted N Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer
Tanning/Massage%Sody 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
PLANNING & DEVELOPMENT Reviewed On
Signature_
COMMENTS_'tjii�(Iy
ritoh 1 d w N&) Tro L 1 to
CONSERVATION
COMMENTS ?!, _Q lv7l10 DEPM-1627 _
HEALTH Reviewed on /, /f .
COMMENTS
Zoning Board' of Appeals: Variance, Petition No: u Zoning Decision/receipt submitted yes
Planning Board Decision: _Tzct�-b I ill*l4 Comments
c
l oft"servation 'Decision:_DeP 2kZ-16Z--7- Commend;
Water & Sewer Connection/s
DPW Town Engineer: Si
tlKt D;EPARTME111T' - Temp Qurnpster
Located at 124 Main Street
F.i.re Depa_r-tment signature/date
COMMENTS
Osgood Street
Dimension
Number of Stories: 2 Total square feet of floor area, based on Exterior dimensions..3ZOZ Sc -
Total land area, sq. ft.:19,PS : -f
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)
FuONDA-DAow,
❑ Notified for pickup Call Email
Date Time Contact Name
Doe.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
❑ 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/Cross Section/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
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
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
Doe: Building Permit Revised 2014
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