HomeMy WebLinkAboutBuilding Permit #641-13 - 2005 SALEM STREET 4/3/2013BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: -0" Date Received �q pOR^TED 2-1
SSACHL
TYPE OF IMP
eNew Building
❑ Addition
❑ Alteration
MENT PROPOSED USE
Residential
XOne family
❑ Repair, replacement
❑ Demolition ,
OWNER: Name:
❑ Two or more family
No. of units:
❑ Assessory Bldg _
❑ Other
Non- Residential
❑ Industrial
Q Commercial
❑ Others:
DESCRIPTION OF WORK TO BE PREFORMED:
iit otf
Please Type or Print Clearly)
E L-rzNy�
ne: 6'97. 94x'q
ARCHITECT/ENGINEER /9r2T Rose(&Q- Phone: (03 41 2. 4`04
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $10005 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
/0"'
Total Project Cost: $ /0 FEE: $
Check No.: 0 y Receipt No.:
NOTE: Persons contracting wit qy hregistered contractors do not have access to th5gw0ranty fund
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑
Tanning/1VIassage/Body Art ❑
Seng 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 AP PR VED
PLANNING & DEVELOPMENT ❑ �/ 3
COMMENTS �� �F''� �6G� j/� C �li1c�l11G�f7S 51�� 1 ec�l
DATE REJECTED DATE APPROVED
CONSERVATION ❑ —4
COMMENTS r — q
DATE REJECTED DATE APPROVED
HEALTH ❑ 0
COMMENT `
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
c Planning Board Decision:
Comments
Conservation Decision: Comme
Water & Sewer Connection/ si nature Date q 1 Za Driveway Permit i
Located at 384 Osgood Street v
Dimension
Number of Stories: 6� Total square feet of floor area, based on Exterior dimensions.23;?<
Total land area, sq. ft.: d- ( 61 ( � \
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
Nu i is ana UA 1 A — (vor department use
❑ Notified for pickup - Date
Doc.Building Permit Revised 2007
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/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
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
Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2007
00
Location -,
No. /// / ?,
Check # /�
26248
X
Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee
TOTAL $
Building Inspector
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Massachusetts - Department of Public SafetN
Board of Building Re(.),Ulations and Standards
Construction Supervisor License
License: CS 103765
Restricted to: 00
GEORGE HASELTINE
32R OLD POINT RD
NEVVBURY, MA 01951
Expiration: 1 1 129/201 3
Tr#: 103765
Commissioner