HomeMy WebLinkAboutBuilding Permit #854-13 - 201 CARLTON LANE 6/6/2013TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: ^ 1 Date Received
Date Issued:id
' l
IMPORTANT: Applicant must complete all items on this page
LOCATI
PROPERTY
Print ll 100 Year Old Structure yes
MAP NO: N!D77 PARCEL: 0 ZONING DISTRICT: Historic District yes
Machine Shop Villaqe yes
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
One family
❑ Addition
Two or more family
❑ Industrial
Iteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
�Setic ❑ Well
El Floodplain 11 Wetlands
El Watershed District
a Sewer
DESCRIPTION OF WORrAO BE PERFOR
Identification Please Type or Print Clearly)
OWNER: Name: '����.'� �, Phone: S' 60 -1
Address: 2.�k l.�r•��4,�+-�
CONTRACTOR Name: Phone: 0
Address: C V S �
Supervisor's Construction License: 05-16RO Exp. Date: 6U -c. 13
Home Improvement License: k 0 t $ "1�1 Exp. Date: SA Z 5�
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: $ 2\; OSO FEE: $ 2S�
Check No.: I (--�72 Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have acce s to the guarantyfund,
Signature of r2 Signature of contractor
Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans
Locationo;�)�� ��� =.,.
No. Date
CheckJj7-)7j2--2---
26492
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee $-'
TOTAL $
i�
Building Inspector
Plans Submitted ❑ Plans Waive 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
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENT
CONSERVATION
COMMENTS
HEALTH
COMMENTS
Reviewed on Signature
Reviewed on Siqnature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
WE
Conservation Decision: Com
Water & Sewer Connection/Signature & Date Driveway Permit
DPW 'lbw; Engineer: Signature:
Located 3M gS,g2pU Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 MainStreet
Fire Department signature/date
COMMENTS
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Dieter 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.$10041000 fine
NOTES and DATA — (For department use
® Notified for pickup - Date
Doc.Building Permit Revised 2010
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: Doc.Building Permit Revised 2012