HomeMy WebLinkAboutBuilding Permit #820 - 21 FULLER MEADOW ROAD 5/16/2012TOWN OF NORTH ANDOVER
T APPLICATION FOR PLAN EXAMINATION
Permit N0: - 0 ' Date Received
Date Issued: 5 - I,�..—
IMPORTANT: Applicant must complete all items on this page
LOCATION oC JC L- ��� �'I C�%�✓�%D I =� �JA
Print
MAP NO:I6 Vd PARCELPrint
;�� ZONING DISTRICT:
TYPE OF IMPROVEMENT
❑ New Building
❑ Addition
❑ Alteration
❑ Repair, replacement
❑ Demolition
❑'Septic, D, Well'
❑ Water/Sewer•
PROPOSED USE
Residential
ne family
❑ Two or more family
No. of units:
❑ Assessory Bldg
❑ Other
D Bloodplain; � Wetlandsr
T T",
Historic District yes n
Machine Shop Village yes no
100 year-old structure yes o
DESCRIPTION OF WORK TO BE PERFORMED:
t
OWNER: Name: (Identification Please Type or Print Clearly)
r
Address
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Non- Residential
❑ Industrial
❑ Commercial
❑ Others:
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CONTRACTOR Name: d ��v` 2�—� Phone:
Address: a T,-_,�PJ e__ �n
Supervisor's Construction License: Exp. Date:
Home Improvement License: kj�? d S ( Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No
3bot 3
FEE SCHEDULE: BULDING PERMIT. • $92.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ l�° FEE:
Check No.: 3ql-4— Receipt No.: ori 3 —
NOTE: Persons contracting wit un r istere contractors do not have access to the gu my fu d
Signatureaof�Agent/Owner Signature�ofrcoritractor;-�� - -- ,
Location IF ' I i�u *14w—w
No. aD Date w '
Check # 3 —1
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $''
Foundation Permit Fee $
Other Permit Fee $,
TOTAL $
25307 Building Inspector
N
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
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION Reviewed on Signature
• ►C•Z7�iliil►1•9
HEALSTH
COMMENTS
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:, Comme
Conservation Decision: Comments
y Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signatyre:
FIRE DEPARTMENT - Temp Dumpster on site
Located at 124 Main Street
Fire Department signature/date
COMMENTS
■
Located 384 Osgood Street
yes no
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:.Building Permit Revised 2011 June/mi
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
o Copy of Contract
❑ Floor Plan Or Proposed Interior Work
o 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 2008mi