HomeMy WebLinkAboutBuilding Permit #836-12 - 21 WEYLAND CIRCLE 5/1/2018 NORTH
BUILDING PERMIT
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TOWN OF NORTH ANDOVER o
APPLICATION FOR PLAN EXAMINATION
Permit NO: � Date Receivedq�gA7ED•PP��y
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Date Issued:
IMPORTANT: Applicant must complete all items on this page
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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
Floocplaim: Vl/etlands WatershedDistnct -
S tic Well
�: Water/Sewers r
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DESCRIPTION OF WORK TO BE PREFORMED:
dentificat'on Please Type or Print Clearly) //��
OWNER: Name: a4.� raj VSA i Phone! -)k-QO -b VQ .
Address:
-CON TRAaCTOR, :Name S Pi� _ ,- Phone -
Su a.rvisor'stCoristruction Lcense .Exp ,Date
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HomeImprovement�License t Expo'®ate '
ARCHITECT/ENGINEER Phone:; :
Address: Reg. No.
FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED CO S ON$125.00 PER S.F.
Total Project Cost: $_)aY� FEE: $
j Check No.: a Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
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Si nature�ofhA ent/Owner . � Si natiare�of!contractor�, , �� °> ��
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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
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THE FOLLOWING SECTIONS-FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM {
DATE REJECTED DATE PPROVED
PLANNING & DEVELOPMENT 7
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COMMENTS
CONSERVATION Reviewed on Signature
1
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
j Planning Board Decision: Comments
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Conservation Decision: Comments
Water & Sewer Connection/Signature &Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
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FIRE DEPART�MENT�f TempBumpster=:on�site,�yesm
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Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
I land area, . ft.:q
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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 2008
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Building Department �.
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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
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❑ 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
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Doc:INSPECTIONAL SERVICES D EPARTMENT:BPFORM07
Revised 2.2008
Location y
No. �..3� " �2 Date
e - TOWN OF NORTH ANDOVER
e= Certificate of Occupancy $
'�. Building/Frame Permit Fee $ �
Foundation Permit Fee $
Other Permit Fee $
t TOTAL $
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25326 Building Inspector
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ANODYI� ,yA1'.LIC,VVJ'e"TTS O/S/D
NORTH TONM of Andover ': .
�, o , lover, Mass.,
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COCHICHEWICK i
ADRATED
S BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT...... ...C�....:�....(i
................................................................................................................................. Foundation
has permission to erect...........:............................ buildings on . /.1�'�FrY/ , . ..��r`" F........................................ Rough
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tobe occupied as ......................................................................................................................................................
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION T Rough
Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Rough
Display in a Conspicuous Place on the Premises — Do, Not Remove Final
No Lathing or Dry Wall To Be Done FIRE.DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
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SEE REVERSE SIDE smoke Det.