HomeMy WebLinkAboutBuilding Permit #524-13 - 222 MARBLEHEAD STREET 1/22/2012TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued: 1A
IMPORTANT: Applicant must complete all items on this page
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!PROPER#TtY'®V1INE
-- Print . Y 100jY�ear�®Id Strructur Yes n < +
WA NO3, PARCEL �Z®NING 0fjT T°a '� Historl District _ yew n_
_ �`p h`llarh`Ina��hrnn'�\�Lilla[i � vest n0� ''
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ 9ne family
Addition
VTwo or more family
❑ Industrial
❑ Alteration
No. of units: 4
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
fi®Septicl ®T1NeIC_F
ool dp al m� Di1Net�Wa
e hed District
�iWater/Sewers
DESCRIPTION OF WORK TO Ut NtKruKIVItU:
.� Identification Please Type or Print Clearly)
OWNER: Name: /< 'i a >^;z+- Phone:
Address
C®N,TRACTO,R'Nam�e� _-
S
. b oZfi Ex Dates �. ' I6
Sup�enrtisor's�Constrtuctio,�n�License
°Inmoti�'rrmnrnCicman� � IranCP RM, D.ate� _
ARCHITECT/ENGINEER U 2 o"Phone: 77? 30c
Address: ! PA 011'-fReg. No.
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ �/®�y0C-) FEE: $
Check No.: g 2 Receipt No.: 2 �;Aq .
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
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"SI nature ofd ent/Owr"rer; �6up��_ofFcontractorr 1
Plans Submitted ❑ Pla s Wa-ived -e Certified Plot Plan ❑ Stamped Plans ❑
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
VOTE: 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
40TE: 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 submAted with the building application
Doc: Doc.Building permit Revised 2012
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans
TYPE OF SEWERAGE DISPOSALL
Public Sewer Q
Tanning/MassageBody 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 ?-a 3 Si nature V
COMMENTS J\j lh t_j Q_ o, Ab 1,� �v� O o ( °
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
W
DPW Town Engineer:
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
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® Notified for pickup - Date
Doc.Building Permit Revised 2010
Location 4 a 2 2 •2 f/r/j�f fifes! } I
No. S•2L/!j Date �2
Check # �-2
26103
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $L/�
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
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Enter construction cost for fee cal -
North Andover Fee Cakulation
Construction Cost
40,000.00
m
$ -
$
480.00
Plumbing Fee
$
60.00
Gas Fee 100 comm.
$
100.00
Electrical Fee
$
60.00
Total fees collected
$
700.00
222-224 Marblehead Street
524-13 on 1/22/2013
Expansion, add laundry room,
add master bath, enlarge master bedroom
Enter construction cost for fee cal -
North Andover Fee Cakulation
Construction Cost
40, 0'0'0.00
m
$ -
$
480.00
Plumbing Fee
$
60.00
Gas Fee 100 comm.
$
100.00
Electrical Fee
$
60.00
Total fees collected
$
700.00
222-224 Marblehead Street
524-13 on 1/22/2013
Add first floor laundry room,
add master bath, and enlarge master bedroom
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