HomeMy WebLinkAboutBuilding Permit #636-11 - 222 MARBLEHEAD STREET 3/24/2011TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: -(0- f/ Date Received
Date Issued:
: Applicant must complete all items on this
Print
PROPERTY OWNER�.�
Print
MAP NO: / 0 ' 0PARCEL: q'� ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
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
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®�Floodplainl� q Wetland`s
¢';� Wat6R ed�District, lid= j
�xWater/Sewerw _.1lEk
DF,qCRIPTION
OF WORK TO BE PERFORMED:
OWNER: Name
Address:��
CONTRACTOR Name:
Address:
Please Tie or Print Clearly)
_LA J ,� Phone:q-f<.tf<q cS
Supervisor's Construction License: CS 6 9 2 `` z Exp. Date:
Home Improvement License:
Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No
FEE SCHEDULE. BULDING PERMIT: $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COSTBASED ON $925.00 PER S.F.
Total Project Cost: $--U �1-5- A
FEE: $ 0 2
Check No.: Receipt No.:_,,V A�
NOTE: Persons contracting wA unregistered contractors do not have access to the guaranty fund
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
DOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
ri all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
xat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
rust be submitted with the building application
Doc: Doc.Building Permit Revised 2008mi
Plans Submitted ❑ - Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑
Well ❑
Private (septic tank, etc. ❑
TanningWassage/Body Art ❑ Swimming Pools ❑
Tobacco Sales ❑ Food Packaging/Sales ❑
Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED
PLANNING & DEVELOPMENT ❑
COMMEN
CONSERVATION
COMMENTS
HEALTH
COMMENTS
DATE APPROVED
Reviewed on Siiqnature
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Comments
Y Conservation Decision: Comments
,-Water & Sewer Con neCtioWSianature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
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 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
Doc:.Building Permit Revised 2008
Location 22 Z 4 / X� -1"v
No. Date '74
TOWN OF NORTH ANDOVER
-4001A
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee
TOTAL
Check # a—ff-
239L8
X/
Building Inspector
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Ylassacbusctts - Dcp:u'trncnt of public S:rfctl
Board of Buildin!g Reg
ulations and Standards
Construction Supervisor License
License: CS 69242
Restricted to: 00
FRANK R STEWART
115 BLUERIDGE RD
N ANDOVER, MA 01845
Expiration: 5/13/2012
('nnunlsiuncr
�— Tr#: 26305