HomeMy WebLinkAboutBuilding Permit #745-15 - 25 CLARENDON STREET 3/31/2015l G PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#:�,— Date Received
Date Issued: 17Z ti t (5 -
IMPORTANT: Applicant must complete all items ori this page
LOCATIO— a7 dcke-
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PROPERTY OWNER'+l.
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100Year:StructuMAP ZONING DISTRICT: Historic District
u Machine Shop Villa
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TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ One family
❑ Addition
ifwo or more family
❑ Industrial
❑ Alteration
No. of units: r"Lo®
❑ Commercial
epair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑ Septic ❑. Well
❑ Floodplain ❑ Wetlands
❑ Watershed District
El Water/Sewer
utSGRIPTION OF WORK TO BE PERFORMED:.
lue-U, T6� ± To,i I-ef" Rt 0 1 kt'juv ca k'vd-5 bad
Id ntificatii n - P ease Type or Print Clearly p _
OWNER: Name: Irl"I, j�C,(PTA h Phone: l l9 7 %6 t :5,
Address: 23
l , AyJove(L /SIA
Contractor Name-Mck 615*hone: CC�3 G / 1:&(0 0
Address:Ott�
Supervisor's Construction License: C 1,% Q, Exp. Date:
Home Improvement License: I H42
Exp. Date: 2" ��
ARCHITECT/ENGINEER41APhone:-
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: $ 37 53-4, ,7 FEE: $
G /
Check No.: IS.�49Receipt No.:
NOTE: Persons contracting w(th unregistered contractors do not have access to theguaranty.fund
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Plans Submitted ❑ Plans Waived ❑
f,
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Certified Plot Plan ❑ Stamped Plans ❑
FSEWERAGE DISPOSALblic
FypF
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
PLANNING & DEVELOPMENT
COMMENTS
Reviewed On
Signature_
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH
COMMENTS
Reviewed o
Sianature
mooning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
i`
Planning Board Decision:
NOTE: 'onservation Decision:
Comments
Comments
In all ca Ater & Sewer Connection/Signature & Date Driveway Permit
that PDPW Town Engineer: Signature:
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 Call Email
Date Time Contact Name
Doc.Building Permit Revised 2014
� i
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
o Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
a 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
o Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
a Floor/Cross Section/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)
o 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
u 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: Building Permit Revised 2014