HomeMy WebLinkAboutBuilding Permit #723-13 - 25 CLARENDON STREET 5/2/2013TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Z3� Date Received
Date Issued: S12-113
IMPORTANT: Annlicant must complete all items on this Daize
LOCATION 6 A cc na 0 A 5T
A A • i /A Print
PROPERTY OWNER l C'..
2,
MAP NO: PARCELO� )
Q Q C.
Print
ZONING DISTRICT:
100 Year Old Structure
Historic District
ye no.
es no
Residential
Non- Residential
Machine Shop Villaqe
es
no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ One family
❑ Addition
D Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
vf,epair, replacement
D Assessory Bldg
D Others:
❑ Demolition
D Other
❑ Septic D Well
❑ Floodplain ❑ Wetlands
❑ Watershed District
❑ Water/Sewer
D )kaLC'. 1 \G
N OF WqRK TO BE (K D0rJ/\EROcchD
Identificati n Please Type or Print Clearly)
OWNER: Name: � j r � hQ M `K)aC k
Address:
CONTRACTOR Name:
Address: eJ910� IT
5�
J I' W^ )SO
Supervisor's Construction License: 0 _Exp. Date: 2 -12 -it
Home Improvement License: H43 Exp. Date: 4 —2 8-15'
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: FEE: $
Check No.: g� S�l� Receipt No.:
NOTE: Persons contracting.,wit cnregister d actors do not have access to the guaranty fund
v �
;Signature,of Agent/Ownerature of contractor
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans 11
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
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed
DATE REJECTED DATE APPROVED
❑ ❑
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
t
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision:_ Com
Water & Sewer Connection/Signature &Date Driveway Permit
DPW T'owo Engineer: Signature:
Located :3R4 n.rnnnri Straat
FIRE DEPARTMENT - Temp Dumpster on site yes,
Located at 124 Main Street
Fire Departihent signature/date
OMMENTS x
Me
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 2010
Building Department
The folowing 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
o Workers Comp Affidavit
o Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o Copy of Contract
Li 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
o Building Permit Application
Li Certified Surveyed Plot Plan
o Workers Comp Affidavit
o Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Mass check Energy Compliance Report (If Applicable)
o 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
Li Certified Proposed Plot Plan
o Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Copy of Contract
o Mass check Energy Compliance Report
o 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 app, al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be subm;tted with the building application
Doc: Doc.Bui!ding Permit Revised 2012