HomeMy WebLinkAboutBuilding Permit #546-2011 - 25 MAIN STREET 1/31/2011TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: _ .2011 Date Received
Date Issued:
nRTANT: Applicant must complete all items on this page
LOCATION 4,5 M
Print
PROPERTY OWNER n h n?a ri c, P,,
Print
ic District yes no
MAP NO: 6 ARCEL-(I� ZONING DISTRICT: M �e Shop Village yes no
TYPE OF IMPROVEMENT
❑ New Building
❑ Addition
[/Alteration
repair, replacement
❑ Demolition
4
PROPOSED USE
Residential
❑ One family
d'Two or more family
No. of units:
❑ Assessory Bldg _
❑ Other
Non- Residential
❑ Industrial
❑ Commercial
❑ Others:
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DESCRIPTION OF WORK TO BE PERFORMED:
Identification Please Tyl
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or Print CIearly)
y2 P- 6 k) 2 7,13
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Address: L'
CONTRACTOR Name: 6 � r n �, J'r t C '7 d ,'1 Phone:
Address: 9 / cye /'4- /Z Of yl
Supervisor's Construction License: % Z2-1??
Home Improvement License: /6 3 � Y ;z
Exp. Date: F12- yI/ 2 -
)Exp.
Exp. Date: ? d' Za
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT: $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F.
Total Project Cost: $ .-D D 0 , 2( a FEE: $ (oO ._
Check No.: / z Receipt No.: .2 6
NOTE: Persons contracting with unregistered contractors do not have access
Plans Submitted ❑ - Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
FWe]I
WERAGE DISPOSAL
❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑
❑ Tobacco Sales ❑ Food Packaging/Sales ❑c 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
COMMENTS
HEALTH
COMMENTS
Reviewed on Signature
Reviewed on Siqnature
Zoning Board of Appeals: Variance Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Comments
Conservation Decision: Comments
i-
Water & Sewer Connection/Siqnature &Date Driveway Permit
D -PW 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 LIi"ERATURE: Yes No,
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
Doc:.Building Permit Revised 2008
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
o Engineering Affidavits for Engineered products.
®TE: z ,All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
aII cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
it the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
[st be submitted with the building application
Doe: Doc.Building permit Revised 2008mi
Location
No. .yy./ -Z6 //
Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ G
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # �3�L
23E69
/Building Inspector
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