HomeMy WebLinkAboutBuilding Permit #874-13 - 250 CLARK STREET 6/14/2013 TOWN OF NORTH ANDOVER
2APPLICATION FOR PLAN EXAMINATION
Permit N0: �7G1'/3 Date Received
Date Issued: &�Yho
IM ORTANT: Applicant must complete all items on this page
LOCATION - �►SM 64NrAel, S-\'
PROPERTY OWNER ) ELPrintwfl¢ r{�y�,"�'
Print 100 Year Old Structure yes no
MAP NO: PARCEL: 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: PCommercial
UkI air, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
o Water/Sewer '
DESCRIPTION OF WORK TO BE PERFORMED:
3?\^�.s
Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address:
CONTRACTOR Name:O�y�o �� csS�h ,Ccyvice=9�fone:� � � `'1 '�4 ly
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Address:A eet\w •. Ny t M MASS ORO & '
Supervisor's Construction License: CS Exp. Date: ,1 -VA r�t3
Home Improvement License: wfk1- Exp. Date: 11*1.114
ARCHITECT/ENGINEER V4 v-s�r�y �re�A -ems Phone: 11 -Ly
Add ress:L(I"? COv%Cyr� (Ay,-P- Cc>rr)br:cig Reg. No. _A00171,
FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ I , I'18. OD FEE:
Check No.: /`lob .5-? Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund
:Signature of Agentt%O/wner Signature of contractor
Plans Submitted LAY Plans Waived ❑ Certified Plot Plan ❑ Stam ed Plans
Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans El
TYPE.OF SEWERAGE DISPOSA
Public Sewer Tannin assa eBod Art ❑ .. Swimming Pools El� g Y
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
6
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
e
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
r
Planning Board Decision: Comments
i
Conservation Decision: Comments
Water & Sewer Connection/Signature& Date Driveway Permit
DPW Tower Engineer: Signature:
e
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Located 384 Osgood Street
FIRE DEPARTMEN't Temp Dumpster on site yes no
Located at 124 Main Street
Fire Departirner t signature/date S2
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
I
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A-F and G min.$10041000 fine
NOTES and DATA— (For department use
El Notified for pickup - Date
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Doc.Building Permit Revised 2010
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
wilding Permit Application
al"'Workers Comp Affidavit
�'hoto Copy Of H.I.C. And/Or C.S.L. Licenses
o Copy of Contract
a0000'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
o Building Permit Application
❑ Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
o Photo Copy. of H.I.C. And C.S.L. Licenses
o 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)
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
o Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
❑ 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;pted with the building application
Doc: Doc.Builjing permit Revised 2012