HomeMy WebLinkAboutBuilding Permit #786-14 - 28 WOOD AVENUE 5/5/2014TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
i
Date Issued:
L*dOR-TANT: Applicant must complete all items on this page
= LOCATION
m Pri
PROPERTY OWNER aV �G�
Print 1 OO Year Old Structure yes no
MAP NO: PARCELt1t1v ZONING DISTRICT: -Historic District y no
Machine Shop Village ye no
.TYPE OF IMPROVEMENT.
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ One family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Assessory Bldg
❑ Commercial
❑ Repair, replacement
❑ Others:
❑ Demolition
❑ Other
❑ Septic ❑ Well
❑ Floodplain. 10 Wetlands
❑ Watershed District
❑ Water/Sewer
DESCRIPTION OF WORK To bh PhKru
OWNER- Name: I` ►S Ifn yr
Address- a( Wood AVe NO rt
r"
Andovex VAA 01��5'
ARCHITECT/ENGINEER Phone:
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: $ FEE: $
Check No.: Receipt No.:26 7_
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
ei
- r _
Signature of A`geritlOwner Y Slg_pature of contractor
Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
C)
- Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans F1
TYPEDF-SEWERAGE.DISEOSAL '
Public Sewer ❑
Tanning/MassageBody Art ❑
Swimming Pools ❑
Well ❑_
.Tobacco.Sales ❑
Food Packaging/Sales ❑
-Private-(septic tank,etc__
11Permanent Dumpster onsite
THE -FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE:A_PPROVED
PLANNING & DEVELOPMENT ❑
COMMENTS
-CONSERVATION
COMMENTS (-
�
HEALTH
CONAMENTS.
Reviewed on b 1 t 11 �-I -
CL �0V-2
LN
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: IComm
Conservation Decision: Comments
Water & Sewer Connection lSignature & Da#e Driveway Permit
DPW Tmvv;, Engineer: Signature:
Wcaieo M4 USgood Street
FIRE-DEPARTi d `NT -`Temp Dumpster on site yes no
Located -at 124 Mair Street --
Fire'Departmeiitsignatiji"' date '
COMMENTS
Dimension
Number of Stories.- Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of. Mate r,location., mast -or service drop requires approval of
Electrical Inspector Yes No
DANGER.Z®NE LITERATURE: Yes No
MGL -.Chapter 166.Section 21A -F and G min.$100-$1000.:fine
Doc.Building Permit Revised 2010
Building Department
The fol Awing is a list of:the reOired.forms to be filled out for:the a ppropriate:permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
o` Building Permit Application
o 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
u 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
u 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
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
In all cas<s if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the apw'�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
Locatio� A—
No. — Date _ t�
Check #
�f X32
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee G
Foundation Permit Fee $
Other Permit Fee $_,
TOTAL , $
Building Inspector
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