HomeMy WebLinkAboutBuilding Permit #609-13 - 287 CHICKERING ROAD 3/20/2012TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit N0: 0 1 - l 3 Date Received
Date Issued: -d 0 - ) ;—
IMPORTANT: Applicant must complete all items on this page
LOCATION' C r
Print
PROPERTY OWNER S- tT e,.� (�_ i t. r -SS i. X A-
Print 100 Year Old Structure yes
MAP NO: PARCEL:VrZONING DISTRICT: Historic District yesno'
Machine Shop Village ves
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
Pone family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑ Septic ❑ Well
❑ Floodplain ❑ Wetlands
❑ Watershed District
❑ Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
k
Identification Please Type or Print Clearly)
OWNER: Name: �a�Tr� c,c� i Yk- Phone:
Address:
CONTRACTOR Name: _ A, - vR- y t r' S Phone:
Address: Lc-c.�
Supervisor's Construction License: Exp. Date: 12, Z o
Home Improvement License: n Exp. Date: / )c7 1 7 p
ARCHITECT/ENGINEER Phone:
It
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: $ 5A90 FEE: $ (9 b
Check No.: l Receipt No.:�—
NOTE: Persons contracting with unregistered contractors do not have access to the ggu�aranty fun
Signature of Agent/Ovvner ~� Signature of contractor
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan 0 Stamped Plans ❑
Location C 4,
No.
CheckWk4i--3
26212
Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Frame Permit Fee'
Foundation Permit Fee
Other Permit Fee $
TOTAL $-
Building Inspector
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
COMMENTS
HEALTH
COMMENTS
DATE REJECTED DATE APPROVED
❑ ❑
Reviewed on Signature
Reviewed on • Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decisiom Comm
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Towp_ Engineer: Signature:
Located 384 Os ood Street
FIRE-DEPARTMEN Temp Dumpster on site yes no
Located at •124 IVleir�6St�eet - : >- __, ?o -!s y' : `c , , ,� �' _ - ...,.:.:.''� �� ">, `
Fire Department signatureld4Me tt `rte
CONINIENTS''- w= :,, t�, ;: _ .. ;:::, iw!r.-���_,..
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.$10041000 fine
NOTES and DATA — For department use
El Notified for pickup - Date
i
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
❑ 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
❑ 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 appy 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.Building Permit Revised 2012
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