HomeMy WebLinkAboutBuilding Permit #468-14 - 36 Kingston Street 12/2/2013TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: M Date Received.
Date Issued,
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IMPORTANT: Applicant must complete all items on this page
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TYPE OF IMPROVEMENT
PROPOSED USE
Resjdential
Non- Residential
El New Buildingne
family
V,
D Addition
o or more family
El Industrial
Alteration
No. of units:
El Commercial
Repair, replacement
El Assessory Bldg
0 Others:
D Demolition
11 Other
AN. MR.roir 'V
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❑ W _66f,
DESCRIPTION OF WORK TO BE PERFORMED:
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entification Please Type or Print Clearly)
OWNER: Name: Kn
Phone: -7X
Address: 3b Ki
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ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE. BULDINGPERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ St 400.0 5 FEE: $A /.
Check No.: M-0- 'R 2 ( A 161-33323D — Receipt No.: 2-1
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
_Signature of A464/b M
tl' igna
t'ure of contractor
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
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Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑
Tanning/MassageBody 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
COMMEN
CONSERVATION
COMMENTS
HEALTH
x
COMMENTS
r
DATE REJECTED
■❑
DATE APPROVED
Reviewed onSignature
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes_
Planning Board Decision: Comments -
Conservation Decision: Comments
Water & Sewer ConneCtion/Signature & Date Driveway Permit
DPW Tow Engineer: Signature:
L
Located 384 Osgood Street
FIRE DEPARTMENT _ Temp Dumpster on site yes no
Located at -1N Wig"Street_
Fire Deparitmerit-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 LITERATURE:. Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA — For department use
B Notified for pickup - Date
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
DOTE: 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
VOTE: 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
dOTE: 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 appEal 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
Location
No. _ / Date 2 2
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #K2cA 1 LPLY�cl323
2 r/
✓ 14- 3 Building Inspector