HomeMy WebLinkAboutBuilding Permit #Exception - 366 FOREST STREET 5/14/2013Permit NO:
Date Issued:
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
IMPORTANT: Applicant must complete all items on this page
LOCATION
Print
PROPERTY OWNER
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
0 New Building
11 One family
11 Addition
11 Two or more family
El Industrial
El Alteration
No. of units:
El Commercial
El Repair, replacement
El Assessory Bldg
0 Others:
El Demolition
El Other
El Septic 0 Well
El Floodplain 11 Wetlands
El Watershed District -
El Water/Sewer
OWNER: Name:
Arirlrt--,-,-
DESCRIPTION OF WORK TO BE PERFORMED:
Identification Please Type or Print Clearly)
Phone:
CONTRACTOR Name: Phone:
Address:
I Supervisor's Construction License:
� Home Improvement License:
Exp. Date:
Date:
ARCH ITECT/ENG IN EER Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASED ON $125.00 PER S.F.
Total Project Cost: $ FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund
,�ignature of Agent/Owner Signature of contractor
Plans Submitted Plans Waived Certified Plot Plan El Stamped Plans El
Location 3W, :�;res-4 J+ t-7?
No. —1 15-1 - 1 -5 Date L
Check# 2>SZ-7-
26385
TOWN OF NORTH ANDOVER
Certificate of Occupancy $-
Building/Frame Permit Fee $ 3.1
Foundation Permit Fee
Other Permit Fee
TOTAL
'j5uilding Inspector
0
Plans Submitted 11 Plans Waived 11 Certified Plot Plan [I Stamped Plans 11
TYPE -OF SEWERAGE DISPOSAL
Public Sewer
Tanning/1\4assage/Body Art L1
Swimming Pools
Well
Tobacco Sales 11
Food Packaging/Sales El
Private (septic tank, etc.
Permanent Dumpster on Site El
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATEAPPROVED
PLANNING & DEVELOPMENT F1
COMMENTS
CONSERVATION
Reviewed on f�� ( I k'�� � 1-3 Sianature ,
COMMENTS ME> .,/) N\ (10-01
HEALTH Reviewed on 6, 10 �
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
S
DPW Towo Engineer: Signature:
FIRE DEPARTMENT - Ternp Dumpster on site yes.
Located at"124 MainStreet
Fire De0artinerit signatureldate
COfIJIMENTS
Located 384 Osgood Street
no
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 21 A —F and G rnin.$100-$1000 fine
NOTES and DATA — (For department use
w
U Notified for pickup - Date
Doc.Building Pennit Revised 2010
Building Department
The fol��Owing is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
u Building Permit Application
u Workers Comp Affidavit
u Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o Copy of Contract
u Floor Plan Or Proposed Interior Work
o 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
ci Workers Comp Affidavit
u Photo Copy of H.I.C. And C.S.L. Licenses
ii Copy Of Contract
Li Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Li 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)
u Building Permit Application
u Certified Proposed Plot Plan
o Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
u Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
u Copy of Contract
o Mass check Energy Compliance Report
u Engineering Affidavits for Engineered products
MOTE: 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 submAted with the building application
Doc: Doc.Builfflng Permit Revised 2012
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