HomeMy WebLinkAboutBuilding Permit #779 - 38 BRIGHTWOOD AVENUE 6/30/2008f
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: 7 Date Received �
Date Issued: 6 IfOld .11,
�6*`
6 OL
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I IMPORTANT: Applicant must complete all items on this pate I
MAP NO:: & _ PARCEL: ZONING DISTRICT: Historic District yesAn
ate 1 aG ,q - D �y� <owd-) Machine Shop Village yes
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
Cbne family
Addition
Two or more family
Industrial
Alteration
No. of units:
Commercial
Repair eplacemen
Assessory Bldg 141J,4
Others:
emolition
Other
Well
WerlSew
Floodplain Wetlands
Watershed District
er
I-
DESCRIPTION OF WORK TO BE PREFORMED:
Please Type or Print Clearly)
OWNER: Nam
Address:
CONTRACTOR Name:z
Address: tel' 571-
97e
S? 37
P
Supervisor's Construction License: r"fZd' Exp. Date:i,`z,�c
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER �%� Phone: _
Address: //I//// Reg. No.
FEE SCHEDULE: BULDING PERMIT: $12A0 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ 43, ADD, 00 FEE: $
Check No.: _/ %- Receipt No.: v
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Location c� U ' " {L� ,�i l� Y --,z-
No.
-,?No. 77 OF Date
NORTH TOWN OF NORTH ANDOVER
D
Certificate of Occupancy $
sCMUS Building/Frame Permit Fee $�
Foundation Permit Fee $
Other Permit Fee $ r
o*>
TOTAL $ /�
Check #
2 /,' Building Inspecto�
n
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
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
V CONSERVATION
COMMENTS
HEALTH
Reviewed on
Reviewed on L, 2,
COMMENTS5�417
� maw-
��
Zoning Board of Appeals: Variance, Petition No:
Planning Board Decision: Comments
Zoning Decision/receipt submitted yes
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 3134 Us ood Street
FIRE DEPARTMENT Temp Dumpster on site yes no—
Located
o Located at 124 Main Street
Fire Department 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)
❑ Notified for pickup - Date
Doe.Building Permit Revised 2008
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
Li 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 appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submitted with the building application
Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2008
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Construction Supervisor License
License: CS 65128
ri a `^11 /2010 Tr# 20928
SHAWN R DUFR�SNZ ` t //.Y
85 GOODALE ST��\'�
HAVERHILL, MA 01$flt Commissioner