HomeMy WebLinkAboutBuilding Permit #488-13 - 381 STEVENS STREET 12/27/2012TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: X13Date Received
Date Issued:
IMPORTANT: Applicant must complete all items on this page
Print,,
PROPERTY/
1ritPROP'lEATY/ OWNER
Z,
MAP P--A,'R,C,,E1: ZONING DISTRICT.dHistone
Pant
10,0, Year Old stracture yes
is nct
yes
-Vill
MachineShop: age, yes, 19,:
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
Aew Building
V&e family
0 Addition
El Two or more family
0 Industrial
0 Alteration
No. of units:
El Commercial
0 Repair, replacement
El Assessory Bldg
0 Others:
0 Demolition
0 Other
0 S,eptiq,, EIW611'.
0 Floodplain 0 Wetlands
0 Wate rs.had i E)i strict,
9"'ater/Sowar
&>CIIA145?_� '( t
Identifi"
axon
OWNER: Name:
Address: X_,�
Please Type or Print
CONTRACTOR. Name: Phone:
Address:
Supervigo,
Ws_G"onstruction License: _C Exp: Date:
Home; Im-provetme,,nt,,Li!3-,Orrse.,..
Date:-
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASED ON $125.00 PERS.F.
Total Project Cost: $ FEE: $ /00
Check No.: Receipt No.: v26647
NOTE: Persons contractingunregistered contractors do not have access to he guaranty fun
SignatureM
9Y
—
rn
itfd 6'rifia-6-
09 C05
Plans Submitted El Plans Waived El Certified Plot Plan El Stamped Plans
A.
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans L
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 ❑ b7h--
COMMENTS
CONSERVATION Reviewed on :�Si nature '
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: CommeDts-
2,�2
Water & Sewer Connection/Si nature Driveway Permit
DPW Towp_ ]Engineer: Signature: _ fad A /�
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-$1000 fine
WITPQ nnrl r)ATA _ (scar dPnartrnen$ usel
® Notified for pickup - Date
Doe.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
o Building Permit Application
❑ Workers Comp Affidavit
o Photo'Copy Of H.I.C. And/Or C.S.L: Licenses -
❑ Copy of Contract
o 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
Li Building Permit Application
o Certified Surveyed Plot Plan
o Workers Comp Affidavit
o Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o 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
o Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
o 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
o 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 submtted with the building application
Doc: Doc.Buil,ding Permit Revised 2012
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