HomeMy WebLinkAboutBuilding Permit #286 - 400 OSGOOD STREET 10/11/2006 TOWN OF NORTH ANDOVER
NORTH
APPLICATION FOR PLAN EXAMINATION 0f tt"o -
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Permit NO: Date Received
Date Issued SsgeHus�`��y
IMPORTANT: Applicant must complete all items on this page
LOCATION O S 0 %0 J '
Print
PROPERTY OWNER D S ce lz�o cA S-"- - �^
Print
MAP NO.: PARCEL: ZONING DISTRICT:
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non-Residential
E. New Building ❑ One family
71 Addition ❑ Two or more family ❑ Industrial
alteration No. of units:
Repair, replacement ❑ Assessory Bldg 8 Commercial
Demolition
C Moving(relocation) ❑ Other ❑ Others:
C Foundation only
DESCRIPTION OF WORK TO BE PREFORMED,
C• Identification Please Type or Print Clearly)
OWNER: Name: t P,N t�t �. Phone: '? $—�Q3�5�7
Address: vvPr-
CONTRACTOR Name: Phone:
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT%ENGINEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIM ED COST BASED ON$125.00 PER S.F.
Total Project Cost :$ .19(0 a FEE:$ o --0
Check No.:ewe'" Receipt No.: lL'
Paee lof4
TYPE OF SEWERAGE DISPOSAL i
wmmn
SiPools El
Tanning/Massage/Body Art ❑ g
Public Sewer L
Well
Tobacco Sales ❑ Food Packaging/Sales ❑
❑
❑ Permanent Dumpster on Site ElPrivate(septic tank,etc. Electric Meter location to
project
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Ow er Gam^ Signature of contractor
Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans El
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF-U FORM
DATE REJECTED DATE APPROVED
PLANNING& DEVELOPMENT ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
CONSERVATION ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH ❑ ❑
COMMENTS
FIRE DEPARTMENT - Temp Dumpster on site yes no
Fire Department signature/date
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water& Sewer connection/Sitynature& Date Driveway Permit
Building Setback (ft.)
Front Yard Side Yard Rear Yard
Re uired Provided Re uired Provides Required Provided
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
NOTES and DATA—(For department use)
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Page 3 44
Doc:INSPECTIONAL SERVICES DEPARTMENT WORM05
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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
o Copy of Contract
❑ Floor Plan Or Proposed Interior Work
Addition Or Decks
❑ Building Permit Application
❑ Surveyed Plot Plan
❑ Workers Comp Affidavit
o 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)
New Construction (Single and Two Family)
❑ Building Permit Application
o Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
a Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Copy of Contract
❑ Mass check Energy Compliance Report
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 DEPARTNIENTMFORN105
Page 4 44
Location 'oo � .-a,� --,e-�
No. - U Date
I
�oRTM TOWN OF NORTH ANDOVER,
F R
a
Certificate of Occupancy $
••o'E<� Building/Frame Permit Fee $
AC MUS
Foundation Permit Fee $
' Other Permit Fee $
TOTAL $ •
Check #
19679
Building Inspe2o`r