HomeMy WebLinkAboutBuilding Permit #Exception - 42 JAY ROAD 5/1/2018 BUILDING PERMIT o�No RT 6 Atipa
TOWN OF NORTH ANDOVER F`. , - p
APPLICATION FOR PLAN EXAMINATION
Permit NO:
Date Received 4911-111,40
ACHUS
Date Issued:
IMPORTANT:Applicant must complete all items on this page
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ONINGD.ISTRICT,. _ 'FlstoncDistnct. _Yes_. in x
Machine Shops-Villag a yes b
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New BuildingOne farm
Addition Two or more family Industrial
AIra io No. of units: Commercial
Repair, replacement Assessory Bldg Others:
Demolition Other
Septic; Well :Floodplain Wetlands V1/atershedsDistrict 4
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
..74 5 1 �V
Identification Please Type or Print Clearly) �
OWNER: Name: v^tiL, M11-" WPhofie• 9 Z7- -SD`s"
Address: 412- - �a oy.�r
'CQNTRAjOR' Name: !' C��br -etA Ph'one.. 'D. - x79
Address
'Supervisors Construction License, _ _� T ~_ ExP. Date
Home,lmprovement License; _ PA ___. Exp: Date;
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
I
Total Project Cost: $ 2, 6—00 - FEE:
Check No.:
Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
An ent/Owner Signafur'e:of contractor. ,-
i
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
Li 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:Building Permit Revised 2008
CanSubmitte 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
I
5 a sep i nk,etc. Permanent Dumpster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATEREJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
V
CONSERVATION Reviewed on Signature
COMMENTS
.`
HEALTH Reviewed on Signature
COMMENTS
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 Town Engineer: Signature:
Located_ 384 Osgood Street
FIRE DEPARTMENT TemptDumpsterfon`site :yes no _
111ocatedat'1.24.Mam
Faire Departmenfsignature/date
`MMMENTS>
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 min.$100-$1000 fine
NOTES and DATA— For department use
❑ Notified for pickup Date
Doc.Building Permit Revised 2010
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OFFICIAL, INSPECTION FORM[
NOT FOR VO1J71°dTA.RY ASSESSMENTS
SUBSURF.A.CE SJC',VV.AGE DISP08AI.. SYSTEM,INSPECTION FORNI
PART C
SYSTEM INFORMATION (cozztz,aued)
Fropert,Address: �42 JAY Road
_North Andover
Cawner. Singh -
Date Of inspection:_S/IJ/2063w
5KETC-11 OF SEWAGE]USPOSA 1,
Provide.a sketch of the sewage disposal Systeryl iti.rlvding•ties to at least fwo iacn7»anent refereoc:e latldrnarks or
benchmgrks.Locate all wells within 100 feet.locate whote public water supply enters the building-
House 'Water;Metter
A Garage
A to Tank=23'Y:S➢:y:.
iia v)D-Bore=36'6"-
'13 to Tauk 15�1:617
B to D•-B.f)x=26�
Driveway
Tank
62
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6 0 T~IXF S7?X 'T AVRTH A MM? MA 7M. (508) 975-7117
AfQf4T6U6Qfir �N B KALPANA GYdADEED REF. 9167/252
4DCA Mtt 42 .del Y Raw PLAN R07. 687
CITY. BTAM /VY.WrH ANDOVER AM N SCALE' 1• 50 '
a4 M Akar ? ist" _ R 9305183
LOT LOT 2
4000 S.F.
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$g
52 H BT�Y
$Q0.00
{.JA Y ROAD