HomeMy WebLinkAboutBuilding Permit #Exception - 42 ROYAL CREST DRIVE 5/16/2007BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Z
Date Issued:
of
IMPORTANT: Applicant must complete all items on this page
PROPOSED USE
LOCAT ON", X '6V C4 -J'
Non- Residential
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PROPE, 0 N
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OWNER: Name:
El Addition
11 Two or more family
11 Industrial
11 Alteration
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11 Commercial
11 Others:
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0 Assessory Bldg
STO RIC
TYPE OF IMPROVEME
PROPOSED USE
Residential
Non- Residential
New Building
0 One family
N Identi ti Please Type or Print Clearly)
OWNER: Name:
El Addition
11 Two or more family
11 Industrial
11 Alteration
No. of units:
11 Commercial
11 Others:
ARepair, replacement
0 Assessory Bldg
0 Demolition
ke Other
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Address: Reg. No.
FEE SCHEDULE. BULDING PERMIT. $12.60 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: 1,)06 FEE: $
f
Check No.: 1<Y-5'7 Receipt No.:
NOTE: Persons co(ntracting h un d contractors do not have access to the guarantyfund
Signature of A''
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OWNER: Name:
973
Phone: 6
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ddress: C Qtt-7 66(./ ��
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ONfkACTOR r
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ARCH ITECT/ENG I NEER L D,, Phone:
7 Z/ -
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Address: Reg. No.
FEE SCHEDULE. BULDING PERMIT. $12.60 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: 1,)06 FEE: $
f
Check No.: 1<Y-5'7 Receipt No.:
NOTE: Persons co(ntracting h un d contractors do not have access to the guarantyfund
Signature of A''
n ureo'coritfacto
gent) �'W- r:
Plans Submitted 11 Plans Waived 11 Certified Plot Plan El Stamped Plans El
TYPE OF SEWERAGE DISPOSAL
Public Sewer 1�
Tanning/Massage/Body Art E]
Swimming Pools
Well E
Tobacco Sales 0
Food Packaging/Sales 11
Private (septic tank, etc. El
Permanent Dumpster on Site El
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATEAPPROVED
PLANNING & DEVELOPMENT F] El
COMMENTS
CONSERVATION
COMMENTS (156-.
HEALTH
COMMENTS
71 --
PATE REJECTED DATEAPPROVED
-E]
DATE REJECTED DATEAPPROVED
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Water & Sewer Connection/si
Located at 384 Osg-oodittrecit
Comments
Comments
nri%10%A1n%1Pnrmif A//,'� T4—V
AIR p ips eron sit
P IJEP —`T'M''ENT - .,urn It e�les
4
L ated at 1 -�treel
i*Main��
31
'61 77
Fire Devairtinent signat6i date -A�A'
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 21 A —F and G min.$ 10041000 fine
NOTES and DATA — (For department use)
J Notified for pickup - Date
................. ..... .. .... ............................................................... ............................... ...... ........ .................. ........................ ................ ........................... - ............ ............. ............. ............. ..................... ................................. i
Doc.Building Pennit Revised 2007
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
• Copy of Contract
• Floor Plan Or Proposed Interior Work
Li 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
L3 Workers Comp Affidavit
Li Photo Copy of H.I.C. And C.S.L. Licenses
u Copy Of Contract
u Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
'Hydraulic Calculations (if Applicable) Wit.
Li Mass check Energy Compliance Report (If Applicable)
u 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
Lj Workers Comp Affidavit
u Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Li Copy of Contract
Li� Mass check Energy Compliance Report
:i Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
.e,
In ail cases iWdvariance 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 2.2007
Location
No. Date
,&O*Th TOWN OF NORTH ANDOVER
4,
Certificate of Occupancy $
Building/Frame Permit Fee $
Mus
Foundation Permit Fee - $
Other Permit Fee $
TOTAL
\�,- IC
Check #
2 0 2 6
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