HomeMy WebLinkAboutBuilding Permit #267-16 - 478 WAVERLY ROAD 9/1/2015 TOWN OF NORTH ANDOVER
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APPLICATION FOR PLAN EXAMINATION ,,_�•° do
Permit NO. Date Received ' 4 •h`' "
�SSACNUSEt
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION liff
P nt
PROPERTY OWNER
Print
MAP NO.: PARCEL: ZONING DISTRICT:
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ !A
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non-Residential
New Building One family
,Addition Two or more family Industrial
/Addition
No. of units:
Repair,replacement Assessory Bldg Commercial
Demolition
Moving relocation Other Others:
Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
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O-WAVI rVoLge" r %rA jets I r�:J( 'n 5� l
Identification Please Type or Print Clearly) n
OWNER: Name: \�C A A(Nif\ ti b Phone: "t Z( - 3 to
Address: I 1 �,'(�' y► m , !
CONTRACTOR Name: �C,t i Phone•"L N 3 u g 3
Address: �) QyL
Supervisor's Construction License: 1���3Z- Exp. Date:
2
Home Improvement License: t® Exp. Date:
ARCHITECT/ENGINEER Name: Phone:
Address: Reg.No. ;
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost :$ :�)R�n tp j x12.00=FEE:$ •�B
Check No.: �1� Receipt No.:
Page 1 of 4
11
BUILDING PERMIT NO0 ,
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TOWN OF NORTH ANDOVER �2 .,
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APPLICATION FOR PLAN EXAMINATION 70
T y
Date Received
Permit No#: �gSSgcHus���y
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION
Print
PROPERTY OWNER
Print 100 Year Structure yes no
MAP PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no °
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building 0 One family
0 Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: 0 Commercial
❑ Repair, replacement 0 Assessory Bldg 0 Others:
_ ❑ Demolition ❑ Other
❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
r
Identification- Please Type or Print Clearly
OWNER: Name: Phone:
Address:
Contractor Name: Phone:
Email:
Address:
Supervisor's Construction License: Exp. Date:
li Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone: }
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans F1
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Taming/Massage/Body Art ❑ Swimming Pools ❑ i
Well ❑ Tobacco Sales ❑
Food Packaging/Sales ❑
Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑
i
M
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
s�PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
j
CONSERVATION Reviewed on Signature
COMMENTS
I 9
HEALTH Reviewed on Signature
COMMENTS
I
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
e Planning Board Decision: Comments
i
Conservation Decision: Comments
Wafter& Sewer Connection/Signature& Date Drivewav Permit
DPW Town Engineer .Signature:
REDEPARLocated 384 Osgood Street
IMENTemp�tDumpsterontsit
T e; ,yeses
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COMMEN�T�S; '!
1
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
it
ELECTRICAL: Movement of Meter location, avast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G rnin.$10o-$1000 fine
NOTES and DATA— (For department apse)
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® Notified for pickup Call Email
Date Time Contact Name
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Doc.Building Permit Revised 2014 T
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
i
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 osed I
nt
erior
Work
�.
Engineering Affidavits for Engineered products
IN OTE: 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/Cross Section/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
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
Building Permit Application
4- 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
2012 IECC Energy code
Engineering Affidavits for Engineered products
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit
In all cases if a variance orspecial 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 2014
GJ�v
Location
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No. Date /
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. - TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $J
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
�/ k
Check# 3
r Building Inspector