HomeMy WebLinkAboutBuilding Permit #632-12 - 5 KIERAN ROAD 3/5/2012Permit NO: s%Z
BUILDING -PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received2 ,29 iI.
NORTy�
O tTLlD �6 �tt--
r
* =—
OF WORK TO BE PREFORMED:
q'- w.v�D A-0&" A... t,�
Identification PIease Type or Print Clearly)
OWNER: Name:_ 1 �? �s��w Ph -one: ei,_Aa�'� 3 K "?
ARCHITECT/ENGINEER i� j Phone: ` -1 1;� 6%-S
Address:_ ',.c O i! Up.4,m.- Reg. No. I
FEE SCHEDULE. BULD/NG PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Tota[ Project Cost: $ rl �'� V FEE: $_ �' VV d)-?
Check No.: Receipt No.:��
NOTE: Persons contracting unro ered contractors do not have access to the guaranty fun��
Pians Submitted
Plans Waived Certified Plot Plan Stamped Plans
T E OF SEWERAGE DISPOSAL
Pub licSewe
Tanning/MassageBody 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
l
COMMENTS 41 �(�1�iYc(� 054qe-
CONSERVATION Reviewed on�o�� �� Signature
Cl)IV11V1ENTS NO
HEALTH
COMMENTS
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Com
Conservation Decision: Comments
�• Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
- .: .. I..rv. .: -.... .. '.' ._...: .1..,.-....s :.._ .-w .: �f� :",;,, .:1.. �'_� '",rr(::� •— i - `fi't, „s 't<:ss'^ ?1p-= ! — - _
�'�'�rR���iEjP�► �-NIEII�IT• � : �fer� s ;�D,ur�: sten � mit � ,� � 7fi.� , r s .:: _:. � . ��.
124W 1h,
�cr�e;., .::�:.:�1._ �,,:_ _ _ - _ -�.�.. - _.�=��` �•�_. _ _ ..,.�_.
:,.-.:..ter-•.. ......-s•.....:.-><.• •.-.:d:..,.,..,,.., ._ :;+.�- yrs -_ '-
4 '� + :'.°==it==y'•�
J� -
rr�',
- T'uAl.-
71
:
.n
...v
T
Dimension
a�
Number of Stories:Total square feet of floor area, based on Exterior dimensions. *L? -Li
Total land area, sq. ft.: `1-`7'3 t* -V#
ELECTRICAL: Movement of Meter location, mast or service drop re vires approval of
Electrical Inspector Yes No -
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
NOTES and DATA - (For department use)
❑ Notified for pickup - Date
Doc.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
❑ 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
❑ 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
o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ IVI
"ass 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
' R Plot
Ce...L:t: a
❑ Pd Proposed lot 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