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Home My WebLink AboutBuilding Permit #884 - 5 KIERAN ROAD 6/18/2013' � NORTH q BUILDING PERMIT 3�' brbtD nb!ON�OL TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received °0 Top Date Issued: 1 1 3 CNUS .�, IMPORTANT:Applicant must complete all items on this page LOCATION IS 4Le 1,1 11 40 t A PROPERTY OWNER Print MAP NO: PARCEL: ZONING.DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition 0 Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial -iKRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic 0 Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer r = I,deenn�tification Please Type or Print Clearly) OWNER: Name: Phone: Address: e- 4AI A CONTRACTOR Name: r,_ Phone: lad 3--7 s- r_573 Address: JP gd�oi X cry- , ✓.osoy' /V d °v l 2 Supervisor's Construction License: Exp:::Date: J 3 r t Home Improvement License; Exp; Date: IS' ? `y ` �ju �cr - ? 13 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Co : $ 9�.S�6 . FEE: $ J� d Check No.: Receipt No.: ` NOTE: Persoret it nr_egistered c retractors do not have access to t ae gua anty fund i nature of Agent/Ow Signature of contractor TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION Print, PROPERTY OWNER - Print 100 Year Old Structure yes no MAP NO: PARCEL: ZONING°DISTRICT: Historic District yes no Machine. Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑.Floodplain, ❑Wetlands ❑ Watershed!District: 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: 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 guarantyfund Signature of Agent/Owner - Signature of contractor.. Plans Submitted ❑ _ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF.SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art Swimming Pools ❑ Well r ❑ Tobacco Sales ❑ f Food Packaging/Sales ❑ Private(septic tanl y etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS 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'Tol*c';a Engineer: Signature: Located 384 Osgood Street FIRE-DE�ARTME NT - Temp Dumpster on site yes no Located at 124 Main}Street Fire Qepartinerit signature/date r COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions_ Total land area, sq. ft.: ELECTRICAL: Movement of fleeter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A-F and G min.$10041000 fine NOTES and DATA— For department use El Notified for pickup - Date i Doc.Building Permit Revised 2010 Building Department Tine folowing is a list of the required forms to be filled out for the appropriate permit to be obtained. F;Zoofii-;g, Siding, Interior Rehabilitation Permits ❑ Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses a Copy of Contract ❑ Floor Plan Or Proposed Interior Work D Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses N o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) Li 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) o Building Permit Application o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract a Mass check Energy Compliance Report o 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 app,-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must bf- submated with the building application I Doc: Doc.Building Permit Revised 2012