HomeMy WebLinkAboutBuilding Permit #Exception - 50 MARTIN AVENUE 5/1/2018 G TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:
IMPORTANT:A licant must com Tete all items on this age
-LOCATION--L-i---
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OCATION �,
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PROPERTY OWNER �` �� �/l/1�1ooke ct�1%.(Unit#
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MAP NO: 0 PARCEL:_ZONING DISTRICT:Z`� Historic District yes no
`z (� C) Machine Shop Village yes no
t 100 year-old structure yes no
TYPE OF IMPROVEMENT PROPOSED USE
Resid ntial Non- Residential
ew Building P-6ne family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
► - �iFloodplam { Wetltd0 Wate
srshedpistriC`_t
D� Septic Well �~'` --..
DESCRIPTION 0 WORK.TO BE PERFORMED:
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(IdentiPicatiQn Pleas ,Type or Print Clearly)
OWNER: Name: Sc-e�� �-v\� S �� Phone:
Address:cCo;�k_ C-3-A O`er, EV14- o <''K
CONTRACTOR Name: �wcr Phone:
Address: --rr
Supervisor's Construction License: �° S Z Exp. Date: �i
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Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER J (7���-� �� t' Phone: ,
Address: < n -QLA D
f/ /Pl Reg. No.
FEE SCHEDULE.BULDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 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
Signature ofrAgerit/Ovuner .,,i . . .. . : Signature_ofFcortra"cto�A. :,` ,a` ` _ `� "�
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 productsament rior to issuance of Bldg Perm
NOTE: All dumpster permits require sign off from Fire Dep p
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
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NOTE.
All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permi
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 Affidav� it
❑ 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 .Pern
In all cases if a variance or special permit was required the Town clerks office must stamp the decision from the Board of Appeals
I p and roof of recording
that the appeal period is over. The applicant must then get this recorded at the Registryof Deeds. one coy p
must be submitted with the building application
Doc: Doc.Building Permit Revised 2008mi
Plans Submitted ❑ Plans Waived ❑
Certified Plot Plan ❑ Stamped Plans ❑
[Public
YPE OF SEWERAGE DISPTFTanniing/Massage/Body
Sewer ArtSwimming Pools ❑
ell cco 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 ❑ ❑
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 Town Engineer: Signature:
FIRE DEPARTMENT - Temp Dempster on site yes Located 384 Osgood Street
no
Located at 124 Main Street
Fire Department signature/date
COMMENTS
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Dimension
Number of Stories:____ Total square feet of floor area, based on Exterior dimensions.
Total land areas . ft.: '
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ELECTRICAL: Movement of Meter location, mast or service droprequires Electrical Inspector Yes No q approval of
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
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NOTES and DATA— For department use
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❑ Notified for pickup - Date
Doc:.Building Permit Revised 2011 June/mi