HomeMy WebLinkAboutBuilding Permit #350-13 - 575 OSGOOD STREET 10/30/2012 TOWN OF NORTH ANDOVER
APPLICATION FORPLAN EXAMINATION
Permit NO: 3s:� 71-1 Date Received f
Date Issued: 0 —2A 2
IMPORTANT:Applicant must complete all items on this page
LOCATION` ��Q6L�wo�� r. cTi✓�-Y,��, / � Ty
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PROPERTY OWNER L'la
Print, 100 YearOld Structure y no
MAP'"'NOC PARCEL ZONING DISTRICT: Historic District ye no
' Machine Shop.Village yes no,.
TYPE OF IMPROVEMENT PROPOSED USE
Resid Jential
❑ New Building ❑ O ZIZt' �J
❑Addition ❑T �l ' ial
❑A ration No arcial
epair, replacement ❑A ,
❑ Demolition ❑ O
,❑;Septic. ❑Well- ❑ FI i hed:0istrictc
,a• ❑+Water/Sewer_
DESCRIPTIO
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Identification
OWNER: Name: EOG�tio� 11v1� �C. �2 9 760–
Address:
'CONTRACTOR Name: Phone:
Address. Y�' C—;) � /fi// .
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^Su:pervisor,s Construction License:.- 2 Exp 'Date: Slo 13
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fTMHome Improvement License:' Exp, Date:
ARCHITECT/ENGINEER Lccii, w7G .Dar��� ����� Phone: g78 �3-2 74s�S
Address: �-s .�IG�cv Reg. No.
FEE SCHEDULE:BOLDING PERMIT:$12A0 PER$1000.00 OF THE TOTAL ESTIMATED COST BAS D ON$125.00 PER S.F.
Total Project Cost: $____�
FEE: $
Check No.: Receipt,No.:�;L 5
NOTE: Persons contracting with unr er contractors do not have access to the and
Si nature of Agent/Owrie Signature,of contract
Plans Submitted 11 Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
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
(VOTE: 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/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
➢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 +
❑ 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
❑ Mass check Energy,Compliance Report
❑ Engineering Affidavits for Engineered products
MOTE: 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: Doc.Building Permit Revised 2012