HomeMy WebLinkAboutBuilding Permit #303-11 - 6 KATHLEEN DRIVE 10/14/2010 BUILDING PERMIT NI-eD
OFSSL �bORTII q+O
TOWN OF NORTH ANDOVER o
APPLICATION FOR PLAN EXAMINATION ~
T H
t n 4 eH
K 1:
Permit NO: Date Received
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION
Pr'nt
ROPERTYOWN ._ . . ,. . .
s
Y. . Prim ,A:•:s'.3.'.w . - w• 7 niY+ ti�+t Kn ,
PARCEL ZONING DISTRICT:,, Histone Distnct yeachine Shop Village ye
TYPE OF IMPROVEMENT PROPOSED USE
E
Residential Non- Residential
❑ New Building 9 One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
-repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
`Septic p Well p Floodplain ❑Wetlarids Watershed District.
VI%ater/Sevver.
DESCRIPTION OF WORK TO BE PERFORMED:
/ %'' «'' J
I
1 Identification Please Ty a or Print Clearly)
OWNER: Name: '471 la /,a_14 � �Jr"i/,L�c. Phone
Address:
7 70
CONTRACTORName:11
J���
Address.
Supervisor's_Construction License: .1 12 xp. Da1//
Home..lmprovement License:
1 Si�OZ- Exp. Date:` D v7lJ�� '
i
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
I
FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON
$925.00 PER S.F.
Total Project Cost: —FEE: $ O �
Check No.: �J ��1� � Receipt No.: -
NOTE: Persons contracting with unregistered contractors do not have access to the guar ty fund
fI %
contractor
Signature of Agent/Owner ignature of
i
i
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑
Well ❑ Tobacco Sales ❑ Packaging
/Sales 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:
t
Located 384 Os ood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no'
Located at 124 MainStreet
Fire Department signature/date
COMMENTS..
Dimension
Number of Stories:_Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Motor location, mast or service drop requires approval of
Electrical Inspector Yes No
DANCER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$10041000 fine
NOTES and DATA— For department use
i
® Notified for pickup - Date
I
Doc.Building Permit Revised 2010/October
iJ
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
❑ 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
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
f
❑ 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
OTE: 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
4hat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording i
Must be submitted with the building application �
I
Doc:Building Permit Revised 2008
LocationL 'off/�ItIf
No. Date
NORTo# TOWN OF NORTH ANDOVER
~ 9
Certificate of Occupancy $
J'uMUsE<�' Building/Frame Permit Fee $ G d
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # 6�--Yy
23550
Building Inspector