HomeMy WebLinkAboutBuilding Permit #69-15 - 64 BLUE RIDGE ROAD 7/22/2014TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: �� I Date Received
Date Issued:1 J
*1M"ORTANT: Applicant must complete all items on this page
LOCATION
PROPERTY OWNER
-� Print 100 Year Old Structure
MAP NO: 6 PARCEL: ZONING DISTRICT: Historic District
Machine Shop Villa
yes no
yes no
ves 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
D Floodplain ❑ Wetlands
❑ Watershed District
❑ Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
I NS4qlL A 16 x 19 S 4�O
OWNER: Name:
ArIrIrP¢¢-
CONTRACTOR &5-
Name:
Address: Ca
OIL(
LA, JF
Print Clearly)
_W7 J Sy0
Supervisor's Construction License: CS --03`? l 1J,3 Exp. Date:
Home Improvement License: 3 3/3 Exp. Date: -
ARCH ITECT/ENGI NEE
ate:
ARCHITECT/ENGINEE
Address:
Phone:
Reg. N
FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED CO B/4SF,D ON $125.00 PER S.F.
Total Project Cost: $�� FEE: $
Check No.: � l � � Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner _
Plans Submitted Fi Plans Waived ❑
_ Signature of contractor l
Certified Plot Plan ❑ Stamped Plans ❑
Location W (1vt'l— Ij
No. Date
Check # `5 13
— ! / 00,
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee
Foundation Permit Fee $—
Other Permit Fee $
TOTAL $
,9015 ding Inspector
Plans Submitted ❑ Plans -Waived"❑. '_Certified.Plot Plan ❑
Stamped Plans ❑
-T OOF- SEWERAGE DiS OSAL"
-
Public Sewer ❑
Tanning/Massage/Body Art ❑ ..
.Swimming Pools ❑
Well ❑
Tobacco Sales 0
Food Packaging/Sales ❑
Private -(septic tank, etc._ ❑ --..--
_".
-permanerit Dunpster on Site El
THE, FOLLOWING SECTIONS FOROFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
-CONSERVATION Reviewed on , Si nature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Commen
Conservation Decision: Comments
Water & Sewer ConnectiottlS_ignature &Date Driveway Permit
DPW Tovr;! Engineer: Signature:
Located 384 Osgood Street
FIRE DEP-Ak � NT Temp Dumpster on site yes.. no
Located -at 124.Mair; Street
--Fire Departme►it signature/daWe _
COMMENTS
_Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions._
_Total land area, sq. ft.:
ELECTRICAL: Movement of Meter,locatFon, rr'iast or service drop requires approval of
.Electrical Inspector Yes No
DANGER.Z®NE LITERATURE: -Yes No
MGL-.Chapter166.Section 21&._F and G min.$100-$1000.fine
NOTES and DATA — (For department use
auL
B Notified for pickup - Date
Doe.Building Permit Revised 2010
Building Department
The foKswing is'a-Iist of -the required:forms to be- filled out for. the appropriate. permit to: be obtained.
Roofing, Siding, Interior Rehabilitation Permits
- o 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)
o 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
o Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
o 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 cans if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the apn,�al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be subm.tted with the building application
Doc: Doc.Bui?ding permit Revised 2012
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