HomeMy WebLinkAboutBuilding Permit #Exception - 67 CRICKET LANE 5/1/2018 l
BUILDING PERMIT i 0 "°DT" q�
TOWN OF NORTH ANDOVER �. cr 4`y?-
APPLICATION FOR PLAN EXAMINATION `'
Permit NO: LilalDate Received �
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Date Issued:
IMPORTANT Applicant must complete all items on this page
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N? URERT WISER ��t� I' x
TYPE OF IMPROVEMENT PROPOSED USE
Residential on- R 6siden ial /
New Building ne farm
A--d—d-i Two or more family 11nustrial
eration No. of units: mmerci I
Repair, replacement Assessory Bldg thers:
Demolition Other
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P FIoAplarn 1l�letlarads
4-
1,110 W
DESCRIPTION OF WORK TO BE PREFO�MED:
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/2'X 2 x IT yj�.A i-t c Q 6-F+ T4 A-�,
Identification Please Type or Print Clearly)
OWNER: Name:_c�A<(���J r�yii� r ((�x>.t . K�� Phone:
Address:
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Address"Wfx,
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�Iaer �sor' Const tuct�o�a'�.ce�s `
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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 Cost: $ 42,(�, �� FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unre istered contractors do not have access to the guar ty fu
5�gnature of A en#/0-a er r
9 . . _ �. Signature ofonhactor
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer Tanning/Massage/Body Art Swimming Pools
Well Tobacco 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
DATE REJECTED DATE APPROVED
CONSERVATION p �i310
COMMENTS_ 1.6,K 0(,'„ loo' 4 tyJL,,j Re��5Gu.rc_e_ );il viae. -0 k cA'+ o�
o-D C1ronr;r�i a. OX4�oh
DATE REJECTED,) DATE APPROVED
HEALTH f f. !
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COMMENTS rte ` .40;
f,
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
Located at 384 Osgood Street
777777777777777-
FARE3EP�ARTMENT Temp Durnpster on site fires no .
Located at 1'24�1am Stree�
iF�re DSpar trnent si nature c� r
9 I ate
ti_ t
COMI�IE`Nl"S
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter 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.$100-$1000 fine
NOTES and DATA— (For department use
❑ Notified for pickup - Date
Doc.Building Permit Revised 2007
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
o 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
❑ 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
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 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2007