HomeMy WebLinkAboutBuilding Permit #Exception - 701 SALEM STREET 1/28/2010 f TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:
iLywORTANT:Applicant must complete all items o 's e
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MAP NO: P CEL: ZONING DISTRICT: to c District yes
a e Shop Village yes l./
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building II One family
[]Addition �2°'�^ N� ❑ wo or more family ❑ Industrial
[i Alteration
No. of units: Commercial
❑As sory Bldg ❑ Others:
I� ❑ Repair, replacement ement _
[i Demolition -1-❑ Other
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DESCRIPTI N OF WORK TO E E MOM
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OWNER: Nam
Address: �
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CONTRACTOR
Name: �
,� Phone: 7 1 c
Address:
Supervisor's Construction License:
Ex D e: L i5
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Home Improvement License:
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ARCHITECT/ENGINEER v� c Phone. a
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Address: O � � t-- + �r� � �� . Jul Reg. No.
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FEE SCHEDULE:BUILDING PERMI -$12-00 PER$I000.00l THE TOTAL ESTIMATED COST BASED O 25.00 PER S.F.
Total Project Ib®St: $ -7 4sU FEE: $
Check No.: L. Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
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Si`-iiature:of,:Agen ` __ _
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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
13 . 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 .
OTE: All dumpster permits require sign offrom Fire Department prior to issuance of Bldg Permit
all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Eoard of Appeals
i't the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
is be submitted with the building application
Doe: Doc-Building Permit Revised 2008mi
Plans Submitted� Plans Waived El Certified Plot Plan El Stamped Plans ElM,
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
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DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
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CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
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Planning Board Decision: Comments
Conservation Decision: Comments
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Wates'& Sewer Connection/Signature&Date Driveway Permit
I)PW TOW)a Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
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Dimension
Number of Stories: -Total square feet of floor area, based on Exterior dimensions.
Total land area, sq, t.:
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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 n
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NOTES and DATA— For department use
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® Notified for pickup - Date
Doc:.Building Permit Revised 2008
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