HomeMy WebLinkAboutBuilding Permit #Exception - 72 Elm Street 8/18/2016BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#: Date Received
Date Issued: v
I M P0 R TANT: Applicant must complete all items on this page
'7 -k
LOCATION r,2 71
Print,
PROPERTY OWNER 4-i
Print 100 Ye4 Structure
MAP PARCEL: ZONING DISTRICT: Historic District
Machine Shop Village
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TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
0 New Building
El One family
11 Addition
[I Two or more family
0 Industrial
D Alteration
No. of units:
[I Commercial
11 Repair, replacement
[I Assessory Bldg
11 Others:
11 Demolition
[I Other
11 septic 11 Well
El rloodplain D Wetla ds
n
0 Watershed-'DiStriGt
[I Water/8ewer
DESCRIPTION OF WORK TO BE PERFORMED:
Identification - Please Type or Print Clearly
OWNER: Name:
Addrp-,-,-
Contractor Name: Phone:
Email:
Address:
Pho
Supervisor's Construction License: Exp. Date:
Home Improvement License:
ARCH ITECT/ENGI NEER
. Date:
Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASED ON $125.00 PER S.F.
" 0
Total Project Cost: $ S�,4- TEE: $
Check No.: / 9 6!�4 ReceiptNo.:
NOTE: Persons contracting with unregistered contractors do not have access to the �uarantyfund
Location 7P , E /, - 5hJ -
No.
Check#
3C746
Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee
TOTAL
Building Inspector
Plans Submitted Plans Waived Certified Plot Plan D Stamped Plans El
TYPE OF SEWERAGE DISPOSAL
Located M4 US900CI 6treet
TMEWTj;.',j11 IDD 6 �6hts'
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Public Sewer El
Tanning/Massage/Body Art El
Swimming Pools
well 0
Tobacco Sales El
Food Packaging/Sales El
Private (septic tank etc. 1:1
Permanent Dumpster on Site El
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
/ANNING & DEVELOPMENT Reviewed On Signature—
P L)
COMMENTS %YCO.4i
ONSERVATION Reviewed on Signature
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Comments
Conservation Decision: Comments
Water & Sewer Connectionisignature & Date DrivewaV Permit
DPW Town Engineer: Signature:
Located M4 US900CI 6treet
TMEWTj;.',j11 IDD 6 �6hts'
.,F,,l R3 RA mmW
No -2,4,,1MainjStre'et-',',* r
I Td t &d I j
n
4t
-,ire q
ITS
C@M.MLN 4
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
MGL Chapter 166 Section 21A —F and G min.$100-$l 000 fine
NU I Lb ana DA I A — wor ciepartment use
Ll Notified for pickup Call Email
Date Time.
Doe.Building Permit Revised 2014
Contact Nam
IM
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
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
4 Building Permit Application
4 Certified Surveyed Plot Plan
4 Workers Comp Affidavit
Photo Copy of H.I.C. And C.S.L. Licenses
Copy Of Contract
Floor/Cross Section/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
10TE: 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
2012 IECC Energy code
Engineering Affidavits for Engineered products
10TE: 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
Doe: Building Permit Revised 2014
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