HomeMy WebLinkAboutBuilding Permit #723-14 - 79 GRAY STREET 4/16/2014i
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: (4 M—.
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OWNER: Name:
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ARCHITECT/ENGINEER Phone:
Address: Reg. No
FEE SCHEDULE.- BULD/NG PERMIT. $12,00 PER $9000.00 OF THE TOTAL EST/MATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ `1 ;� QQ .1)FEE: $ �j
Check No.: -4 Receipt No.:
NOTE: Perso conk cta g ith unregistered contractors do not have access to the Guaranty fA o
Location 7� j r
No. s- f Date q11( /
Check
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $�U
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ ;
Building Inspector
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_
CONSERVATION Reviewed on Signature
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HEALTH
COMMENTS
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
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Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
uocateo ;3t$4 usg000 Street
Dimension
Number of Stories:
Total land area, sq. ft.:
Total square feet of floor area, based on Exterior dimensions.
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
NU I t5 and UA I A — (For
❑ Notified for pickup - Date
Doc.Building Permit Revised 2010
nt use
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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
o Workers Comp Affidavit
o Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o Copy of Contract
❑ Floor Plan Or Proposed Interior Work
o Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or..Decks
o Building Permit Application
o Certified Surveyed Plot Plan
o Workers Comp Affidavit
o Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o IVI
"ass 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)
o Building Permit Application
o Certified Proposed Plot Plan
o Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Copy of Contract
o 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 Red stry of Deeds. One copy and proof of recording
must be submitted with the building application
Doc: Building Permit Revised 2008