HomeMy WebLinkAboutBuilding Permit #394-13 - 8 Royal Crest 11/13/2012 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issuedoe
: I �/
IMPORTANT:Applicant must complete all items on this page
LOCATION ' - . -
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PROPERTY OWNER
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Print 100 Year Old St[ucture z yes o0
MAP NO: PARCEL:_ZONING DISTRICT _ HistonceDistrict yes no-
IVlachne Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
11cDepair, replacement ❑Assessory Bldg ❑ Others:
` ❑ Demolition ❑ Other
❑ Septic ❑wlNell ❑ Floodplain; ❑Wetlands; ❑ Watersheistdct
❑Water/Sewer;
j DESCRIPTION OF WORK TO BE PERFORMED:
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Identification Please Type or Print Clearly)
OWNER: Name: 1 Phone:
Address: So \ C ec
CONTRACTOR Name Phone-..
Address: - � � - ► n= 2y(� f7v�`i�Z�'1
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Supervisgr's Construction License _ _ Exp. bate:
Home.Improyement License: Exp Date:
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ARCHITECT/ENGINEER n � ✓� `Gh�. Phone:
Address: Reg. No.
ti FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ � ��. o0 FEE: $(00 do
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Check No.: 1\ 2-� Receipt No.:
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NOTE: Persons contracts wit ' ter contractors do not have acce to ra ty and
,- Signature of Agent/Ovv r" Sgnafurexof contract a.
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Plans Submitted ❑ lans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
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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 FORINT
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
1
HEALTH Reviewed on Signature
COMMENTS
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
DPW Towa Engineer: Signature:
1
Located 384 Osgood Street
FIRE DEPARTMENT = Temp Dumpster on site yes no
Located at 124 Main Street:
Fire Departinent.signatu"re/date
COMMENTS
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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 lies No
DANGER ZONE LITERATURE: Yes filo
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
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NOTES and DATA— For department use
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® Notified foricku - Date
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Doc.Building Permit Revised 2010
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Building Department
The fohowing 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
a 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
❑ Certified Surveyed Plot_Plan
❑ 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 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)
L3 Building Permit Application
o Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And j
Hydraulic Calculations (If Applicable)
o Copy of Contract
Li Mass check Energy Compliance Report
o 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 was ors special permit required the Town Clerks office must stamp the decision from the Board of Appeals
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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: Doc.Building Permit Revised 2012
Location
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No. ! Date
'S
v
e JOWN,OF NORTH ANDOVER
Certificate of Occupancy $ r
44Z" Building/Frame Permit Fee
A> r Foundation Permit Fee $
Other Permit Fee $
TOTAL $
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Check# 112-1
25939 Building Inspector
NORTH
-Tiown of t _E : I, Andover
No.
�.K. h ver, Mass, �• 13• ��....
�,� COC NIC HIWI[H �Ot
A°RATED ►'f�,�'(y
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BOARD OF HEALTH
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PERM. T Food/Kitchen
Septic System
THIS CERTIFIES THAT ............. ....:......... .4�.. L...... . :#'�-...... BUILDING INSPECTOR
has permission to erect .......................... buildings on .. ..... '. ./:9' .....�'k�-�......... Foundation
_ ,
Rough
to be occupied as ....D7, , dA:.6n....K)a4',... .��. .. ...`.-�.... :..... �kB�L'............... Chimney
provided that the person accepting this permit shall in eve resp t conform to the terms of the application Final
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and
Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
Sq UNLESS CONSTRUCTRTS Rough
Service
.................. ........................................................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
SEE REVERSE SIDE