HomeMy WebLinkAboutBuilding Permit #Exception - 857 CHESTNUT STREET 5/1/2018 i
TOWN OF NORTH ANDOVER
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APPLICATION FOR PLAN EXAMINATION OEst�•o <b;�tio
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Permit NO: Date Received
Date Issued: 1SS�cHusr`�
IMPORTANT:Applicant must complete all items on this page
LOCATION
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PROPERTY OWNER t2 ✓ CrCM-e e-
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MAP NO.: } L PARCEL: ZONING DISTRICT: - �-
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non-Residential
[!?New Building ❑One family
❑Addition ❑Two or more family ❑Industrial
❑Alteration No. of units:
❑Repair,replacement ❑ Assessory Bldg ❑Commercial
❑Demolition
❑Moving(relocation) ❑Other ❑ Others:
❑Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
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Identification Please Type or Print Clearly)
OWNER: Name: lsTQ ue e— Phone:
Address: 8 S :T C��S�-n✓�- S+
CONTRACTOR Name: (�r¢e k\o tr) YLS+f'yc4t dyt, (.,,LC.. Phone: 603-23/- DT i'-
Address: W x ?JT1Lq Yi BPac�, lU� 0.38;4/
Supervisor's Construction License: CS C731496, Exp. Date:
Home Improvement License: 2 Exp. Date: S/1 Z As
ARCHITECT/ENGINEER -S' % vac �-b54-,J Name: Phone:
Address: ,:, M".J 60le— Reg. No.
FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMAT COST_BASED ON$125.00 PER S.F.
Total Project Cost :$ 2.1 Dao FEE:$ li� F O�
Check No.: S Receipt No.:
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TYPE OF SEWERAGE DISPOSAL Swimming Pools 11❑ Tanning/Massage/Body Art E]Public Sewer
Tobacco Sales ❑ Food Packaging/Sales ❑
Well ❑
Permanent Dumpster on Site ❑
Private(septic tank,etc. Electric Meter location to
project
NOTE: Persons contracting witb unregistered contractors do not have access to the guarantyand
Signature of Agent/Owner / Signature of contractor
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Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF-U FORM
DATE REJECTED DATE APPROVED
PLANNING& DEVELOPMENT ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
CONSERVATION '❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH F1El
COMMENTS
FIRE DEPARTMENT -Temp Dumpster on site
Fire Department signature/date
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 Z"4.. Driveway Permit
Building Setback(ft.)
Front Yard Side Yard Rear Yard
Required Provided Require Provides Required Provided
Dimension Z/
Number of Stories: ' Total square feet of floor area,based on Exterior dimensions.
Total land area, sq. ft.: Jr / GO C1 . S' 5;5 • I% t .
NOTES and DATA—(For department use)
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Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05
Created JMC.Jan.2006
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
Addition Or Decks
❑ Building Permit Application
❑ 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)
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
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 DEPARTMENTMITORM05
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