HomeMy WebLinkAboutBuilding Permit #875-15 - 96 DALE STREET 5/4/2015tpl
l BUILDING PERMIT o4 NORTH q
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TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
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Permit No#: (� Date Received 'Zjq p�OAr.Ep CPQ t �5
Date Issued:
'IMPORTANT: Applicant must complete all items on this page
LOCATION
Print
PROPERTY OWNER G L 6 2—\ 4 L• C i-( dLl�'S
)))))),,...�..,,,,,,,,,,,����������-- Print 100 Year Structure yes no
MAP �3 PARCEL�� ZONING DISTRICT: Historic District yes no
TTTTT Machine Shop Village yes. o
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
PI\New Building
❑ One family
0 Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
0 Commercial
0 Repair, replacement
0 Assessory Bldg
0 Others:
❑ Demolition
0 Other
❑ Septic ❑ Well
❑ Floodplain ❑ Wetlands
❑ Watershed District
0 Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
Identification - Please Type or Print Clearly
OWNER: Name: G i� ��' �� G K ���5 Phone:ri
Address: L1 "a7�'tL s =�- �v. dt�✓r�ara�r< v-rw,7� o 1 �;4c
Contractor Name: S 449- D Phone: q" 5 2
Email: a-SArc- 6 y• -n
Address: 61-12,
Supervisor's Construction License:
Home Improvement License:
Exp. Date:
Date:
ARCHITECT/ENGINEER Phone:
Address:
Reg. No.
FEE SCHEDULE: BULDING PERMIT., $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F.
Total Project Cost: $ �,�(� b FEE: $ �f
Check No.:Receipt No.:
NOTE: Persons contracting; with un egister contractors do not have access to the guaranty fund
Locatio
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No. 41 :ZC——/ r— Date
Check # �55 �--
2
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 ❑ 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 e U FORM
PLANNING & DEVELOPMENT Reviewed On �'�' �{ Signature_A,4-
COMMENTS d IY �� > LoC.hiM Hr G1*_@,W P
CONSERVATION Reviewed on_`4
COMMENTS f\ -
HEALTH
COMMENTS
re ` I
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
t.
Planning Board Decision: Comments
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Conservation Decision: Comments
Water & Sewer Connection/Signature &Date Drivewav Permit
DPW Town Engineer: Signature:
ZFIRE)ERARNTMEN
drnp*Dumpsteron site'`syes cat
tLatecl at 124 MaintreeeCl 00X4
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Fire Depai tment signs eF,dat -,
,i f ''2 •'%' .' c fro t ,. Tr`.,�`�"W#`"'^:k-- �. COx"777
MMENTS`' .�
t
Street
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-$1000 fine
NOTES and DATA — (For department use
® Notified for pickup Call Emai
Date Time Contact Name
Doc.Building Permit Revised 2014
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
4 Building Permit Application
-- 4. 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
TOTE: 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
Copy Of Contract
Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
4 Mass check Energy Compliance Report (If Applicable)
Engineering Affidavits for Engineered products
IOTE: 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
4. Engineering Affidavits for Engineered products
TOTE: 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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