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HomeMy WebLinkAboutApplication - 223 FOREST STREET 1/9/2009 BUILDING PERMIT of NORrH qti Building Department TOWN OF NORTH ANDOVER The following is a list of the required forms to be filled out for the appropriate permit to be obtained. APPLICATION FOR PLAN EXAMINATION Roofing, Siding, Interior Rehabilitation Permits Permit NO: Date Received �SSgCHuSE�4� Date Issued: ❑ Building Permit Application IMPORTANT:Applicant must complete all items on this page ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C.And/Or C.S.L. Licenses LcATIaN " ❑ Copy of Contract RPERryvuNE ��� ���"fit �� 1 � i � ❑ Floor Plan Or Proposed Interior Work �nnt a Engineering Affidavits for Engineered productspN PAR�EL�� ON1N01�fSTR1CTI�stoilcDlstnct yep Machine Sholi Ulllagt3 yes tee'..:: NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit TYPE OF IMPROVEMENT PROPOSED USE Addition Or Decks Residential Non-Residential New Building One family Li Building Permit Application Addition Two or more family Industrial Li Certified Surveyed Plot Plan Alteration No.of units: Commercial ❑ Workers Comp Affidavit Repair;'replacement Assessory Bldg Others: Demolition Other ❑ Photo Copy of H.I.C.And C.S.L. Licenses se --- Well p FJootlpJam Wetlands Watershed Dlstnpt a Copy Of Contract 3Na#erXSewer: ❑ FIOor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And __, DESCRIPTION OF WORK TO BE PREFORMED: Hydraulic Calculations(If Applicable) ❑ Mass check Energy Compliance Report(If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Identification Please Type or Print Clearly) New Construction (Single and Two Family) OWNER: Name: �, _ -.F Phone. '4 N11"I Address: ❑ Building Permit Application ❑ Certified Proposed Plot Plan CONTRACTOR Nome I t _ Phone �- ❑ Photo of H.I.C.And C.S.L. Licenses ❑ Workers Comp Affidavit A�1d�esst ' ❑ Two Sets of Building Plans(One To Be Returned)to Include Sprinkler Plan And Supersor ConsrhTo#lon License :: E [3ate. Hydraulic Calculations(If Applicable) _ ❑ Copy of Contract Homs Improvement License?. p.;0816:- y ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products ARCHITECT/ENGINEER Phone: NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Address: Reg.No. In all eases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.P. that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Total Project Cost:$ .` �,uC FEE:$ �d) 11 � Doc:Building Permit Application Check No.: '� Receipt NO.: f "'#[ NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Revised 2.2006 ..cto - Signature of Agent/Owner�d ;c.t �e,.- Signature.of contrar Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Dimension Public Sewer Tanning/Massage/Body Art Swimming Pools Number of Stories: Total square feet of floor area,based on Exterior dimensions. Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site Total land area,sq.ft.: THE FOLLOWING SECTIONS FOR OFFICE USE ONLY ELECTRICAL:Movement of Meter location,mast or service drop requires approval of INTERDEPARTMENTAL SIGN OFF-U FORM Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No DATE REJECTED DATE APPROVED MGL Chapter 166 Section 21A­Fand G min.$100-$1000 fine PLANNING&DEVELOPMENT NOTES and DATA—(For department use) COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance,Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer Connectionisianature&Date Driveway Permit ❑ Notified for pickup- Date DPW Town Engineer:Signature: Located 384 Osgood Street ----- — - -- —-------- n ps er ----mpster ota'site yes iso LQoated 2t (nL4 At�ilr!$treat Doc.Building Permit Revised 2008 Fire I�+�partmen"t stgnafureldate �.• � f � M � � 71 x 3 Cl2NMN1ENTS . "