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Home My WebLink About- Permits - 740 TURNPIKE STREET (7) pORTH Building Department BUILDING PERMIT af,, =o agHo TOWN OF NORTH ANDOVER ,°�r The following is a list of the required forms to be filled out for the appropriate permit to be obtained. APPLICATION FOR PLAN EXAMINATION x r Roofing,Siding, Interior Rehabilitation Permits Permit NO: 00 Date Received aqs �0� SacNusE Date Issued: -5 I ❑ Building Permit Application IMPORTANT:Applicant must coipplete all items on this page ❑ Workers Comp Affidavit , ❑ Photo Copy Of H.I.C.And/Or C.S.L. Licenses ,LOCATION � ❑ Copy of Contract PROPERTY--OWNoe ER ' '� at o Floor Plan Or Proposed Interior Work Print Rt ❑ Engineering Affidavits for Engineered products MAP NO PARCEL. ZONING DISTRICT: Histflric District yes no NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Machine Shop Village !yes no Addition Or Decks TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential New Building One family ❑ Building Permit Application Addition Two or more family Industrial ❑ 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 Septic : Well Floodplain Wetlands Watershed District ❑ Copy Of Contract WaterlSewer ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And DESCRIPTION OF WORK TO BE RREFogM§q Hydraulic Calculations(If Applicable) � �c tl V cZ1 o 9 4 l7 ca c v 1 liJ q AIi, ❑ 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 Iden ificnfio Please Type or Print Clearly) New Construction (Single and Two Family) OWNER: Name: t Phone: r 6 S M4 Address: o Building Permit Application Li Certified �� Certified Proposed Plot Plan CONTRACTOR Name: � \ Phone: o Photo of H.I.C.And C.S.L. Licenses ❑ Workers Comp Affidavit Adores: �l > vc�t��%�� o Two Sets of Building Plans(One To Be Returned)to Include Sprinkler Plan And Supervisor's Construction Licenser Exp. Dater Hydraulic Calculations(If Applicable) o Copy of Contract Home improvement License:. Exp. Date: ❑ 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 cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals FEE SCHEDULE:BULDIJG PERMIT:$12.00 PER$1000,00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording i must be submitted with the building application Total Project Cost:$ t-,L�o `- FEE:$ /� >c Dac:INSPECTIONAL SERVICES DEPARTMENT:DPPORM07 Check No.: i�C �i Receipt NO.: �21 f G NOTE: Persons coutractr w't f rnregistered contractors do Hot have access to the guaranty fund Revised 2.2008 Signature of Agent/Ownr� Sigaa�ture of contractor Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Dimension Public Sewer TanningllvlassageBody 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 21A—F and 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 Decisionlreceipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer Connection/Sianature&Date Driveway Permit ❑ Notified for pickup- Date DPW Town Engineer:Signature: E Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on sit y"s no Doc.Building Permit Revised 2008 Located at 124 Main Street Fire Department signature/date COMMENTS