HomeMy WebLinkAboutBuilding Permit - 101 PRESCOTT STREET 9/16/2015 T%ORT#1
BUILDING PERMIT 0.1 F.D
TOWN OF NORTH ANDOVER 0
APPLICATION FOR PLAN EXAMINATION
Permit No#: Date Received 41 TED
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION -lot Alog-4-6 Ar'ldollete, I
Print
PROPERTY OWNER d lr' MAdev 868-41ci-L
P�int 100 Year Structure no
MAP 2;L, PARCEL: ZONING DISTRICT: Historic District yes C.
pD
Machine Shop Village yes
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building x One family
KAddition ❑ Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
12
DESCRIPTION OF WORK TO BE PERFORMED:
A-pT>i-r;L),-J or-, A-T
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Vi a` C66 Ve -
Identification- Please Type or Print Clearly 7
Phone: 9 79-to 9,�-• 3A7
OWNER: Name: c6j &),qNc�j
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Address: 101 �°rr-e.scr)44- 6+-., &Jng-441
Contractor Name: Phone:
Email:
Address:
Supervisor's Construction License: Exp. Date:
Home improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ FEE:
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Snoaturii6f
Flans Submitted ❑ Flans 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 m U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
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 Connection/signature& Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE
DIE
PAI�pfMENT, Temp Du on,site yes
mpster
Located at 124 Mein
Fire Department signature/date
COMMENTS
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions. l
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 No
MGL Chapter 166 section 21A—F and G min.$1oo-$1000 fine
NOTES and DATA— (For department use)
Ll Notified for pickup Call Email
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
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
Engineering Affidavits for Engineered products
NOTE: 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)
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
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
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 or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
of Deeds. One co and roof of recording
e Registry g
applicant must then et this recorded at th R y PY P
that the appeal period is over. The appl g g
must be submitted with the building application
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Doe:Building Permit Revised 2014
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