HomeMy WebLinkAboutBuilding Permit #Exception - 0 Martin Ave Lot 36 10/11/2012 (2) BUILDING PERMIT "ORT"
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION10
IL
Permit N0: I p
Date Received l I Sys RwrEo
Date Issued: SgCHU
IMPORTANT:Applicant must complete all items on this page
LOCATIQ `
Print `
PROPERTY OWNER..: lr—
Pnnt
-MAP NO PARCEL: ZONING'DISTRICT ` –
. — 4Histonc'District yes . no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building One family
Addition Two or more family Industrial
Alteration No. of units: Commercial
Repair, replacement Assessory Bldg Others:
Demolition Other
Se tic Well Floodplain' Wetlands Watershed District
ater/Sewer
ASCRIPTION OF WORK TO BE PREF OR ED:
64 4
Identification Please Type or Print Clearly) ��L
OWNER: Name: ttn ��`� Lv�� T'It t' I 'hone: 97L, L -/ i)
Address �/ ��f�
CONTRACTOR Name:y�L_e- Phone-
Address:.
hone Address
Supervisor'sConstructiori,L�icense :: i Exp:` .Date
Home Improvement p ment License: Exp. Date:
ARCHITECT/ENGINEER Phone: 9��'�7a
Address..0,,,_,_z p Reg. No.
FEE"SCHEDULE:BULDING ERMIT:$12.0�PRV 1000.00 OF THE�,n,,,, ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ � � FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with icnregistered contractors do not have access to the guaranty fund
Signature of Agent/Own Signature of contractor
' 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 - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
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 DEPARTMENT -Temp Dumpster on site yes no
Located at 124 MainStreet
Fire Department signatureldate
COMMENTS
Dimension
Number of Stories:_Total square feet of floor area, based on Exterior dimensions.Z?'Z3
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.$100-$1000 fine
NOTES and DATA— (For department use)
❑ Notified for pickup - Date
Doc.Building Permit Revised 2008
"• 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/Crossection/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
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
N OTE: 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
Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2008