HomeMy WebLinkAboutBuilding Permit #Exception - 425 Waverley Road 5/1/2018 f NORTN 1
Ot
9 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
SACMUSF
Permit NO: Date Received:
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATIONZ�
rint
PROPERTY OWNER �'�-� G ti J,�PP0
Print
MAP NO.: PARCEL: �10 ZONING DISTRICT:1—
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non-Residential
New Building ❑ One family
❑Addition R-wo or more family ❑Industrial
❑Alteration No. of units:
0 Repair, replacement ❑Assessory Bldg ❑Commercial
0 Demolition
❑Moving(relocation) ❑ Other 0 Others:
❑Foundation only
DESCRIPTION OF WORK TO BE P FORMED
Identification Please y e or Print Clearly)
a
OWNER: Name:--'` Phone:
Signature
Address: 7le f7— 14A�{
CONTRACTOR Name: SZV / 5—
�f Phone: 7 tla�a.�1
Address:
Supervisor's Construction License: / �,�j s /741 Ex p. Date: / — Q
Home Improvement License: Exp. Date: — LM
ARCHITECT/ENGINEER " Name: Phone: 77
Address://� GtSf/u'(!r'i��1 �0�'�,ecrJ�'I Reg.No. ^'] ']
FEE SCHEDULE:BULDING PERMIT:$10.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost :$ � U x10.00=FEE:$
100
1 .. i i d -L�---
Check No.: Receipt No.:
Page loi'4
r
TYPE OF SEWARGE DISPOSAL
Tanning/Massage/Body Art ❑ Swimming Pools ❑
Public_"Sewer
Well ❑ Tobacco Sales ❑ Food Packaging/Sales El
Private(septic tank,etc.
❑ Permanent Dumpster on Site ❑
NOTE: Persons contracting with unregistere4 contr ctors do not have access to the guars ty fund
Signature of Agent/Owner Signature of Contractor Z"&
Plans Submitted L'J Plans Waived ❑ Certified Plot Plan Stamped Plans
I
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF-U FORM
I
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT . q1 7&6
❑Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
COMMENTS
ATE REJECTED- - DATE AP,PRQNED
CONSERVATI Zce
COMMENTS V /C��c � �I � Q, C- Qq_l�lmV
DATE REJECTED DATE APPROVED
EALTH ❑ ❑
COM
MEN
Zoning Board of Appeals: Variance,Petition No:
Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water&Sewer connection signature&date
Temp Dumpster on site yes—no— Fire Department signature/date
Building Permit Approved and Issued by:
Page 2 of 4
Building Setback (ft.)
Front Yard Side Yard Rear Yard
Required Provided Required Provides Required Provided
DIMENSION
ca
Number of Stories: Total square feet of floor area,based on Exterior dimensions.
Total land areas .ft.: /0�/
NOTES and DATA—(For department use)
Page 3 of 4
Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05
Created JMC.Jan2006
Building Department
i
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
Addition Or Decks
❑ Building Permit Application
❑ 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
CalculationsI
( f Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
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
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
i
Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05
Page 4 of 4
INSTRUCTION54.
This form is used to verily that all necessary approvalslpoffnft tram
nts having jurisdiction have been obtained: This does not relieve
Boards a i cable or requirr�ments•
the applicant anddor landoiwner from ia� � i aPpl
APPLICANT FILLS OUT THIS SECT?
PHONE. G r 5 Y/W
APPLICANT
Map
NunDer
LOCATION•. �f Uzi
LOT(S) �"' 39
SUBDIVISION 43-7 '.
ST.NU R Q4! 443
STREET
OFFICIAL USE ONLY "
REC WAENDATIONS OF TOWN AGENTS:
CONSERVATION ApN11H�TRATOR DATE APPROVED
DATE REJECTED
COMMENTS
TOWN PLANNER DATE APPROVED
DATE
COMMENTS
FOOD INSPECTOR-HEALTN DATE APPROVED
DATE REJECTED
SEPTIC INSPECTOR-HEALTN DATE APPROVED
DATE REJECTED
COMMENTS
PUBLIC IC WORKS.gEWEROWATER CONNECTIONS
DRIVEWAY PERMrr
'-8-fl
FIRE DEPARTMENT,, � ....
.'ECEIVED BY BUILDING INSPECTOR DATE______
R*vWd 907 IM