HomeMy WebLinkAboutBuilding Permit # 9/8/2016 BUILDING PERMIT o¢ �°Tk"
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
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i Date Received -Permit No#: r < �qS p *„it
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Date Issued:
I VIPQRT1 P:Applicant must completz all items on this pale _
LOCATION € li l 5
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PROPERTY OWNER °` -
Print
100 Year Structure yes = no
MAP i= PARCEL: ZONING DISTRICT: ¢ Historic District yens no
Machine Shop Village yes, —9p”
TYPE OF IMPROVEMENT !PROPOSED USE
i Residential Non-Residential I
New Building .1 One family
0 Addition C Two or more family Industrial
❑Alteration No.of units: D Commercial
0 Repair,replacement Assessory Bldg _ Others:
n Demolition ❑Other
rye tice] \ Floodpl ihr \ Wetlands\ tiWats shed Distr-c\
�,� DESCRIPTION OF WORK TO BE PERFORMED
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Identificafi Please Type or Print Clearly
OWNER: Name: _;= r yPhone: '
I-qlyrshykj
1 H12-85K62 is CIO
Address:
, _
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s
Contractor Namei, h cit Phone 6 610 G
Email r ' '
Address:
',.Supervisor's Construction License: _ Exp" Date:
Nome Improvement License: Exp. Date:
Wdd,
ITECTtENGINEER _ °� :���� � Phane:ssy Y Reg.No.
FEE SCHEDULE BUILDING PERMIT.,$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Tota[Pe oject Cast:$ _ FEE:$ '` '
7 t�
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guarantj faand
SigFt2ture c�f'r1nftOwner s Sign�tiire of CnnPractflr �
Town of0 � NORTyq Andover
No. 26
h ver, Mass, 1'�1'
..,
�..9 aPRR7EPwP"
S
U BOARD OF HEALTH
Food/Kitchen
PER
_ ... Septic System
O IL.
THIS CERTIFIES THAT:....... -CGW' SSG D BUILDING INSPECTOR
I.............................................................................................................
F p �� Foundation
has permission to erect..........................buildings on M...7�t'..
Rough
to be occupied as. � ....... .. .. ".. ..... .. ... .l.. I Chimney
provided that the person accepting th ." ermit,shal►in every respect conform to the terms of the application Final
on file in this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and
Construction of Buildings in the Town of North Andover, 11 PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES 16 MONTHS ELECTRICAL INSPECTOR
UNLESS CONST TIO T Rough
ter. Service
.. . .... �Q ��PECT
Final
BUIL R
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
Display in a Conspicuous Place on the Premises—Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
Dimension
Number of Stories: Total square feet of floor area,based on Exterior dimensions.
Total land area,sq.ft.:
ELECTRICAL:Movement of Motor 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-$1000 fine
NOTES and BATA— Eor department use)
3
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Q Notified for pickup Call Email
Date Time Contact Name
Doc.Building Permit Revised 2014
Plans Submitted❑ Plans Waived❑ Certified Plot Plan ❑ Stamped Plans❑
TYP$of s wr rz OE DrSPOSAL
Public Sewer
TanningflvlassagetBodyArt ❑ SwimuuugPoo]s ❑
well ❑ Tobacco Sales ❑
Food Pac caging/Sates ❑
Private(septic tank,etc. ❑ Pezmanent Dumps er ott Site ❑
I THE FOLLOWING SECTIONS FOR.OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF-U FORM
PLANNING a DEVELOPMENT Reviewed On I "; SignaturelJ
"COMMENTS Crit
1,
GbL
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: Coma ents
Water&Sewer Connection/Signature&DateQrivewav Permit
DPW Town Engineer:,Signature:
Loca#ed 384 Osgood Street
FIRE DEPARETsM€NT -Terrip Dumpster.on site, es
Located at 224 Main street e `
Fire Department signature/date �/ ,(p
COMMENTS
TEMPORARY
CERTIFICATE OF USE & OCCUPANCY
TOWN OF NORTH ANDOVER
Valid for 30 Days from September 12,2016
Building Permit Number 254-2017 on 9/8/2016 Date:September 12,2016
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 35 Flagship Drive
MAY BE OCCUPIED AS a tenant fit up—Cross Fit North Andover-IN
ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING
CODE AND SUCH OTHER REGULATIONS AS MAY APPLY.
Certificate Issued to: Leander Pease
35 Flagship Drive
North Andover,MA 01845
Building Inspector
Fee:$50.00
Receipt: '�oz�l
Check: 1 j
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Tke Caffmowivealth oft'Vltass-ehusetts
I)epartnneNt aflradustrialAccadents
1 CoRgress street,Suite 100
Boston,AIA 02114-2017
W F` rvwl��aassgouldiu
r y4 y�o3kers'Compeasation?nsurance riffdavit:$u lderslConfractorstEIectaeianslPI tbers.
'r0 BE Fff EII'S�ffff THE YXO1 Z`Tl'ivTGAU'nloRSry'
A 'cantTnfarmafion PleaseFrint Legibly
l\Tame(BvsiaesWojgaaeionffnaiv%aual):� S il n� t!ate= �_
Address: i tr:f Vw
Ci151atefip: `tx Phony#:
Arepou n employer?Cbeck:Iie appropriafe box; 'Type of'project(Tequfred):
l.ED]ZamaemployervY.h s empIoye„,(Sill andtorpart-.ine).' 'Z:Q Now MUSLIUCtIOR
Iemasole propzc-lazorpstnership sadhaveno employees workin$ in 8.xRamodeliig -
a.y pseity-j?io rror�ers'c°mn. smence mq-ed-1 9. ❑Deroolitlon
3Q Zem afiom°oFvnardoingatl work-Pelt JN.w.,k—'comn.iusrssncazageaze�]l
10[ Ruilding addition
4-[�Zam afiames w�.,erand—will.hehiriug cnninciomacoaduct an crorkan YF=OP`r13'-bill
ensmc r.'=all wataci°rs eithhave wain co pensauon-'�,surance orare sole 11,L Electrical repairs or additions
pmpsetnrs icifnnosaoloyaes.
12- Plumbing repairs or additions
5.❑ZssaeraelcJntach'ra—*�3Zhavel?i'edtl:a sub-can6acfrtslisfe3an lv=.aEc}dshoet, 13.(�'Root"iepairs'
These seb-cuntracfi*sn�`-Ye empl fees andfiavevrarke:s'camp.;nsu<amce?
_ 14.❑Other
o`.❑vre are acozporatien sadils o�ce ,have eser•isedthpu rgh¢of eemptioaperiUlGi.c. .,-.
152,§S(=),aedt�:�ialapo..e�p7ye�s.[ltavrorkars'comp.i*esm-•'.nce ragaira3.7
tazY applicanttca;--7,e^., eoox'lnnst zlsa'i'il outtfve seeaonbelowowingffie'nwarx�s'compe,sa�onnoLeyaaioaou
i Eomao,-rsrs ono�.a...f.bisfida tmdicvtfiryare doing all�o �d� 5im oatside con+'acfoxsmusf-srpomiianeIIi a:&dav g sag= •. .
Cani=actos ua!check-uv`uog�uscatlaefied a;i addin na!sh-tshowiugnamarLthasra-contraetars ands�tew .flier orno±;he*-'e e^utieafiave
empl Yew.Lxtfiesub-cas'C e6n;AeF;emnloyaes, eym,st nr¢videthea takers'camp.policy nvmbeT_' .
1 uin ars errip7oyer t1Y d isgi•ovidingwarTrers'camgensa�an itrsuranceJor rrzy er�zpZoyees.•BeZoP.�is'the poZi��a-ric�jab sz<'s
inf—abaatz - -
lamnance Company 37i1e;
Policy'-•or Self ins.ro. Exn ra on Date:
Job Site Address: CxtylStatelZ p:
Attach a copy as.thevaopkers'compensation policy declaration.page(shot ing the poNeynumber and expiration date).
Failure to secure covd:age as requizednnderCL¢.152,§25A is a eximina7.zdolatianpnnishable by azina up to$1,500.00
and/or one-year noprionmen�as v'e7l as civil penalties in the form of a STOP WORK ORDER and a zine of up to$254.40 a
da�v against the violator_[>copy of dais statement may be forwarded to the Office of;nvestigadons ofthe DLA,for insurance
coverage verification.
XdoherebycerdifUo&P' assan pet" -esajgetjza�yt1led; zeinfarmaz'i'an,providedc�bau is medea.;'ect.
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Date: tel
Sla atone: ,
Phonein
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01qiciaZ use only. .Do notvvri,`e zn this gree,to be carrzgleled by ei ar town official
City or Town: Perndt/Mceuse#
Issuing AurhoxtV(circle one):
1.Board oMealth 2.BnildingDeparb anent 3.CitylTot,m Clerk 4.Electrzcal lLspeetor S.Plumbinglnspector
S.Other
ContactPerson: Phone,'g•:
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