HomeMy WebLinkAboutBuilding Permit #Exception - 1050 FOREST STREET 5/1/2018 (4) pORTH
BUILDING PERMIT °�tt��° 06 q�o
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION * ,�
Permit NO: Date Received 2 !d 74"°q,re°'�"'y(`�
�SSACHU`���
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION
Print
PROPERTY OWNER �ttj
Print
MAP 210 PARCEL: ZONING DISTRICT: Historic District yes 40
Machine Shop Village yes (
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
Septic Well Floodplain Wetlands Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
n
Identification Please Type or Print Clearly) _ O(o�
OWNER: Name: 4- �-Icl— c.1 T'� Phop)k —79( - !1-i
Address: �nS'� �rv��rsk S� . tJ , d a�,er• �uO -
ot��r- �Sr�-83d7
CONTRACTOR Name: 1y 190-611 f 10ec-h'a Phone: cel(
Address 1 o S'o i�rUa�At.s+ -► . J.� .,�r�ec�, ✓'`��rc . o g c+3
Supervisor's Construction License: 103 Exp. Date:
Home Improvement License: 119 2-o4 Exp. Date: 07 13- Zo It
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: $ � . 45 FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with un istere contractors do not have access to the guaranty fund
." -41
Signature of Agent/Owner-- - L_, Signature of contractor au"Q
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL o
Public Sewer Tanning/Massage/Body Art Sw' mg Poo
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 i
COMMENTS 7 / D! �o fly `7 z E--,' 7-b t�S
s
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 Main Street
Fire Department signature/date
COMMENTS
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
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 2010
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
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
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:Building Permit Revised 2008
N�5g•5g' E
N
i
N y \
4 \
\ N
\ N
Oy
\ O
cJ . \
I'S",vj ,,�/) a4 Fq�ZONE \
�l 2AL E X
cl AL AL
LOT 4 \
LOT 3 I 3.16 ACRES ,
2 STORY
N
WOOD FRAME
10 )g� IRO
I Qf PIN
VNF FOUND
IRON H D WE /
PIN
FOUND
` LEACHINGAl
FIELD
EPTIC a�
Q/r'F' \bse* N�o �A� TANK
ST +y. a9
'0-9-
w E
IRONPIN
N
(Pl1QVC N 80 93 80 FOUND IR
L01 5
BAR/qe� ��� W FOUND
S7REET s 81.00.47' W
67.31'
* LOT 4 LIES WITHIN A RESIDENCE 1 (R-1) ZONING DISTRICT
NOTE: PLOT PLAN
THE PROPERTY LINES SHOWN WERE TAKEN OF LOT 4
FROM A PLAN ENTITLED " PLAN OF LAND ► _�
LOCATED IN NO. ANDOVER, MA," DATE 8/31/94-- �" �+`� � s �� FOREST ST,
N.
ANDOVER
BY CHRISTIANSEN & SERGI, PL #12455 N.E.R.D. "905OWNED BY:
MARK & JEANNIE MCGONIAGLE
SURVEY BY:
SSELL J. BOUSOUET, P.L.S.
SCALE: 1"=80" DATE: 10/10/97