HomeMy WebLinkAboutBuilding Permit #703-14 - 1065 Osgood Street 4/11/2013TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: I Date Received
Date Issued:I i
IMPORTANT: Applicant must complete all items on this page
LOCATION _ 7 _,5
Print"
PROPERTY OWNER
V
/' Print 100 Year Old Structure yes 7no
MAP NO: � PARCEL` j1 ZONING DISTRICT: Historic District ye
Machine Shop Village ye
TYPE OF IMPROVEMENT.
PROPOSED USE
Residential
Non- Residential
ew Building
❑ One family
❑ Addition
0 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 PERFORMED:
Identification Please Type or Print Clearly)
OWNER: Name: Phone:
AArlracc•
CONTRACTOR Name: 6.t F Phone: 60 J�2 - 7
Address: 5 -f% 0b2
Supervisor's Construction License: CS - 05t-4 t, -c Exp. Date: - Z.3 - 2-/6—
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEE
Phone:
Address: Reg. No.
FEE SCHEDULE: BOLDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ FEE: $ �3U
Check No.: 151 Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
nature of Agent70wner Sidnature of contract_
Plans Submitted L Plans Waived ❑ Certified Plot Plan Elto ed Plans
Plans -Submitted
Plans -Waived ❑ _ : _Certified Plot Plan ❑ Stamped Plans ❑
:TN'- P SSEWERAGE.DiSPOSAL" :
-
Public Sewer ❑
Tanning/Massage/BodyArt ❑ .
Swimming Pools ❑
Well ❑
Tobacco Sales ❑
Food Packaging/Sales ❑
Private:(septic tank, etc._ ❑. -:._
Permanent Danpster on Site ❑
THE: FOLLOWING SECTIONS FOROFFICE 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 .
A'Planning Board Decision: Comm
Conservation Decision: :Commen
!Nater & Sewer Connection lSignature &Date Driveway Permit
DPW Tovv;! Engineer: Signature:
Located 384
FIRE DEPAR� M�`VT Temp Dumpsteron site yes no
Located at'124 Mair Street
-Fire Departure►it signatu"reldate
COMMENTS
Street
-Dimension
Number of Stories:
Total land area; sq. ft.:
Total square feet of floor area, based on Exterior dimensions.
ELECTRICAL: -Movement of Meter location, niast or service drop requires approval of
"Electrical Inspector Yes No
DANGERZ®NE LITERATURE:. Yes No
MGL-.Chapter-166.Section 21A.—..F and G min.$10041000:fine
NU 1 1=5 anti UAI A — (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.
Roofirg, Siding, Interior Rehabilitation Permits
o B,ailding Permit Application
o Workers Comp Affidavit
o Photo Copy Of H.I.C. And/Or C-S:L =Licenses
o Copy of Contract
o Floor Plan Or Proposed Interior Work
Li Engineering Affidavits for Engineered products
NOTE: All dumpster,permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
o Building Permit Application
o Certified Surveyed Plot Plan
Li Workers Comp Affidavit
o Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Mass check Energy Compliance Report (If Applicable)
o 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)
o Building Permit Application
o Certified Proposed Plot Plan
o Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
Li Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Copy of Contract
o Mass check Energy Compliance Report
o Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
In all case if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the apw-�al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be subm.tted with the building application
Doc: Doc.Building Permit Revised 2012
Location 1 b 1 I �(`y (e 0
No. d?J - (4 U Date ('
Check
TOWN OF NORTH ANDOVER
Certificate of Occupancy $ 6
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit FeeT�v,-PT(— $ "
TOTAL $
Building Inspector
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