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Home My WebLink AboutBuilding Permit #622-12 - 111 PEMBROOK ROAD 2/28/2012 i TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: - --:7- JP /� IWORTANT:Applicant must complete all items on this page LOCATION i'_Qe4 . . Print L PROPERTY OWNER T LD L L,C Unit#_ _ Print MAP NO: PARCEL: 9 ZONING DISTRICT: Historic District yes Machinno e Shop Village yes 100 year-old structure yesCO TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential I, l New Building X One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration _ No. of units: ❑Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other klml ell Q, � �;�j 4 ®!Floodplain ' ®iWetlands r Q 7aterseti ct.� ,`4`,` X ` .� t �`? x• .f r .. f 'i.. F. XT.+;Y .. < S,�/Sewer ' ;� .��) � k: .�.FeL +.aG?i.S:. .>'3'�.: .r3._ _ .tm - G'a X52iaL .'Ll. '..: DESCRIPTION OF WORK TO BE PERFORMED: C F0 (Identification Please Type or Print Clearly) OWNER: Name:_ . _1 LD LLC Phone:a7-9-687-Z43, . Address: Ronk L3. AJ v ,r AA 6 l � CONTRACTOR Name: Phone: CM`S-&g Address: AD Supervisor's Construction License: Exp. Date: JZ Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE;BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ FEE: $ -Ilge2 do foo A�roti-�O�l�y _Check No.; 7- 736 J Receipt No.: NOTE: Persons contracting with acre gistered retractors do not have access to the ranty f n �gnature of�A "ent/Qwnerr�i �� ; � ��3 ,� , 3Si nature ofF.contractors � _: �,y§ ,,� �� j Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public SewerTanning/MassageBodyArt ❑ 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 ❑ ❑ nn COMMENTS I H CONSERVATION Reviewed on CT Signature COMMENTS C�' c �..� i`n Dd _ cti I HEALTH Reviewed on Signature COMMENTS 7"Ow W ff-Trk ActvaA Zoning Board ofAppeals:Variance,ce, Petition No: � oning Decision/receipt submitted, yes �?lanning Board Decision: Comments conservation Decision:_I A Comments 2- - 1Z Water& Sewer Connection/Signatmle-19ate Ko Drivewav Permit �lY� y DPW Town Engineer: Signatur [A Located 384 Osgood Street FIRE DEPARTMENT :Temp D ster onsite yes no Located at 124 Main Street\ n G_ I Z Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Z3�2 Si Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector t ilpr Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A-1-and G min:$100-$1000 fine NOTES and DATA— For department use 4 0 Notified for pickup. Date L _ Doc:.Building Permit Revised 2011 June/mi i Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. �I 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 k ❑ 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 1 Addition or Decks I - ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Bp rinkler Plan And I Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) t ® 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 ❑ 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 Calculationslicable If Applicable) pP ) ❑ Copy of Contract o Mass check Energy-Compliance Report ❑ Engineering Affidavits for Engineered products - i NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Permit Ia 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 Doe: Doc.Building Permit Revised 2008mi Location /// No. r� Z Date ® ' TOWN OF NORTH ANDOVER Certificate of Occupancy $ x Building/Frame Permit Fee $ Foundation Permit Fee $;fb20 0, ther Permit Fee f D $ s-0,Gjo TOTAL Check# oz ? 25055 9 P uilbin Inspector s NORTH ToNm of _ 10 , lover, Mass.,— Q �p O CCICHIC EWICK 7 Sf4ATED P'P�\,�Ri� U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT............. .....6i.. .... .: ............................................................... ............................ " ' " ""' Foundation has permission to erect........................................ buildings on .j//..�.. .�.....d...w.......�...... � ................................. Rough L to be occupied as.................... .............. .� ........ - ................................................... Chimney h' provided that the person accepting this permit shall in every respe�onform to the t rms of the application on file in Final' 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR L'1LESS CONS1RVTCTION STARTS Rough Service 49_zziUILDING--INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. 1 ZONING IN17ORMA770 ZONING DISTRICT. R4 =EX SPOT GRADE MIN. BLDG SE78ACKS. ^ _ �� FRONT 1rrr 0 30 FEET EX SIDE. 15 FEET CBO =CATCHDASIN REAR: 30 FEET FFE =FIRST FLOOR ELEVAnON .DEED REFERENCE EDP =EDGE OF PAVEMENT BOOK: 5599 PAGE. 319 —%S— = WATER SERVICE ASSESSOR 1NFORMABON. —SS— = SEWER SERVICE MAP 33 PARCEL 9 .sem N19 02'30"E TiO4'2T10"E 6236' 37.8 I 4�HIGH PICKET FENCE - 3i_ 18'T LOT AREA 0 10.550 &F.± :8 s i�N:_BU/lDM6�TDACK LINE—LiYPZ_ ��— 29.7 1 � N o' EX 1 STORY OD WOW FRAME 11 �+ STRi1CTURE rn o 78�T 1 N�Yy 4. : 0 0 co— t�,x i 2 1 FFE=10271 1 i P X11 10 U —z —� oa` n An '9 2 359' 0 i 36'T. I R=570.58' L=12288' ce S.......__ SEWER MAIN PEMBROOK I ROAD W— . — . — . — EX.WATER MAM BENCHMARK: PK NAIL ELEV= 100.0' (ASSUMED DATUM) i PRoPaseD PLOT PLAN OF LAND 111 PEMBROOK ROAD N. ANDOVER, MASS PREPARED BY. SULLIVAN ENGINEERING GROUP, LLC 22 MOUNT VERNON ROAD BOXFORD, MA 01921 (978) 352-7871 DATE. 10/4/11 SCALE: 1".=20' i Massachusetts-Department of Public Safety- ` Board Of Building= ,.Rc�uiations and Standard. Construction Supervisor License license: t:s 95417 Restricted-to: 00, THOMAS.D -... IKO 115 CARTE RFIELD-RD k N ANDOVE"A 01845- . �-- J�- Expiration: 4/5i2M2 C`nmmicciuner Trn. 210 I