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Home My WebLink AboutBuilding Permit #623-12 - 111 PEMBROOK ROAD 2/28/2012 f TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N �� Date Received Date Issued: -:2, IMPORTANT:Applicant must gomplete all items on this page LOCATION / f rZ1a AJ Print PROPERTY OWNER TLJ:) LL-G Unit# Print MAP NO: PARCEL: _ ZONING DISTRICT: Historic District yes Machine Shop Village yes 100 year-old structure 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: ' emolition ❑ Other �06ptic ®W�11 , oodplain' ®W�elauds ' ti `� �1iTa�rshed strict t., ow s '-'- a'S `'x y ®Water/Sewer{ a. t - k DESCRIPTION OF WORK TO BE PERFORMED: ti Lkn r dentifica on Please Type or Print Clearly) OWNER: Name: L �- Phone: Address: Y 1 J R.V -, J�J AtA CONTRACTOR Name: u.t [.!Phone: Address: 5 Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER 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. f Total Project Cost: $ Z)SL1 T 1aVU FEE: $ 6-0 i Check No.: Z 7 Receipt No.: 3 S^� NOTE: Persons contracting with unreg' tered con actors do not have access to the gu ranty f d i gnature o-f Agent/ .caner . - __ .4 ,._,,. Signature of;.contragori ,. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ 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 ❑ ❑ COMMENTS CONSERVATION Reviewed on nature COMMENTS HEALTH Reviewed o i nature COMMENTS 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. y 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.$1oo-$1000 fine NOTES and DATA— For department use KOn ® Notified for pickup - Date Doc:.Building Permit Revised 20117une/mi 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 a ❑ 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) 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) ❑ 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 roust be submitted with the building application Doc: Doc.Building Permit Revised 2008mi IAORTH Town of AndoverNo. wr 0 _ o '� dover Mass. LAKE 1 ' COCMICMEWICK D"?ATED � �5 PERMITT BOARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THAT.........77' /� BUILDING INSPECTOR ............................................................ has permission to erect.......... Foughndation .... buildings on, ��. �yle'av .................................... Rou to be Occupied as � .. . .. . .............................................. Chimney provided that the person accepting this permit shall in eGery resp conform to the ter of the application on file in. this office, and to-the provisions of the Codes and By-Laws relating to the Inspection, Iteration and Construction of Final Buildings in the Town of North Andover. VIOLATION of the Zoning or Building Regulations Voids this Permit. PLUMBING INSPECTOR Rough PEIi1Vi11 E MES IN 6 MONTHS THS Final UNLESS CONS UC. ON TS ELECTRICAL INSPECTOR Rough Service BUILDING INSPECTOR Final Occupancy Permit Required t® Occupy Building GAS INSPECTOR - Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. :De -DEPARTMENT i [BurnerSEE REVERSE SIDE I Town-of North Andover NORTH q Building Department �0 1T%,E° .1 .6it6�— 1600 Osgood Street o r;, °� North Andover MA 01845 0- Tel: = �'` Tel: 978-688-9545 Fax: 978-688-9542 O twtE � 4,o coc«Icnewicw`, DEMOLITION OF BUILDING AFFIDAVIT �,9 ORATED 2 SSAC HUSH DATE OWNER'S NAME &ADDRESS T LfJ I IS C A(Z E 1h M M )y.AhmO M, AkA_ LOCATION OF PROPERTY TO DEMOLISH 1 l Mb �i)�� ROOM DESCRIPTION. WoabMFRA,3,kE KANG� Rff,MkAN CONTRACTOR'S NAME &ADDRESS M A 1 L.ttT 6o4197rR0 6,h) 6fly-sr-Tp-lo. DEPARTMENT SIGN-OFFS DEPT. OF PUBLIC WORKS -WATER: rr WN A N)o cu a SEWER: N NU 0*14 DEPT OF CONSERVATION�o� 'IEALTH.DEPT: Septic N IJ Well NLA HISTORIC COMMISSION W /A GAS_ h ELECTRICyiscoW�J � Z� �►L TELEPHONE I CABLES 2( 2 TAXES POLICE'y "111� �1 FIRE EXTERMINATOR I A DUMPSTER—ON/OFF STREET DIG SAFE NUMBER NIA - A%6w GRbbe "R g Q ULY DATE REC'D BLDG. INSPECTOR Doc.form demolition of building affidavit