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HomeMy WebLinkAboutBuilding Permit #423-12 - 12 MASSACHUSETTS AVENUE 11/17/2011 - L TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: `12 3 Date Received !r Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER / � G'r- �ET-f-7 Unit# Print MAP NO: PARCEL: O� _ZONING DISTRICT: Historic District yes no �� d3�2r3S Machine Shop Village yes no 100 year-old structure yes no III TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑One family El Addition ❑Two or more family ❑fI�dustrial ❑Alteration No. of units: /Commercial Repair, replacement ❑Assessory Bldg ❑ Others: Ilh ❑ Demolition DODther iSept f�® ellMi r oodplamW tlands .4 ,® #W, ershed r ice`stt DESCRIPTIO/N_OF WORK TO BE PERFORMED: Alp Identification Please Type or Print Clearly) Y) OWNER: Name: d Pmt- c Phone: 0 Address: � U�ll� c CONTRACTOR Name: Phone: t� S� Address: Supervisor's Construction License: e5 Exp. Date: Home Improvement License: Exp. Date: - I` ARCHITECT/ENGINEER Ayea �Ca Phone:_Qe3' II Add ress:W,1Y(;?;-�-?M- o ,od /23829 Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ A0© FEE: $_ Check No.: a-IIli 4 L/y Receipt No.: vz/j,2 NOTE: Persons contracting with unregis red contractors do not have access to the guaranty fund Sg__ reofAgent/Ownerr` -rtea' Siynature ofonfractor �__ _. iia_ - - - I" J 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 r ❑ - 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) i ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products VOTE: 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 TOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Permit a all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals iat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording gust be submitted with the building application Doc: Doc.Building Permit Revised 2008mi I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ I 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 I DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS i CONSERVATION Reviewed on Signature COMMENTS I ti HEALTH Reviewed on Signature COMMENTS d Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes d Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/S�nature& 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 j ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi Location v F No. 4,12 9 Z- Date r NORTIy TOWN OF NORTH ANDOVER 3? OL . 9 ;s Certificate of Occupancy $ sACHUS<�'+ Building/Frame Permit Fee $ yy� Foundation Permit Fee $ { Other Permit Fee $ TOTAL $ Check 2 4 8 2 5 lding Inspector —� NORTH An dove Town of No. low _1 Y_ o dover, Mass., �. 0 - lAKE . coCM,CKEWICK '7d�oRA T E D BOARD OF HEALTH 7v Food/Kitchen PERMIT T Septic System BUILDING.INSPECTOR !y � Foundation THIS CERTIFIES THAT.. ............................................ ... !s'� Rough haspermission to erect........................................ buildings on ..� .............. S.............. .................................................... b �'G e�o� ..................... -to be occupied as.............. .P� ............................................ .. ./e......:. � .... .. ... . . -- Final S � Chimney e in provided that the person accepting this permit shall in every fespect conform to the terms of the application on i�ln of this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction PLUMBING INSPECTOR Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough ............. ..................................... Service BUILDING 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. Smoke Det. SEE REVERSE SODE ��tAA1�t;JlIV��O6d�J e �l�®9 �UV�® MEMBER � ! 37 FEDERAL HILL ROAD • OXFORD, MASS. 01540 RR TELEPHONE: (508) 987-5322 November 16, 2011 State of Massachusetts Building Department, Town of North Andover RE: Permitting,UST Replacement&Re-pipe Mobil, 12 Massachusetts Ave.,North Andover, MA Dear Sir/Madam: Please be advised that I, Peter D. LaMountain, President of LaMountain Bros., Inc. of 37 Federal Hill Road, Oxford, Massachusetts grant permission for Benjamin LaMountain, LaMountain Bros., Inc. to use my Construction Supervisor License#CS 65103, expiration date 09/03/2013 to obtain the required permits necessary for the work described above. Should you have any questions or require any additional information,please do not hesitate in contacting me in my office at(508) 987-5322. Signed this day of 2011. 8eterrountain n Bros., Inc. Construction Supervisor Lic. #CS65103, exp. 09/03/2013 The above individual personally known to me appeared and signed before me this to day of p;�avesnti�Q , 2011. c,a of y Public ommission Ex ' 24 v ^v_ •. -3-�•- Massachusetts - Department of Puhlic Safctl Board of Building Regulations and Standards Construction Supervisor License ' I License: CS 65103 PETER D LAMOUNTAIN 37 FEDERAL HILL RD OXFORD, MA 01540. �• Expiration: 9/3/2013 (ummissiuncr Tr--: 489 a J