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HomeMy WebLinkAboutBuilding Permit #383 - 12 SAMUEL WAY 12/8/2008 Il 41 pORTIi-0&- BUILDING PERMIT o* t�ED $6gti TOWN OF NORTH ANDOVER or ...6 0 APPLICATION FOR PLAN EXAMINATION I- 7D Permit NO: Date Received ! SHU Date Issued: �SAC MPORTANT: Applicant must complete all items on this page LOCATIdNF . g .'. Print PRQPERTY OWNER --QMH PriniT r� w -MAP NO PARCEL: - ZONING OISTRICT: ^-iiistoric District fres _. ° .Machine Shop Viilage TYPE OF IMPROVEMENT PROPOSED USE Re idential Non- Residential New Building One famil Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other . �Se tapWeO Floodplain Wetlands Watershed D'istnct ` U iter.Seuver� DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: i 'moi hone: Address: GONTRAGT "R. Name: �—•`` = � ,' _Pfione �. > dtiress, " Su ervisor ton �. � ? _ Ex 'Date-, Z s .� - Home lm�r©v,�ment License: �r " Exp. Date:. ARCHITECT ENGINEER lel � � ��MII� Phone:`��� X71 7�' Address: ���a ®�lt�N'( 1 Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$10000 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $X1 ,1 x IV,W01-200 FEE: $ C �3 Check No.: GJ Receipt No.: NOTE: Persons contracting with nr 'st ed crotractors do not have access to the guaranty fun agnature of�Agentl Signature of contractor Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL =PublicSewer 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 DATEAPPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on S Signature 1414- COMMENTS ZO e HEALTH Reviewed on Signature t° COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments `0 Water & Sewer Connection/Si nature& Date� ----��- rjvaav Permit DPW Town Engineer: Signature: AKW4' k Located 384 Osgood Street FIRE"RE' PARTMENT =Tem Dorn sten on,;site P� P YeS- no . Located at 1.24; in Street F�re,Department sign ttireldate COMMENTS : Dimension I Number of Stories: -- Total square feet of floor area, based on Exterior dimensions.,'-'— Total imensions.�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 2008 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 Ili 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 i In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals I 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 �I Doc:Building Permit Application Revised 2.2008 z, Location �G'" U �f �G No. Date1 O�MOeTq,� TOWN OF NORTH ANDOVER O • Certificate of Occupancy $ �� y .,.. •X07 .-A Me � • Building/Frame Permit Fee $ C2 ' F F` Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 6 , w; Check # 900 21741 =. Building Inspector i . Vlassachusetts - Depai-tment of Public Safct.N Board of Building Regulations and Standards j. Construction Supervisor License License: CS 99769 Restricted to: 00 AARON SASSEVILLE _ 24 BUFFUM STREET SALEM, MA 01970 dL Expiration: 7/24/2011 ( nunisin.•r Tr#: 99769 fl NORTH Town of TL dover, Mass., 0 COC MIC HE WICK � S E BOARD OF HEALTH PERM, IT T Food/Kitchen Septic System BUILDING.INSPECTOR THIS CERTIFIES THAT....... ¢ Foundation ,r..Gtl.`.r.�.�'F°r: ..:..........`.............. ........... . . .. . .</r........................ has permission to erect........................................ buildings / ' . . . .......................... Rough tobe occupied as............ Ccw....,1 .C. .l..�:...1.....�'.k �C.<... ................. � . ?. ../ ..... ............................... Chimney provided that the person accepting this permit shall in every rest conform to the terms 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. t Rough Final PERMIT EXPIRES IN 6 MONTHS 9 ELECTRICAL INSPECTOR. UNLESS CONSTRUCTION STARTS Rough ...................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocmpy 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.