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HomeMy WebLinkAboutBuilding Permit #201-2016 - 124 BLUEBERRY HILL LANE 8/17/2015 V%ORTH q BUILDING PERMIT o �tLeo 6 a TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 7D Permit No#• ) - 2jo/ Date Received q ^7EDw 1 SSAC HUSH Date Issued: IMPORTANT: Applicant mustt complete all items on this page LOCATION � b�%✓tel i� I / I v� `� Print PROPERTY OWNER T�bl�s P'GuS� Print 100 Year Structure yes no MAP PARCEL ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family 0 Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition 11'Other ❑ Septic ❑Well ❑ Floodplain. ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: RAh'1 -- 5'1u►YS fD U Ti►nv, G I -7- Identification- Please Type or Print Clearly OWNER: Name: I00)lns Y-aus it Phone: Address: IVB b t�i i Z Contractor Name: 6Y-(Ad Phone: Email: (01- /lJF c- hcv- (oyi Address: e 0197& Supervisor's Construction License:�, ©(v ��'!Ll Exp. Date: �J- l 3 -/� Home Improvement License: �I�I Q Exp. Date: G "lq - / 7 ; ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ C )o• "� FEE: $ 1 Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Location �� `ir eQ lZ ✓1 ' ' ° ` '�` No. �U1 Z I yo Date 1 . - TOWN OF NORTH ANDOVER STGD T646 . 0 " Certificate of Occupancy $ , " Building/Frame Permit Fee $ Foundation Permit Fee $ �� ,off Other Permit Fee TOTAL $ Check# 2 2 Building Inspector 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENT'S CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes F Planning Board Decision: Comments t "Conservation Decision: Comments a Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street �.� ... �.., , a rnpDumpster��ori,is tgi �yesa..� _ l�Located ,FreDepattmentsignatur�e%dateA _ i C®MMENtTS; i 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 DANCER 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 Call Email Date Time Contact Name Doc.Bnilding Permit Revised 2014 f 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 4... 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 OTE: 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/Cross Section/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 OTE: 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 must be submitted with the building application Doc:Building Permit Revised 2014 NORTH Town of Andover 20 . zo No. 1 - X261�• _'h ," ver, Mass, All MR �} O 1• A- COC NICIC NIwKw � 7�A�R^TEO ►.P�`�,(5 S BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT . .� 4� kg.a.4vm ........... BUILDING INSPECTOR .... .. ...... . X6.0... 11I.L"'46 Foundation has permission to erect .......................... buildings on ......... .... .... �® Rough to be occupied as ......lze. o'..... .. ..*4.4.t-ft.... .... . ... . . .tw...4.....X4%. ........ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in 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.of PLUMBING INSPECTOR u Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MOELECTRICAL INSPECTOR UNLESS CONSTRUCT5.% Rough Service ........... .. ...................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. 11C2gnl- V940 , 8�