HomeMy WebLinkAboutBuilding Permit #107 - 125 Main Street 8/7/2008 BUILDING PERMIT Ot NORT►1
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TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received 8 5- 4q
��SSACHUS
Date Issued: 4?- / d U
IMPORTANT:Applicant must complete all items on this page
LOCATION A5«�Y ��-► � G1�6 � 1� ?
PROPERTY OWNER
Z44 8;�- klt) 7zaSr-
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MAP N049 PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building One family
Addif Two or more family Industrial
eratio No. of units: e
replacement Assessory Bldg ers:
Demolition Other
Septic Well Floodplain Wetlands Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFO ED:
Identification PleVaseT eo'r n�tClearl
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Phone: ?76�OWNER: Name:
Address: 1(:nI A414) S7' /V• AJDOM4 m1k
CONTRACTOR Name: -; CJ�tt.�- Phone:
Address:
Supervisor's Construction License: g Exp. Date- l- 0-- '
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER (1L/ 1,,(Q = Phone: ?116
Address: Reg. No. S
FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ ��/ O0 ✓ FEE: $
9 ' t No.:
Check No.: 745�7 Receipt � ? 9�
NOTE: Persons contracting w'th nre istered contractors do not have access to the guaranty d
Signature of Agent/Owner _ , ignaturg of contract LL
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 r
COMMENTS Per F P/C-Ziq ///CA " ,�9
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
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 si#e yes. no,
Located at 924 Main Street s -
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
❑ Notified for pickup - Date
Doc.Building Permit Revised 2008
r
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
❑ 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
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:INSPECTIONAL SERVICES DEPARTMENT:13PFORM07
Revised 2.2008
is
Location
No.
Date t? 7 f1
MORTIy TOWN OF NORTH ANDOVER
3? � BOOL
Certificate of Occupancy $
Building/Frame Permit Fee $ `
�cMus ..—
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ - 0
Check # _7,5—
2 S9U
�/ `Building Inspec
,tACiRTH Andover
T0VVn of
No. ape
0 dover, Mass.,
0 4t- LA
GOC MIC HEWICK
RATED P"'
BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT ... ... . ........ ...... .................................. Foundation
has permission to erect........................................ buildings on ..4014 ........ . . ....... Rough
tobe occupied as.......... ......... .................................................................... Chimney
provided that the person accepting this permit shall in every respect 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. Rough
Final
PERMIT EXPIRES IN 6 MONTHS
UNLESS CONSTRUCTION S ELECTRICAL INSPECTOR
Rough
................................... Service
BUILDING INSPECTOR Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
vI 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 SIDEl Smoke Det.
OFFICE OF BUILDING INSPECTOR
TOWN OF NORTH ANDOVER
`• ti"�` ..r► CONSTRUCTION CONTROL
PROJECT NUMBER: V0 • OC%�✓
PROJECT TITLE: Y_!iA2e;W:
PROJECT LOCATION:-log ' Ime L 41M 44ft4 .
NAME OF BUILDING: 60
NATURE OF PROJECT: `
IN RDANCE WITH TICLE 116 OF THE MASSACHUSETTS STATE BUIL,DV4G CO E,
REGISTRATION NO.
BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HEREBY CERTIFY THAT I
HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS,
COMPUTATIONS AND SPECIFICATIONS CONCERNING:
ENTIRE PROJECT ARCHITECTURAL 0 STRUCTURAL 0 MECHANICAL 0
FIRE PROTECTION 0 ELECTRICAL 0 OTHER(SPECIFY)
FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEGE, SUCH PLANS,
COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS
STATE BUILDING CODE,ALL ACCEPTABLE ENGINEERING PRATICES.
AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY.
I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B
EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT
THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING
PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0
1. Review,for conformance to the design concept, shop drawings, samples and other submittals
which are submitted by the contractor in accordance with the requirements of the construction
documents.
2. Review and approval of the quality control procedures for all code-required controlled materials.
3. Be present at intervals appropriate to the stage of construction to become, generally familiar
with6the progress and quality of the work and to determine, in general, if the work is being
performed in a manner consistent with the construction documents.
PURSUANT TO SECTION 116.2 .2 1 SHALL SUBMIT WEEKLY, A PROGRESS REPORT
TOGETHER WITH PERTINENT COMMENTS TO.THE NORTH ANDOVER BUILDING INSPECTOR.
UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE
SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUP
SIG TU
\SUBSCRIBED AND SWORN TO BEFORE ME THIS.
DAY OF �gaCx��s
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NOTARY PUBLIC MY COMMISSION EXPIRES jo '3 ��
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North Andover, MA 04/23/oa 221 Washington Street
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