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Home My WebLink AboutBuilding Permit #105-13 - 143 LACY STREET 8/6/2012 BUILDING PERMIT of t►O R TH�t�rD ,6 +�r.b` '' -�'''6 0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: r/� Date Received RAraDc5 �SSACHU5�� Date Issued: v IMPORTANT:Applicant must complete all items on this page LOCATION y Pri t ri t PROPERTY OWNER UC Print MAP NO: 10 PARCEL: C . ZONING (STRICT- Historic District yes Rn Machine Shop Village 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 Othe s: 05—em olition Other Septic Well Floodplain Wetlands_ Watershed District Water/Sewer CRIPTION OF WORK TO BE PREFORMED: NJN JESC(I Vr' Identification P ase Type or Print Clearly) OWNER: Name: ` r Phone: Address: CONTRACTOR Name: Phone: Address: 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. Total Project Cost: $ D FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owne Signature of contractor j 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 — Si nature l IlUczf COMMENTS HEALTH Reviewed on Siqnature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments J. 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 j Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions.Lw—`9A Total land area, sq. ft.: ?-acre S ELECTRICAL: Movement of Meter location, mast or service drop req ires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 2 1 A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup - Date I 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 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:BPFORM07 Revised 2.2008 Location No. v Date 6 �� - ' TOWN OF NORTH ANDOVER s Certificate of Occupancy $ •�F� t�� dip(A `teYi.„Y Building/Frame Permit Fee $ Foundation Permit Fee $ � Other Permit Fee�xwfo $ TOTAL $ Check oz�i 25588 Building Inspector Town'of North Andover NORTH q Building Department %-F 1) ,;.61 - 1600 Osgood Street �'� y',''`f 0� North Andover MA 01845 Tel: 978-688-9545 Fax: 978-688-9542 - app ccc"1 e:. cK DEMOLITION OF BUILDING AFFIDAVIT x.95 RATED (9— + ` SACHU5 DATE C9— l s, OWNER'S NAME &ADDRESS LOCATION OF PROPERTY TO DEMOLISH G Z4 97 DESCRIPTION. U CONTRACTOR'S NAME &ADDRESS DEPARTMENT SIGN-OFFS DEPT. OF PUBLIC WORKS -WATER: SEWER: DEPT OF CONSERVATION HEALTH DEPT: Septic Well HISTORIC COMMISSION GAS /vt�vt p ELECTRIC TELEPHONE CABLE TAXES POLICE FIRE EXTERMINATOR DUMPSTER–ON/OFF STREET DIG SAFE NUMBER DATE REC'D BLDG. INSPECTOR Doc.form demolition of building affidavit NORTH own of t ndover &A- I No. _rh �S-' l / o ver, Mass, Xl C/z C CHICA..C. �1. A�RATe 0 S U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System ��--ff � �c/JJ�� '/ BUILDING INSPECTOR THIS CERTIFIES THAT .....: l. . . .... ..l..l.......C�.l.� .. ., ..�.!�?'�t,,1. ..... .................................. has permission to erect g Foundation .......................... buildings . ....f.�?�.......•l�.�. .....:S.� Rough to be occupied as �0.6#.W..A'.ZJ, ..,..I! .....a./ .....................` ` '�............. 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST TS 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. SEE REVERSE SIDE