HomeMy WebLinkAboutBuilding Permit #401-2011 - 15 COLGATE DRIVE 11/12/2010 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO:__��— Date Received A�11
Date Issued: / 2 /D
I ORTANT:Applicant must com lete all items on this page
LOCATION 1!5
,� Print
PROPERTY OWNER / n,4 oty 4:�11"�
, / Print
MAP NO:0910 PARCEL)0/4 ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
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Residential
Non- Residential
❑ New Building ne family
El Addition El Two or more family ❑ Industrial
Iteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
� ((] Septic �0'tWell �� IDIFloodplam `q Wetlands �� l�''Watershed�Disti= ct
Water/Sewer.
j DESCRIPTION OF WORK TO BE PERFORMED:
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Identification Please Type or Print Clearly)
OWNER: Name: ����' Phone: ��` z-`�40
Address: fi � �� f�r �.c�O`'a'' ,Gly
CONTRACTOR Name: Phone: �i t
Address:
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Supervisor's Construction License: G$S Exp. Date: ! "bo/I.--
Home
Home Improvement License: Exp. Date:
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ARCHITECT/ENGINEER Phone:
Address: Reg. No.
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FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
Total Project Cost: $ 0 % FEE: $ 4/0
Check No.: �. Receipt No.: .3 JC
NOTE: Persons co ' g with unregistered contractors do not have access to a guaran f nd
Sign'ature„ofAgenOwntiSignatu�e_of�contractor�
Location t.-d 4✓ �/'
NoDate
MORT►� TOWN OF NORTH ANDOVER
3? •. O
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} ° Certificate of Occupancy $
Musa Building/Frame Permit Fee $ 2 ZQ
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
s
236 , 5
B61ding Inspector
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/MassageBody 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
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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
4 Conservation Decision: Comments
e Water & Sewer Connection/Signature& Date Driveway Permit
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DPW Town Engineer: Signature:
Located 384 Osgood Street r
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
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DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
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NOTES and DATA— For department use
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® Notified for pickup - Date
Doc:.Building Permit Revised 2008
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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
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❑ 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: Doc.Building Permit Revised 2008mi
ORTH
TONM Of Andover .
6. -M
No.
L A K- o dover, Mass.,
Orb
COCMICMEWICK V
7� DRATED P'' C7
`S BOARD OF HEALTH
Food/Kitchen
Septic System
, .PERMIT T D
BUILDING INSPECTOR
THIS CERTIFIES THAT
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. ........................................�................................................... Foundan'on..
S� G'V6
has permission to erect.........:....:......................... buildings on ../ ,....................................:..........:........ Rough
Chimney
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to be occupied as.......................,, ���....elill k ,...... . �,1 ............................................
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
ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION ST TS Rough
Service
BUILDING ECTOR
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.
Smoke Det.
—_-. _ SEE_REVERSE__SID.E,_ _ -