HomeMy WebLinkAboutBuilding Permit #286 - 163 MAIN STREET 10/15/2007 BUILDING PERMIT of "oRT" q
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TOWN OF NORTH ANDOVER F
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:LO Q
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IMPORTANT:Applicant must complete all items on this page
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MAP NO; PARCEL:: ZONING"DISTRICT; Historic Distrlct yes
Machine Shop Village yes no
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 Others:
Demolition Other
"Well Well Floodplain; Wetlands " Watershed District
Water/Sewer-
DESCRIPTION OF WORK TO BE PREFORMED:
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Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address:
CONTRACTOR -Name; . . Phone:
Address:
Supervisor's Construction.License: Exp, Date. `
Home-'Improves-rent License. Exp, Date.
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.
Y
Total Project Cost: $ 000 FEE: $ Aof-F- 0--
Check No.: 144 Receipt No.: �9Q (--;'5-3
NOTE: Persons contracting with unregistered contractors do not have access to the g ra fu
Srgrature of Agent/Owner. Signature of contractor
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
DATE REJECTED DATE APPROVED
CONSERVATION
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Pla�n':ng Board Decision: Comments
Conservation Decision: Comments
Water $ Sewer Connection/Signature& Date Driveway Permit
Located at 384 Osgood Street
P
FIRE DEPARTMENT =Temp Dumpster onsite Vires no
Located at 124 Mairi Street
Fire,Department_s gnatureMate
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 2007
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
9 9 9
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 2.2007
Location! 62
No. 2Date/ �{
NORTH TOWN OF NORTH ANDOVER
3? i • O
` Certificate of Occupancy $
yes'•••°'E<�' Building/Frame Permit Fee $
s�CHus
Foundation Permit Fee $
Other Permit Fee $ Q
TOTAL $
Check
P
20G : S
Building Inspector
NORT1y
To of
No.
o dover, Mass.,
T` O - LAKE
COCKICKEWICK
ORATED PP�t�S
v ` BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
III BUILDING INSPECTOR
THIS CERTIFIES THAT................ . ... ................ .........
Foundation
has permission to erect........................................ buildings on .I.. ... !.....�t..I......5. .............................. Rough
t0 be OCCUpled as....��. !!. ... ... .�.. ......... A.................. Chimney
e
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
I6&' PERMIT EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
UNLESS _, bNSTRU j Rough
Service
BUILDING INSPECT
Final
Occupancy Permit Required to Occupy 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.
Copy
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COMPONENT PLAN
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