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HomeMy WebLinkAboutBuilding Permit #364-2012 - 17 MILLPOND 10/25/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO..3� — �� Date Received Date Issued: MPORTANT: A Applicant must complete all items on this page LOCATION (y) ' _ rin PROPERTY OWNER `AUG C>i'1 A _C'(p►�'1� e__ Unit# _T Print MAP NO: YPARCEL: 1-7 ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 'S One family ❑Addition ❑Two or more family ❑ Industrial No. of units: ❑ Commercial ❑Alteration ElRepair, replacement ❑Assessory Bldg El Others: ❑ Demolition ❑ Other _ Septic ❑ Well ❑Floodplain q Wetl'and's, ❑ Watershed District ❑ Water/Sewer - - DESCRIPTION OF WORK TO BE PERFORMED: � ►�C n Cale r2k t5 I-0_0 i (Identification Pease Type or Print Clearly) OWNER: Name: �U n i �-��'(L'� t S_ Phone: i Address: I m i n ip CONTRACTOR Name P������ �a��l/acho.v C Phone: 34/&' ZA77 Address: Supervisor's Construction License: 1035-417 Exp. Date: ;2 1,9 ell,? Home Improvement License: /l '/223 Exp. Date: Vas/a ARCHITECT/ENGINEER Phone: r Address: Reg. No. FE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. E Total Project Cost: $ !f-V9� 0,0 el FEE: $ .oo° `� a Check No.: 5 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the ua ty fund Signatureof Agent/Ovvner ignature�of�confra - Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, 9 Siding, Interior Rehabilitation Permits ❑ Building Permit Application a Workers Comp Affidavit ❑ Photo Copy of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work o 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 pp Permit Application ❑ Certified Surveyed Plot Plan a Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o 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 Li Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit Li 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 PI ans Submitted❑ TypE plans OF SEERA Waived ❑ Sewer Public WGE DISPOSAL Certified Plot plan Well ❑ Stamped Plans ❑ Private , et ❑ Tann. a���MassageBody Art aseptic tank c ❑ Tobacco Sales ❑ ❑❑ SN�in g Pools Permanent Dumpster on SiteFood Packaging/Sales 0 THE�E FO'LLO I NT ERDEPAR MEN ECTIO►VS FOR PLANNING T AL SI GN O FU OFFICE USE ONLY & DEVELOPMENT DAT E J ORM E R ECT COMMENTS 0 ED DATE APPRO ❑ VE D CONSERVATION Reviewed on COMMENTS Si nature HEALTIJ CpIVjMENTs Reviewed on Si nature Zoning Board ofgppeals. Va nance, Petition No: 1 Pl anning Board Decision: Zoning Decision/receipt s Conservation D COmmenfs ubmitted Decision: Yes Water � & Sewer Connection►/ . COmrnents DPW S, nature FI T oWn Engineer: Signat Date ure; Lo d aPARTMEjV _ T Orivewa Fire De 124 Main Street emp Dum Permit Aster on site yes Cp Partrnent signature/date 'Ocated 384 Osgood Street D Dimension Number of Stories: Total square feet of floor area, based on Exterior Total land area, sq. ft.: dimensions. ELECTRICAL: Movement of Meter location,Yes ma service drop requires app Electrical Inspectormast or serviapproval of DANGER ZONE LITERATURE: No MGL Chapter 166 section 21A-F and G min.$10$e000 fine No NOTES and pgTq _ For deartment use f b f C II I I F • I ❑ Notified for pickup - Date r Ic:.Building Permit Revised 2011 June/mi - --_-- -- i Location No. 7,C, yea U/Z_ Date j;{( j F I M°"'.,ti TOWN OF NORTH ANDOVER 9 l + i Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ ©� 3 C14USE 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # } G 24754 Building Inspector i} NORTH Town- of ? ` Andover _. Ovq'•4y ti�'•F', ��v'131:.fir.. � i 10 , lover, Mass.,_/_O_, T O -- LAKE 1• I� COCHICKEWICK V 7�ADRATED P`P�,`�� `S U BOARD OF HEALTH Food/Kitchen F= RM �IT T D Septic System � BUILDING INSPECTOR THIS CERTIFIES THAT......... .......................................................... ,nr.. .................................. ...... Foundation has permission to erect........................................ buildings on 17 �i % off! J . � �."f...�7 Rough .. ............................. ... ....................... � ��ta�.C¢/.. .�.1..9`f /?.t5.r Chimney to be occupied as............................ . , ..................................................................................... h. 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 STARTS t_ Rough Ys.c���rZSc Service ... . ...... ........ .... . . . BUILDING INSPECTOR 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 Miall To Be Done FIRE.DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SB DE Smoke Det. lassachusettti Deliat-tf entof Public 5 ifetv* ' $bard of Building Regulations and St tndtta d4 Construction Supervisor Liconse c License: CS- 103569 •sg 'Restricted to:, 1 G ROBERT DUMONT L�k-362.1US RTE. 3THORNTON, NH 03285 Expiration: 2/261201-3."'71. CInkill)issii ner .' "i> TrR• 103569' Office A.0iOm'ei` fail rs "lidiness egu a"iion"" License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: y_167725 Type:. Office of Consumer Affairs and Business Regulation ; Expiration: 1:0/25/2012Private Corporation 10 Park Plaza:Suite 5170 Boston,MA 02116 DU NT CONSTRUCTLON=,INC::=? ROBERT DUMONT ,E _ 3621 US RTE 3 Yr THORNTON, NH 03285,:`= _, :% Undersecretary. Not valid without s' nature