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Home My WebLink AboutBuilding Permit #1163-2016 - 174 GREENE STREET 5/9/2016 1 BUILDING PERMIT TOWN OF NORTH ANDOVER ✓� APPLICATION FOR PLAN EXAMINATION Permit N0: I I� - l� Date Received �s9 AATFD SSACHUS� Date Issued: I PORTANT:Appficaqmust complete all items on this page LOCATION I7 V Cr, 31-4- n� _�" / / c PROPERTY OWNER /r i Cyl r'ck / �Print Print MAP NO: �PARCEL: ZONING DISTRICT: Historic District yesnn Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Adition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic Well ❑ Floodplain . G Wetlands ❑ Watershed District Water/Sewer !A-i,3IOW /-)Web -fa Sx-&12 wm is 9-33 Q)000 -6 'f a�. �cL1'!�J �•�'"'� ,�o411J �fJ�� 7)ds��ee,� ii-- Identification Please Type or Print Clearly) OWNER: Name: 01 C6,el c ,S!&e. (o3 Phone: '4136-59 S- y3,4 Address: '7 4 I- �e_t&�E cS'i ��b6-3��'-- CONTRACTOR Name:KWT44 > VA(� Phone: J-7S-OW349 j t1LnT1 Address: ccaz- Supervisor's Construction License: Exp. Date: j��) - Home Improvement License: ga�� Exp. Date: `h -'Al 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. Total Project Cost: $ 10o ,� FEE: $ -61 Check No.: I i)(o C5 Receipt No.: 26_,5`{o NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contract C - j�c, 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS 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 i Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street AR+TMENT r�� x - --srx- r r; -�.;� :`fir }"�'. -•..r.� .. ,-� FIRE DEP � , � empJrDumpster�yon f�, ifeyes .� r s lA--�• 41Lcated at1.24 Maintreet r. N ti ,; . {tFire Departmentsnatuur4e�dare'. Dimension Number of Stories: Total square feet of floor area, basedtoa,Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service strop-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) I I ® Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Dimension Number of Stories: Total square feet of floor area, basecV.ou Exterior dimensions. Total land area, sq. ft.: , ELECTRICAL: Movement of Meter location, mast or service dro]R-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) I ❑ Notified for pickup Call Email i Date Time Contact Name Doc.Building Permit Revised 2014 _ � M Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanaing/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 e U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature { COMMENTS HEALTH Reviewed on Signature i COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments z Conservation Decision: Comments Water& Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street `FIRE DEPARTMENT ;ernp pu�m�p t n> iteyes ;iLocated a1R24 MainriStreet�,� Fire Departments mature/,d to 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4, 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/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) .rr Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products OTE: 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 a. Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 Doe:Building Permit Revised 2014