HomeMy WebLinkAboutBuilding Permit #553-13 - 19 PLEASANT STREET 2/4/2013 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:
IMPORTANT:Applicant must complete all items on this page
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�PRQPERTi�YOVI/NER __
Want: 00 Year OId�Struc ye 'r
IP _ �1� s x
a r
(MAP NOF PARCEL`' ZONIN-Oi0 TRICT m - Historic District;t
ure'
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".achiri �hop`�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 ❑ Others:
Demolition ❑ Other
<❑ SepticlDtWeli V,: E;Floodplaina '❑�1lVetlantls� �� trtWatersh`ed Districts ` .3
❑Water/Sewer . ,� .,
DESCRIPTION O ORK TO BE ERFORIYIED:
l ��l��� &
Identification PI ise Type or Print Clearly)
OWNER: Name: E D �� �,��( e ,� Phone:!I'?
Address:
CONTRName IPnone
ACTOR
1 x
77
Address � r_�.6�G!��_ _ _ •_
SuperviExp' ®'ate _
K n
i _
Home Improvement Y6eFn§e
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: $_ � J FEE:
V
Check No.: S Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaran fund
Signature;'of A "' OOwner `_ Ssgnature of contracto .
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ ISta ped Plans ❑
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
o Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
o Floor Plan Or Proposed Interior Work
a Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
a
o Building Permit Application .
a Certified Surveyed Plot Plan
o Workers Comp Affidavit
o Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
a 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)
o Building Permit Application
o Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (if Applicable)
❑ Copy of Contract
Lt Mass check Energy Compliance Report
o 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 submAted with the building application
Doc: Doc.Building Permit Revised 2012
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 Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
j I
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
i
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature&Date Driveway Permit
DPW TowL Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster onsite yes , no
Located at>124 MainStreet.. .
Fire ®epa_men. 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
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
I �
Doc.Building Permit Revised 2010
Location /
No. SS Date
• ' TOWN OF NORTH ANDOVER
ASU
er Certificate of Occupancy $_
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee $
TOTAL $
Check#4Ar
26137 Building Inspector
Town of North Andover Page 1 of 1
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Owner Prop__ID (Address
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http://mimap.mvpc.org/NorthAndovermimapNiewer.aspx 2/4/2013
NORTH
oven of � : _ ndover
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No. LAKE
oh ver, Mass,
A- QA COC HICKIWICK
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01#4 TED
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BOARD OF HEALTH
Food/Kitchen
Septic System
THIS CERTIFIES THAT BUILDING INSPECTOR
....PERL
.. .........�. ........... .. .. ......... ................................... .........
has permission toe t ......................... buildings on ..�.q. ... ..� !* .,,,, „q.... Foundation
Rough
Aa
to be occupied as . .. .......... .�. ........ ......... .................... 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 MON T ELECTRICAL INSPECTOR
UNLESS CONSTR S S
Rough
Service
........... .. ........................................................... /
BUILDING INSPECTOR Final
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