HomeMy WebLinkAboutBuilding Permit #871-13 - 190 GRAY STREET 6/13/2013TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit N0 "' �� Date Received O
Date Issued: ^ t J - 1_j
IMPORTANT: Applicant must complete all items on this page
LOCATION'S �a y �ek
PROPERTY OWNER��.(/���
Print 100 Year Old Structure yesno
MAP NO: 16 7 -PARCEL4( 30 ZONING DISTRICT: Historic District ye no
Machine Shop Village ve 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
Septic ❑ Well
❑ Floodplain ❑ Wetlands
❑ Watershed District
❑ Water/Sewer
Flo
OWNER: Name:
ArIri rAgq-
DESCRIPTION OF WORK TO BE PERFORMED:
PAV
rint Clearly)
Phone:
CONTRACTOR Name: Phone:
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License: _ _ _ _ _ _ Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: SZ Reg. No.
FEE SCHEDULE: BOLDING PERS IT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ /, FEE: $
i
Check No.:
NOTE: Persons cc
0gnature6f1Age
Plans Submitted ❑
Receipt No.:
contractors do not have access to the guarantyfund
Pla
vva1vvu u
_ Signature of contractor
Certified Plot Plan ❑ Stamped Plans ❑
Location
No. Date
'7
Check #
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Feeo" $r2 /9
Foundation Permit Fee
Other Permit Fee
TOTAL $
6 " �
"" Building Inspector
Plans Submitted ❑
Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑Swimming
Tanning/Massage/Body Art ❑
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
COMMENTS
CONSERVATION
COMMENTS
Reviewed
DATE REJECTED DATE APPROVED
❑ ❑
HEALTH Reviewed on Siqnature
COMMENTS
N
Zoning Board of Appeals: Variance, Petition No:
Zoning Decision/receipt submitted yes-.-
es_Planning
PlanningBoard Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date
Driveway Permit
DPW Tovvp+ ngineer: Signature:
I
Located 384 Osgood Street
FIRE DEPARTMid9T - Temp Dumpster on site yes
Located at 124:Main' Street --
Fire De' pa ' t signaIt a/date `
no
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
g�AYVI ru 4t4 4
® Notified for pickup - Date
1
Doc.Building Permit Revised 2010
Building Department
The following is a dist 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
o 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 Permit Application
❑ 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)
❑ 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
o Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
a Workers Comp Affidavit
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Copy of Contract
o Mass check Energy Compliance Report
a 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 app: al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be subm;tted with the building application
Doc: Doc.Buil,ding permit Revised 2012
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SiE
Professional Land Surveyors & Civil Engineers
ESSEX SURVEY SERVICE 1958- 1986
OSBORN PALMER 1911 - 1970
BRADFORD & WEED 1885 - 1972'
PLOT PLAN OF LAND
LOCATED IN
Ao011 A1, b 11 MASS.
) '1-2
ZONE: kZ LOT AREA: LOT FRONTAGE: Isl�•G�
FRONT YARD: 50K SIDE YARD: ")U J t REAR YARD: �iF/
SCALE:
DATE: 6 G l `t 2., z
REVERENCE: BK PG
104 LOWELL STREET
PEABODY, MASS. 01960
I hereby certify to
Building Inspector that the pro-
posed construction shown conforms
'to the dimensional zoning of
AD/Zr' �/l /JGIV Mass.
0
,.2C:. NgTM lgm1 91nn
Professional Land Surveyors Et Civil Engineers
ESSEX SURVEY SERVICE 1958 - 1986
OSBORN PALMER 1911 - 1970
BRADFORD & WEED 1885 - 1972'
PLOT PLAN OF LAND
LOCATED IN
TEL�.,
I hereby certify to thele- V 11W1.2,1, y�;l
dd Building Inspectorthat.the pro -
ZONE: 9Z LOT AREA:"13 aG LOT FRONTAGE: /5/) -GG posed ,construction shown conforms
2to the dimensional zoning of
FRONT YARD: 3�K SIDE YARD: >�Pr REAR YARD: i(�i &Zr Mass.
SCALE:Or N ^-
DATE: OT 2C,J 1 c'STOPHER
R.
REFERENCE: BK PG topher R. Mel
104 LOWELL STREET
PEABODY, MASS. 01960 „.
i in-nt ens ro1n.
�b I -� 0 1 -�-o
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— Rail Line
::`u Wetlands Zoning
Interstates
— Interstate
:: Exempt Lands . -- Busine
C Busine
s 1 District
s2 District
Horizontal Datum: MA Stateplane Coordinate System, Datum NAD63,
— Major Roads
G Busine
O Busine
s 3 District
s 4 District
14ORTH
Meters Data Sources: The data for this map was produced by Merrimack
Valley Planning Commission (MVPC) using data provided by the Town of
Roads
L Easements
Y Genera
O Planne
Business District
Commercial Dev
f �,
O <«�� '��
North Andover. Additional data provided by the Executive Office of
Environmental Affairs/MassGIS.
t
C3 MVPC Boundary
"Corrido
Development Dist
j a+ O
j. C
The information depicted on this map is
for planning purposes only. It may not be adequate for legal boundary
❑ Municipal Boundary
Zoning Overlay
D Cor do
C Corrido
Induslri
Development Dist
Development Dist
I 1 Dislricl
O A
M %)
t ♦
definition or regulatory interpretation. THE TOWN OF NORTH ANDOVER
MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING
ACY,TA. COMPLETENESS. RELIABILITY, BILITYT
13 Adult Entertainment
C Intluslri
12 District
; "s ,? i
OF THESE
OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT
ANDOVER DOES
O Downtown Overlay District
0 Historic District
C Induslri
G Induslri
1 3 District
il S District
o ♦
' "' � �
ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
® Water Protection
Residei
ce 1 District
o
'�,� ++.�e •fit.(°J
SSAC"
THIS INFORMATION
❑ Parcels
tt7 Rodd:
ce 3 D strict
C. Hydrographic Features
l de
ce 4 District
Streams
1 = 152 ft —4 )ude
v de
ca 5 Dist ct
cs 6 District
—ge
Residential District
F�