HomeMy WebLinkAboutBuilding Permit #503-13 - 21 EMPIRE DRIVE 1/8/2013Permit NO: V '
Date Issued: 1 - k
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
PROPERTY OWN _
Print 100 Year Old Structure yes
MAP NO: LQ�r_ PARCEL&I/?-ZONING DISTRICT: Historic District yes
Machine Shop Village yes
GLC
n
TYPE OF IMPROVEMENT
IMPORTANT: Applicant
must complete
items on this page
LOCATION GOAVP
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PROPERTY OWN _
Print 100 Year Old Structure yes
MAP NO: LQ�r_ PARCEL&I/?-ZONING DISTRICT: Historic District yes
Machine Shop Village yes
GLC
n
TYPE OF IMPROVEMENT
PROPOSED USE
Re *d ntial
Non- Residential
ew Building
Vbne family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑ Septic ❑ Well
0 Floodplain ❑ Wetlands
❑ Watershed District
V 1Vater/Sewer
DESCRIPTION OF WORK
L
BE PERFORMED:
u N A-1-1 orJ D&V Lq
Identification -Please Type or Print Clearly)
OWNER: Name:
Address:377 W fi_SNIIJC?�
t�— . --fL2i 4S
CONTRACTOR Name d Phone:�%���
Address:277WASP10�t � rrc� G&OE6gAJQ M14
Supervisor's Construction License: /0 2-1n.3 I Exp. Date:
Home Improvement License:�'7 �2 / Exp. Date:
ARCH ITECT/ENGINEER �� l�iU P� Phone: 90-- 9�Z" T3� F_
Address: ,qe9•/U/4/x) (26DYgeTChw M401ff-?� Reg. No 97 6 S
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ q-5
�AAAd§ �"y"A- FEE: $ ) 0 0
Check No.: �0 g5 0 Receipt No.: ';U,
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
,Signature of Agent/Owner �! Signature of contractor
Plans Submitted LIQ Plans Waived ❑ Certified Plot Plan Stamped Plans 'i4�
0
Location 2� ' Ve- LJ Z1
No. Date'
Check # r w
26075
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ r
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Building Inspector
Plans Submitted Plans Waived ❑ Certified Plot Plan �1/ Stamped Plans
TYPE OF SEWERAGE DISPOSAL
-
Public Sewer L,i�1/
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 �.Q 7 Signature " "14v
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Comments
Conservation Decision: Comments
Water & Sevier Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
FIRE DEP►RTMERIT Temp Dumpster on site
Located at'124-Main Street -
Fire Departinent-signature/date
COMMENTS
LOcatea M4 USgooa Street
Q --'1A
"U-
7—
V. �1
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
El Notified for pickup - Date
Doc.Building Permit Revised 2010
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
o Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o Copy of Contract
o Floor Plan Or Proposed Interior Work
Li 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
o Certified Surveyed Plot Plan
o 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)
o 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
o Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
a Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o 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 2012
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