HomeMy WebLinkAboutBuilding Permit #653-14 - 21 HIGH STREET 3/24/2014TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
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Permit NO: r I Date Received
Date Issued: Z
IMPORTANT: Applicant must complete all items on this page
LOCATION'
.. __. .. -. Drinf,
PROPERTY OWNER i L C- Cr- N f -4 1`1t I.AL L)L-, %�--
Print'T 100'Year Old structure yes no.
MAP NO: _PARCEL ZONING DISTRICT:. Historic Districtye no
Machine Shop Village <W no;
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ One family
❑ Addition
0 Two or more family
❑ Industrial
XAlteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
El Septic ❑ Well
Q Floodplain ❑ Wetlands.
❑ Watershed District
11 Water/Sewer
tt \ DESCRIPTION OF WOMM i U tit rtKrUKivitu:
�1 1 2-, 4 f'--JYN 41r LS fW of -t (4 L9 1{, ! -JT N Cr
S 'f A L✓` ( A S Pte- P `✓��
Identification Please Type or Print Clearly) 1
OWNER: Name: T) ►a✓z r> SILT n -c-+ Phone: 1,7 V Z-Sell
-
Address: to 0 ZJrtU-1-WL 5 �►� O��
CONTRACTOR Name:_ K - Phone:
Address: LrtPLO r�/� .��' ��-Ynoya
Supervisor's.Construction License: - S bis 2 2'-4- Exp. Dater. -
Home Improvement License: _ t_xp. nate:
ARCHITECT/ENGINEER N s,_� Phone:
Address
Reg. No
FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
k
Total Project Cost: $ � I
2- 0 U FEE: $ ! L,_Lr_
Check No.: & �?Receipt No.: L_Q 7 3 �
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
!natureof.A ent/Owner —~ Si nature of contractor
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
vVl
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b
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
PLANNING & DEVELOPMENT ❑
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
DATE APPROVED
El
Reviewed on Signature
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Drivewav Permit
)DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at'124.,Main`Street•
Fire Department 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 Deter 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
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
❑ 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
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
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
❑ 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
❑ Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
❑ 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 2012
Location2—
No. Date L
v
CheckA03
2737b
TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee
TOTAL
Building Inspector
Location
No. Date
Check # 16 �v
2 7 3 �) 6
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee
TOTAL
Building Inspector
< NO YN
ti
MR�' .oi?� 'ti49I
ACH
CERTIFICATE OF USE & OCCUPANCY
TOWN OF NORTH ANDOVER
Building Permit Number 653-14 on 3/24/2014 Date: April 1, 2014
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 21 High Street — Suite 210
MAY BE OCCUPIED AS Tenant fit up — Chinese In New England Education IN
ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING
CODE AND SUCH OTHER REGULATIONS AS MAY APPLY.
Certificate Issued to: RCG NA Mills LLC
21 High Street
North Andover, MA 01845
a 1� \
Building Inspector
Fee: $100.00
Receipt: 27396
Check: 1680
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Enter construction cost for fee cal -
North Andover Fee Calculation
Construction Cost
$ 12,000.00
m
$ -
$
144.00
Plumbing Fee
$
18.00
Gas Fee 100 comm.
$
100.00
Electrical Fee
$
18.00
Total fees collected
$
280.00
21 High Street
653-14 on 3/24/2014
Tenant Fit UP for Suite 210
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