HomeMy WebLinkAboutBuilding Permit #766-12 - 25 HIGHLAND VIEW AVENUE 4/24/2012Permit N0:
Date Issued
6 6 /�L
2y
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
?plicant must complete all items on this pa
vJ U► V -t) Aye i5fi FmET' # ZS
Print
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PROPERTY OWNER T Li) L LG Unit #
Print
MAP NO: PARCEL: II ZONING DISTRICT: Historic District yes
Machine Shop Village yes n
100 year-old structure yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
19New Building
XOne family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
®�Se tic {.: . �r �'•�
p�Z� Well_ r
`-„�--�.-� 3� :�� . -
i®Edodclplamti �� W.etlands ' '� 'F
� - � ..
atershed } istrtct
ITI�Y«
4 _ ater/Sewer' r i
1 € r r-
.. ,
`r
TTP1 lY
-
JJLO l.lur 11VIN yr W 1 u J_5r, rr-tu utuvit”:
si J6 ZP-78,MI r FR6,m h- N6ttj o\?VT /7-16 N
F6,
(Identification Please Type or Print Clearly)
OWNER: Name: T L b LLC—
Address: I/S Csy4p-
MWAIN
956?? ZM
CONTRACTOR Name: De V, Phone: �� f
Address: 11
Supervisor's Construction License: Exp. Date: Gf 2
Home Improvement License:
Exp. Date:
ARCHITECT/ENGINEER Phone:
Address
Reg. No.,---
FEE SCHEDULE., BULDING PERMIT. $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F.
Total Project Cost: $_ --I FEE: $ %OD .
Check No.: /491S
NOTE: Persons contracting with
OD
4
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
COMMENTS
DATE REJECTED DATE APPROVED
El
CONSERVATION Reviewed on C� 2 Signature !, 4mz4l::�
COMMENTS
HEALTH Reviewed on Signature
COMMENTS—' (�i �, Q7.Ury��il� _..
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
I
Conservation Decision:
Water & Sewer Connecti
DPW Town Engineer: Signature:
FIRE DEPARTMENT - Temp Dumpster
Located at 124 Main Street
Fire Department signature/date
`MENTS
Comments
t_ocatea 3M Usgooa atreet
no
I�
Dimension
Number of Stories: 2- Total square feet of floor area, based on Exterior dimensions. ZO 16
Total land area, sq.
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.$10041000 fine
W I is ana uf► i m — rel Ual �--�
Notified for pickup - Date
Doc:.Building Permit Revised 2011 June/mi
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
NOTE: All dumpster permits require sign off from
Addition or Decks
products
Fire Department prior to issuance of Bldg Permit
❑ 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
N OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Permit
Ia 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: Doe -Building Permit Revised 2008mi
Location
Date 60 y
No. 746 '/Z
Check # ��3
25225
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $ X06
Other Permit Fee $
TOTAL $
f ulding Inspector
I
ZONING DISTRICT : R4
103x94
LOT AREA
13,543 S.F. t
104x10
TOCK
6' HIGH STOCKADE FENCE s- HI�HoSADE FENCE o
10460 142.52'
S08'08'21 "E
32.8'
6"T
(102x8) (102x7)1 2-18"T 103x4-2
Lu
MIN. BUILDING SETBACK LINE TYP)
3-12"T 3-12"T
z
(103x0 103x0
,
�2
0 03xO)
0 38.0'
3-12"T 53.3
0
w
ui
a
W22
0'
PROP. 2 STORY
102x66
(102x3)
0
00
WOOD FRAME STRUCTURE
F
O
N PROP. 2 CAR
(SINGLE FAMILY)in
coo t
00
c4 GARAGE
0
FFE=105.0' o
1 O
=
Z 1172x69
GAR. FL=102.5'
V)
TOP OF FND=104.0'
00
cn
�*22
0'
b BASEMENT FLOOR=96.33'
29.2'
(102x5)
c� 38.0'
(102x0)
rT
-To
PROP. BIT.
5 -18
CONC101x66
PS PW
PROP. WATER SERVICE (PW)
3/4" TYPE K COPPER
DRIVEWAY
32.0' 32.0'
6"T
91
1 ,1 x00
PROP. SEWER SERVICE (PS)12"T
�Ln
4" SDR 35 PVC S=0.02 MIN .10
10'
10'x22
MIN.
_
N08' 8'49"W
142.50
Driveway to be set
4" lower than gutterline
6' back from gutterline
(99x73)
(99x6) PS PW
(99x2)
per DPW.
100x46
J
ogk
99x10
EDGE OF PAVEMENT
EDGE OF PAVEMENT
—
W -D
W —.
S— S . — - — .S
Hl GHL A ND VIE W A VENUE
. — - —G — G — —
BENCHMARK: LEGEND
PK NAIL IN PAVEMENT FFE = FIRST FLOOR ELEVATION TAX MAP 67 PARCEL 11
ELEVATION = 100.00
(ASSUMED DATUM) 100x62 = EX. SPOT GRADE PLOT PLAN OF LAND
(102x5) = PROP. SPOT GRADE HIGHLAND VIEW AVENUE
NORTH ANDOVER, MASS.
0>' PREPARED BY:-
SULLIVAN
Y:SULLIVAN ENGINEERING GROUP, LLC
v, 22 MOUNT VERNON ROAD
• 13BOXFORD, MA 01921
,.r- (978) 352-7871
SCALE: 1 "=20DATE: 4/20/12
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MH&9:1ehu4-et#, - Department of Public Safcth-
Board of Building
Rc,,uiations and Standards
Construction Supervisor License
License: CS 35417
Restricted, 00...
THOMAS D ZAHORUiKO
115 CARTERFIELD RD
N ANDOVE(1ti4 0845-
�'•>mmil�ciorter
Expiration: 4552
Trm 21090
The Commonwealth ofmamwi msem
kipDepartanent of £ndustrial Accidents
Office ofinvesfigafir ns
_600 Wash boon Street
Boston, M4 62.11.7
wwK:massgow1dia
Workers' Compewafion Insurance Affidavit: Bailders/Contractors/Electriciams/PIumb-
Apiicant Informationers
Name (Bnsm�nizat;o.&&,id.,):
Address:
C- IS
.444 Q)PjC
Phone t
Are yon an employer? Check the appropriate bow
I.0 I am a employer w th
4. 0 I am a genes factor and I
employees (fiill and/orpar�time)_*
?- ®I am a sole
have hired the svb-
proprietor or partner-
s* and have no employees
listed on the atashed�
Time sob -contractor have
wodkiny for me many opacity_
[No worki2s' comp- inmraace
Wart= cop- .
5. 0 Weare a coapaua ion its
3.0 nXinire•)
and
officers have mmtised &ir
I am a hnmeow= doing aU work
�•
- rW of ea =Wfim per MGL
c. 152, §I(4), and webave
fi
no
employees_ [No *O&M,
comp -
Type of project (reqs):
6- XNew conswwfion
7- Remodeling
8- Demolition
9. 0 Budding addition
10.[] Enol repairs or additions`
1 LD Plumbing impairs or additions
12.[] hoof rem
�4) 13.0 Othe rr
SomeowUM who submit ffis a fir -Y =--doing A w
and fam'hm
`Com ibait& &� bm mast a ort amide mast submit a new
�daaaal_shxshowa:,�af--- ivai�tiaC —=
� aid �wwotio�w
- I am an anploya thatispnovidurg wor&ers' - --
u formaAM �n rmancefm �J' Ploy=
Below is *C po&y and rob az
Policy # or Self ins. Lic. t
ExPitafion Date:
Job Site Address:
Attach a Coff of the workers' compeon Crty/S-
Farltme m Po�9 declaration page (showing the policy number and
sextue ooveasge as regtm� undm Section 25A oi'Ad eapirafion date).
fine Up to $1,300.00 and/or ore year GI. C. 152 on lead to the i�m�positian of mal p of a
Of up to 5250.00 a as �veIl as civrl P m the f0 m of a STOP WORK O, and a fine
�Y against the violator: Be
Investigations of flee DIA fiat insiaance Avised that a copy of this sta� maybe fonvarded to the Office of
I do hely mrdra di -paws and
_PaJo 7 d U r Me infornorc provirisedlah-/ is true and correct
Official use only. Do not faritr ur phis areg to be completed by C*Y or towit offid
City or Town
Authority (circle one)r - P cease
L Board of Health L Bmlftg Department 3- C !i
6. Other d9 oun Clerk 4. Electrical Inspector 3. plumbing Ins.Dector
Contact revolt:
Phone ;V: