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Home My WebLink AboutBuilding Permit #055-2017 - 254 GREAT POND ROAD 7/18/2016 Ily .2eQ BUILDING PERMIT O� NORTIi q ,fit LED /6 TOWN OF NORTH ANDOVER o� 4` o APPLICATION FOR PLAN EXAMINATION Permit No#• - zo Date Received ,] SSACHUS� Date Issued: l� IMPORTANT: Applicant must complete all items on this page LOCATION G/ Print PROPERTY qWNER 61)vL ) (,L L &--- / Q Print100 Year Structure yes no MAP PARCEL:��_ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building XOne 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 �eo►/'DESCRIPTION OF WORK TO BE PERFORMED: Prv�►�w ?&&e: 4- Identification- Please T or Print Clearly OWNER: Name: IW4- ,�� Odle- Y/t°( Phone: Address: evPru a✓ �Ld Contractor Name: (,, o) JJ �� Phone: Email: Address: J k 1z8&4zez1 Supervisor's Construction License:_,C, 66o 4F _Exp. Date: Home Improvement Licenses Exp. Date: ARCH ITECT/ENGINEER. !l/iCl IG�,r r l�LPhone: � 3 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: $ 01/() , FEE: $ A Check No.: Receipt No.: 6 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signent/Owner Sig-nature- cnnof trar+ter ' -- - - ��_._ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan' Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanuimg/Massage/Sody 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 I PLANNING & DEVELOPMENT Reviewed On !l t th Signature_ COMMENTS Pt--a- U3SP 41 1 qh(o k I u5vloS-rr,nncj '?1 I; ll j Wel ok lY rm �0 Cx4 i/eTF-b e 0-t-P1Cc� A// Cemol nm if /At Spt z Perµt T y M 1110 Muse be- rte? # INsub. L)�. r-texo -710011. CONSERVATION Reviewed on 1 1 (o Signature::::3L-, COMMENTS HEALTH Revie e o Si nature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Pla ming Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street EIRE DEPAR=TiMENT TempfiDumpster on,site Nyes___ riot Located,at 12„4iMain.Street - Fire,Depar nient,signature/date ; 2�66� 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, avast 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) V 201kj7 Ll Notified for pickup Call Email { Date Time Contact Name Doc.Building Pennit Revised 2014 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 OTE: 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/Cross Section/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 OTE: 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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:Building Permit Revised 2014 Location t r , No.02-4 4- Date /7?Z�/rte - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ F' Foundation Permit Fee $. Other Permit Fee $ — TOTAL $ Check# '' Building Inspector Enter construction cost for fee cal - North Andover Fee Cakulation Construction Cost $ 105,000.00 m $ - $ 1,260.00 Plumbing Fee $ 157.50 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 157.50 Total fees collected $ 1,675.00 254 Great Pond Road 055-2017 on 7/18/2016 2 car garage