HomeMy WebLinkAboutBuilding Permit #627-12 - 32 EMPIRE DRIVE 2/29/2012TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO:.Date Received
Date Issued: X 2
IMPORTANT: Applicant must complete all items on this Daae
LOCATION 3a -E/1%T !i65 D pzw e S)
Print
PROPERTY OWNER ���� \) ( A!,P LLC Unit #
Print
MAP NO:/ 0% PARCEL:&�//&ONING DISTPJCT;1 Historic District yes
Machine Shop Village yes
100 year-old structure yes
TYPE OF IMPROVEMENT
PROPOSED USE
Resi ential
Non- Residential
AeNew Building
❑ Addition
❑ Alteration
VOne family
❑ Two or more family
No. of units:
❑ Industrial
❑ Commercial
❑ Repair, replacement
❑ Demolition
❑ Assessory Bldg
❑ Other
❑ Others:
OfSep isi ❑6 kw'6fl
, ater�Sewer,
WN ffid TMUI Ti nml 0 FIM, etlands
D Watershed }istnet
DESCRIPTION OF WORK TO BE PERFORMED:
s
We&
FOZI PDA 7-10A) 0 L�
(Identification Plgase Type or Print Clearly)
OWNER: Name: �deG �l \ LL -A K -i P LLC Phone:�3g' -3
7
Address.A7 C ,k)A qfI /I ) IJ S roc �ea)eLM
�
CONTRACTOR Name: D� (� i ►'I �. /�u A- Phone:97,?-FF/- 19Q
Address: a%? W49#10 -Mai. S cec ( 4ou( -,,L— �-?
Supervisor's Construction License:/ �2�.3 J Exp. Date:
Home Improvement License:���Cf- Exp. Date: l
ARCH ITECT/ENGINEE ��Phone:
Address: ��c�f1�,U iN �A 01033 Reg. No. --&f eP7 7� s
FEE SCHEDULE. BULDING PERMIT: $72.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F.
Total Project Cost: $ FEE: $ 1220 • ® 0
Check No.: -11;� Receipt No.:��
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Location A,-/ '&le
Date �2 I.-2,5;11Z—
No. j� 2 -? -/Z
Check# 2911
25059
TOWN OF NORTH ANDOVER
Certificate of Occupancy
VZB'ilding/Frame Permit Fee
undation Permit Fee
Other Permit Fee
TOTAL
Buildil�g Inspector
J
Plans Submitted M Plans Waived ❑ Certified Plot Plan M/Stamp ed Plans L7
TYPE OF SEWERAGE DISPOSAL
Public Sewer L•�d,/
Tanning/MassageModyArt ❑
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
CONSERVATION Reviewed o
COMMENTS
HEALTH
COMMENTS
DATE REJECTED
0
DATE APPROVED
Reviewed on Siqnature
t Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
11
Planning Board Decision:
Conservation Decisi
Comm
Comments
Water & Sewer Connection/Signature &Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dempster 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 Meter location, tmast or service drop requires approval of
Electrical Inspector
DANGER ZONE LITERATURE: Yes No,
MGL Chapter 166 section 21A —F and G min.$10041000 fine
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
o 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
MOTE: 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
o 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
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 2008mi
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.$10041000 fine
Doc:.Building Permit Revised 2011 June/mi
O
z
O
C 0
o
m C
o
t7
CD
a,
°
C y
O
H
GO
A
W
;vV
w°
cn
Gq
-0
w°
a�'
U
u,
p� C
ev ev
w
u.
w
c%
Pr�
v
cn
Cl)
a
a
.T
2
co
O
w
L
O
O v
CD
0.
O CO)
D C
m
O pm
Ip"0
y O.=
m CO
CD Q CD
in O
G Cl
O O d
a �a
CD cc
C
CO2 CD
CL
C..i v2
O C
^^C
0.
H
0
uj
0
Y♦
LLI
Y♦
W
W
19
W
U
C 0
m C
CD
C y
O
c
• � O
;vV
p� C
ev ev
Cc
O L
Ea
.0c
m CD
0 c
N
o m
O c
c_
•�
%�J
'f
`
L
d
y
N
m3
V
cm
m
N
S
N
NO
E CO
O
D
Cf
�`IOQ
�.
•o
m
wv� 0
Z'
0
ti
c CL C2
m
c
•O
Q
i CD C
m
=
~
m
~
N
Ci
N
y0..
c
y CI .�
Lu
0
•N
om,,
CMD
A
.�.
�
.m
dt C
� r CCD
3 ca
z
O
LU
Q CD
Q�Q
Nj
CL
O 'a O 'O
J
cz
=tea
m:10
a
a
.T
2
co
O
w
L
O
O v
CD
0.
O CO)
D C
m
O pm
Ip"0
y O.=
m CO
CD Q CD
in O
G Cl
O O d
a �a
CD cc
C
CO2 CD
CL
C..i v2
O C
^^C
0.
H
0
uj
0
Y♦
LLI
Y♦
W
W
19
W
U