HomeMy WebLinkAboutBuilding Permit #807-11 - 36 EMPIRE DRIVE 6/1/2011TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: ` Date Received
Date Issued:
MPORTANT: Applicant must complete all items on\ this page
LOCATION "131-C, (:5* P/ 6— O gl U e � J
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PROPERTY OWNER V
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MAP NO: b?C PARCELO# ZONING DISTRICT? Historic District yes n
Machine Shop Village yes
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
ew Building
&16ne family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
0 Repair, replacement
❑ Assessory Bldg
0 Others:
❑ Demolition
0 Other
❑ Septic ❑ Well
❑ Floodplain ❑ Weflands
❑ Watershed' District
0 Water/Sewer-
DESCRIPTION OF WORK
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Wa 6 -Le Z r �C'PitlC� 1�- i X9.1
(Identification Please Type or Print Clearly)
OWNER: Name: 2 p -r /M a? ib Phone G%?X-SF2 -3/6-z-,
Address#_41 CQr0f7- ,J%N"b
CONTRACTOR Name: d�r J101 e.S.�t `U Pt Phone�t�-4Fe2-37G -z,--
Address: `1 q P6 tic) h-C---E>>G >(�f-1,2
Supervisor's Construction License:�e� l J�� Exp. Date:
Home Improvement License:
Exp. Date:
ARCH I T ECT/ENGINEERZA-ry-4 CJq A of 0,::5- Phone:�E-2-�
Address/,79C--w INS 51, C', r,A. w N' N1 `6 4 I F33Req. No. ?
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Tota! Project Cost: $ FEE: $ �aC�
Check No.: ®ST- Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owne SGu. Signature of contractor
Location
No. FO %— // Date
TOWN OF NORTH ANDOVER
y
.I, Certificate of Occupancy $
r ,
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # v A
2 4 uj, /1-1 1 -
Building Inspector
Plans Submitted W Plans Waived ❑ Certified Plot Plan U/ 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
CONSERVATION Reviewed o
COMMENTS
HEALTH
COMMENTS
DATE REJECTED
r
DATE APPROVED
III
Reviewed on S-"nat�-
Zoning -Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Comme
Conservation Decision: Com/
Water & Sewer Connection/Si na a at
DPW Town Engineer: Signature:
FIRE DEPARTMENT - Temp Dum r on site yes.
Located at 124 Main Street
Fire Department signature/date
COMMENTS
Located 384 Osgood Street
no
L
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
NOTES and DATA — (For department use
PICKUP -
Doc:.Building Permit Revised 2008mi
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
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
❑ 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
(VOTE: 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 heeds. One copy and proof of recording
roust be submitted with the building application
Doc: Doe.Building Permit Revised 2008mi
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