HomeMy WebLinkAboutBuilding Permit #108-14 - 39 HIGH STREET 7/11/2013 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: /Os..,AlDate Received
Date Issued:
7ab/
I PORTANT: Applicant must complete all items on this page
LOCATION G'' v l'`G(•Y-.S I YJ
Or,nt
PROPERTY OWNER .... �� - --C'' ---
Print 100 Year Old Structure yes no
MAP NO: f PARCEL: ZONING DISTRICT: Historic Districta no
Machine Shop Village no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition 0 Two or more family 0 Industrial
0 Alteration No. of units: ❑ Commercial
9-Repair, replacement 0 Assessory Bldg ❑ Others:
0 Demolition ❑ Other
0 Septic ❑Well 0 Floodplain ❑Wetlands 0 Watershed District
0 Water/Sewer
DESCRIPTION OPWORK TO BE PERFORMED:
c
Identificat' n Please Type or Print Clearly) _
OWNER: Name: #z-vk J Phone:
Address: I t/r9 1,3 0 ��-
CONTRACTOR Name: k'tkyl,� Phone:
Address: �-t C_Km rib
t
� Supervisor's Construction Licensees � � � Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone: 41
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: $ � � , �A_L Le FEE: $ ��� `6,a64.
Check No.: S�Z Receipt No.: 4111C4?�
NOTE: Persons contracting with unregistered contractors do not have access Atohe guaranty fund
Signature of Agent/OwnerSignature of contracto
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
Plans Submitted ❑ Plans Waived,El Certified Plot Plan ❑ Stamped Plans ❑
TYPE OY SEWERAGE DISPOSAL
Public Sewer ElSwimming Pools 0
Tanning/Massage/BodyArt ❑
Well ❑ Tobacco Sales ❑
Food Packaging/Sales ❑
Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑
l
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes -
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT' - Temp Dumpster on site yes no
Located at 124 Mair Street
Fire Departknerit signature/date
r
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, 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
0
® Notified for pickup - Date
Doc.Building Permit Revised 2010
Building Department
The fohowing is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofiv,g, 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 apvaal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be subm.tted with the building application
Doc: Doc.Bui!,ding Permit Revised 2012
Location .�%' 1'7 1;,' Z
No./�d `�y Date
. - TOWN OF NORTH ANDOVER
•
•
Certificate of Occupancy $
Building/Frame Permit Fee
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#�--����
26688 Building Inspector
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BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
THIS CERTIFIES THAT9 BUILDING INSPECTOR
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has permission to erect .......................... buildings on .l.. . .kyr/..N....J .........................................
Foundation
j Rough
tobe occupied as ............... ...........r............................... „Si.... ................................................:... Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and a
Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION STARTS Rough
Service
............. 0 ... �BUIM
......
""""" Final
SPECTOR
GASINSPECTOR
Occupancy Permit Required to Occupy Building Rough
Display in a Conspicuous Place on the Premises - Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
• Smoke Det.
SEE EVE SE SI E
Enter construction cost for fee cal- North Andover Fee Calculation
Construction Cost
$ 119424.00 m
$ - $ 137.09
Plumbing Fee $ 17.14
Gas Fee 100 comm. $ 100.00
Electrical Fee $ 17.14
Total fees collected $ 271.36
39 High Street
108-14 on 8/1/13
Tenant fit out for Semcasting