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HomeMy WebLinkAboutBuilding Permit #522-16 - 46 WINTERGREEN DRIVE 10/28/2015r� Permit NO: 14" Date Issued: I'D 14 E i LOCATION A W i BUILDING PERMIT TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINATI N Date Received `y qq cx.iui:wcw ` 9SSACHUS�t RTANT: Applicant must complete all items on this page PROPERTY OWNER DELI X. s �US�t L.MKf, print MAP NO: PARCELITI. ZONING DISTRICT: Historic District yes no Machineh, Sop Vtilage Yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic [. Well ❑ Floodplain ❑ Wetlands 0 Watershed District ❑ Water/Sewer 11 Identification Please Type or Print Clearly) OWNER: Name: U X �Vksw �A�f t4, Phone: Address: W f N.'TT-I215 ILf�� W- • ct1r5-14 ArtGWCe. IUA DI84S-46S5 FONTRACTOR Name: Phone: Address: ; 28r C+Im�sG Ib �JA-Nt o;L Supervisor's Construction License: Exp. Date: C S - 069 2-0 License: Exp. Date: Home Improvement 2t� IZ. J 4 J�,2. ARCHITECT/ENGINEER %1 Phone: Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT. $1100 PER $1000.00 OF THE TOTAL ESTIMATED COST OOS�T, BASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ 1�l' Check No.: yReceipt No.: rja 1-61 NOTE: Persons contracting with unregistered contractors do not have acc s to the guaranty fund . i f(Ar y x." 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 Reviewed On COMMENTS CONSERVATION 4COMMENTS HEALTH 1 COMMENTS Signature_ Reviewed on Siqnature Reviewed on Sianature 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: FIRE Located 384 Osgood Street kDaEPAR�T ENT . T� ® p . site est IL at 4MainStreet F1re.•Deparfinent>aig�na#ure/date 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 NU I t5 and UA I A — wor department use ❑ Notified for pickup Call Emai Date Time Contact Name Doc.Building Permit 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 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/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 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 o 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) o Copy of Contract o 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 Deeds. One copy and proof of recording must be submitted with the building application Doc: Building Permit Revised 2014 Location &1�24e'i'L ,622 6, Date v r Check #.1 - 3 95 TOWN OF NORTH ANDOVER Certificate of Occupancy $- Building/Frame Permit Fee . $_�(l` Foundation Permit Fee $ ', Other Permit Fee $ TOTAL $ Building Inspector O �r Q �. $ O o p CD CL a� � a' CD OCDT W W .L o CO CD cn CD O O N a r• a n 0 CD CDv B N� U) 0 0 CD O CD c� z m D v z z CA m O m a) O cn O D Z O CD N 5' to O 00 o. CD co 0 0 N 2. N rt o=� ° _ o N N =, < (DD en CD,CL 0 CD 0 0 rt o. n m � o == �. N N rt CD TI O O o.°. Il7 � ::A �_ m W 0• N O CD CD 2 a N CD D O 0 � co CL N 0 � • ° 0 CD CD O < CO N• rt 111 0 o o' � N 0 0 c D m oo �. o. o. —_ N O fi (D U) o CDCD o 2) V '�-- 0 0 O L CO a 1r O ° CD CD C N O _0 CD N O °, e - ID l` D° CD -0 ci as o' CL N O (D � Ln 7 m z O WT .Z7 Sn T N CD w QCQ S T RL .Z7 OCq S -n (7 7 (DrD K X OOq S T Q N A C T 2 \ f+ •" c V D m G) H Z H M O m ^� '° D r _ Z m 0 C Z G) ZLA m 0 C v O 6 _ Z fA M m n 0 3 =r ° W O O T m r x O y 0 IC) N. C O O N 0 O CD f-IIL 0-0 CD so D co. �' 0 O 0 CD cD Q o CL cr CD CCD O UD CD CD a CL o N. 5.0 CO C � v -0 Z CD 0 0r-v O CCD O CD i� z m cn O Z c v z z cn n m x cn z Z V I < o=fig _ O � y, 0 � C IlL O _0 CL0 _3 O O '"" Q mCDCD cin) ON =DV N CD m Z O. G1 @ CD co 0 � O � WS O N :Q = O 'a (O < CD o0 (Q �' v)v Z CD O o -%. C7 o rt N �CDZ�% N r p (Q C. L Q R N CL `NCD CD _ fi CD MQ03 CD -+ r ) :C.. 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