HomeMy WebLinkAboutBuilding Permit #590 - 50 JAY ROAD 4/11/2008 R
BUILDING PERMIT o�"�0 6'�a
TOWN OF NORTH ANDOVER 02a
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date ReceivedR,*ED
SACHUS
Date Issued: � 's0
IMPORTANT:Applicant must complete all items on this page
LOCATION
I
Prin
PROPERTY OWNER � ��
Pnnt
MAP NO: PARCEL: ZONING DISTRICT: HistoricDistrict yes no
Machine Shop Village 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: N
Demolition Other
Septic Well Floodplain Wetlands Watershed District
Water/Sewer
. I
DESCRIPTION O=WK T BE PREFORMED:
94C—V
Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address:
CONTRACTOR Name: Phone:
Address:
Supervisor's Construction License: Exp. Date:
Home lmprovement License: Exp. Date:
i
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125 PER S.F.
Total Project Cost: $ ��� FEE: r
Check No.: S Y 7 Receipt No.: x/ 07 0
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
tS g ature of Agent/Owner` � '� Signature of contractor
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
o 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
r ❑ 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 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2008
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
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 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, mast or service drop requires approval of
Electrical Inspector Yes N
p o
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA— For department use
i
❑ Notified for pickup - Date
i
Doc.Building Permit Revised 2008
Location �6 �✓
No. Date
HQRT1y TOWN OF NORTH ANDOVER
3? •. • pL
� s
+ s
+ � ; , Certificate of Occupancy $
Building/Frame/Frame Permit Fee $
a.+cHust 9
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
e�
Check #
21070
13061i4d Inspector
ORTH
Town of
0 .1.....w. . ..�..
No. D =__. _
_ AK o dover, Mass.,
COCHICHEWICK y�.
ORATED PV C5
BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
/� �,e ,(i a�G �� BUILDING INSPECTOR
THIS CERTIFIES THAT
................. ... .. .........�..Y.................�...................................................................................:............. Foundation
has permission to erect........................................ buildings on..—! . ....J....�h..` ...U.1�. ........................................... Rough
to be occupied as......................... � �...s .. fir...t`-. ............ (.. . .1. :Y :..".............................. Chimney
provided that the person accepting this permit shall in every respect conform to the terms of thtapplication on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and 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 ST TS Rough
............. ............::....... Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS`INSPECTOR
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.
IF SEE REVERSE SIDE Smoke Det.