HomeMy WebLinkAboutBuilding Permit #611-11 - 51 EMPIRE DRIVE 3/15/2011TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO:
—�/ �—
Date Issued hr I
IMPORTANT:
-4 S I , =*'-MA
Date Received
Lt must complete all items on this
Print
Print
MAP NO:/07(f---pARCEL���—BONING DISTRICT_ Historic District yes o
Machine Shop Village yes no
TYPE OF IMPROVEMENT
K New Building
❑ Addition
❑ Alteration
❑ Repair, replacement
❑ Demolitions
PROPOSED USE
Residential
$One family
❑ Two or more family
No. of units:
❑ Assessory Bldg
❑ Other
❑
❑.Floodplain °Wetland"s
DESCRIPTION OF WORK TO BE PERFORMED:
Identification Please Type or Print Clearly)
Non- Residential
❑ Industrial
❑ Commercial
❑ Others:
�n Watershed,Distr
OWNER AAA
CONTRACTOR Name: �p
Address:�`f ,f11��—F V"r)Y i t/e- P A/1 'A O Icl 2- 1
Supervisor's Construction License:
A) %3l Exp. Date:
��r C� �Z
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER �,-lY�(%�T%��� F- Phone:
Address
Reg. No. -I" %
FEE SCHEDULE. BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST B/ABED ON $125.00 PER S.F.
Total Project Cost: $
J -,q 0 40 FEE: $
Check No.: % Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
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Location Alty /6 r
No. 4�1; Date % ::� -ZC7//
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee s /06,
Other Permit Fee $
TOTAL $
Check # n Ty -
23955
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Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISTOSAL
Public Sewer ng/MassageBody Art ❑ Swimming Pools • ❑Well cco Sales ❑Food Packaging/Sales ❑Private (septic tank, etc. nent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMEN
CONSERVATION Reviewed on
COMMENTS nuA-,;
HEALTH
COMMENTS
DATE REJECTED
DATE APPROVED
1-1
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Drivewav Permit
DPW Town Engineer: Signature:
FIRE DEPARTMENT - Temp Dumpster on site yes Locatedno384 Osgood Street
Located at 124 Main Street
Fire Department signature/date
COMMENTS
a
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
❑ Notified for pickup - Date
Doc:.Building Permit Revised 2008
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)
❑ Muss 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
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
QUOTE: 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
Chat 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
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