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HomeMy WebLinkAboutBuilding Permit #375-2016 - 536 FOREST STREET 9/23/2015 f r10RTh q BUILDING PERMIT w. 3��`�1``D `s'°��� .; TOWN OF NORTH ANDOVER 0. �17��� APPLICATION FOR PLAN EXAMINATION Permit NO: Date Receiveda `b9A —ATIP -.9 Date Issued: 9SSACHU 'I PORTANT: Applicant must complete all items on this page r u ? t 7 a?^ � xx F 'Yr '�z .Y„i, '3r, *wra 5'.{ ,� ,� x�q,i%�y �y'�+'" j ✓/ fi TYPE OF IMPROVEMENT PROPOSED_ USE Residential Non- Residential ❑ New Building Kone family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial 0 Repair, replacement ❑Assessory Bldg � ❑ Others: ❑ Demolition ❑Other f%A g, 41 0, VJ00d-S4 Ve, Identification Please'Type or Print Clearly) OWNER: Name: AKt--e-lnorni JPhone: 7- Address; �c�� OUT b. �y -ur— "t z e; ARCHITECT/ENGINEER Phone: Address: Reg, No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$10©0,00 OF THE TOTAL ESTIMATED COST yyyBASED ON$125.00 PER S.F. Total Project Cost: $ r FEE: Check No.: g 1 _ Receipt No.: � 4 01 NOTE: Persons contracting with unregistered corltractoi s do not have access to the guarantyfund F &*-T-pn 1 I { • BUILDING PERMIT -{ o� "O oT"696 6 I� o� h�Atl . ' Q� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION _ Permit No#: Date Received X19 A°RATED PPa�q`� SSACHU`+� Date Issued: IMPORTANT: Applicant must complete all items on this page f 'iX t'+� r a 2 t� }�' - t a r• �'c� ' r t+ s3 Tar � -. r z 1' �, .} .,.�,t + - 't 'z Print> PROPERTY OWNER r� ; ru u f x ',✓+ .y.aw+,YA ".«. '� - ' x. se+4.,i'n" 3',;°rva.. q x: +-�.,asst-a r- ^ ear'^- .x rr x* ,...tis•ys«..r ,r� nt a fPARCELE ,'t ;ZONING DISTRICT r HistoncDistrictU=�, yesno r x _-.k ` '�-4 { •, _t w, s ; ;.��� :�-sa 9 sib;. s * ... st � P '+ �.. i -Kt r4+....{t.. .z�Sax-.. aa.. �v, wadi�.- a,..,.w. � !.&x c,�t.r.�fi•sv....�.r&.i..-*.4. .,,..,,r-�ar'.,,..3..ac-r� ...;x s�-_�a..,...-e r .,r. ,1. _ _ ,'r. tib TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial f ❑ Repair, replacement ❑Assessory Bldg ❑ Others: I ❑ Demolition ❑ Other ' ❑ Septic '�7 We'll ' ' { ' � l7rFloodplain" ❑1Netlards°° `u ❑;1/VatershedDistrictw 44-3 ❑V1later/Sewer# ,_ �.. DESCRIPTION OF WORK TO BE PERFORMED: f f I Identification- Please Type or Print Clearly OWNER: Name: Phone: I. Address: Confractor,Name ,'.t sa `, Y` I?hone f " i Y .- .» r� arm l".• e Ema�I 4 aak r is w r bbl { ' £ i -.'{ F_.v5 }��. A i yyw d ,e, t'}i # I € I T `f a + 2 �. z.ar . a s Z _ ..x. x..'L-. �.t� n .....:awe-.,1:3.•e..°A. &�,M+. .+..,'. +-s-...F- .,ft�..r�a.>+�+ t? iHS2�' .bay a'.�N§- Y - � a � —, - 4 r.�RN'b -.� a t..w+•. �,. ..� , E,of n':«d. A.;� Supervisor s°Construction License = 't t w...� +,LY r r ✓.. r,; Y a { '-�,. `-' �a w tmis-�-A' i .x.) €[ S r+.S.7. �� �: � 'I': Home�ImprovementyLicense aw ,a .43y._ ,. Exp ._ ARCHITECT/ENGINEER Phone: Address: Reg. No. � i O FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guarani tv fund g _ Signature of Agent/Owner Si nature of contractor . t Location I No. / �2I Date I TOWN OF NORTH ANDOVER ^� Vic; ♦ � Certificate of Occupancy $ !; Building/Frame Permit Fee $ I Foundation Permit Fee $ Other Permit Fee $ I TOTAL $ i Check# �� e r 29401 Building Inspector Plans Submitted 1.a Plans Waived ❑ Certified Plot Plairl' ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennanent Dwnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature A COMMENTS x Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments I Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street AFIRE DEPARTMEA m NT � - , - Tern Duster:on �L3 �,,. y t: a,�--� p � p 124IMainfStreetx ; Xx s � , _ f� 'K . 'aL" xss a 'i�' � x? z�F�ireD.eprtment;signature/date .ds a � ..`;t � 4i 5; 'F fur- 4'ka�m5t 'k ,cFk ^a• k� µis ; _ .aarA a w.. ..x. Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, roast 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) i i i ® Notified for pickup Call Email f Date Time Contact Name Doc.Building Pennit Revised 2014 i G 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 i o Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit u Photo Copy of H.I.C. And-C.S.L. Licenses o Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) u Mass check Energy Compliance Report (If Applicable) Li 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) Li Building Permit Application o Certified Proposed Plot Plan Li Photo of H.I.C. And C.S.L. Licenses Li Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) u Copy of Contract u Mass check Energy Compliance Report Li 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:Building Permit Revised 2014 f TOWN OF NORTH ANDOVER Department: Finance Accounting use Only Voucher No: Date Paid Vendor. Invoice Invoice# Number Vendor Name&Address p Account. Description Amount or Date _ Number &U O 2—Ci4pt P 0. (6bx zaI �ee- esco4 , 1- 1A �t�o1 Total $ I hereby certify that all goods, materials,and or services have been received and have been purchased in compliance with Mass. Gen.Laws. Jennifer A Ya rid Treasurer