HomeMy WebLinkAboutBuilding Permit #853-15 - 62 WILLOW RIDGE ROAD 4/27/2015L
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bI l� t - BUILDING PERMIT
{ /�tlf -d�+- Jt TOWN OF NORTH ANDOVER : � y
APPLICATION FOR PLAN EXAMINATION -
-�S
Permit NO: Date Received
1 �9SS�CHU
Date Issued: 1
IMPORTANT: ADMicant must complete all items on this naee
LOCATION &&Q 1Wh 10(0 AdOf 14
PROPERTY OWNER r 1
i Print
MAP NO: +�' PARCEL: ZONING DISTRICT: Historic District ye no
Machine Shop Villaqe ve no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
1;K10ne family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
KfR;pair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑ Septic ❑ Well
❑ Floodplain ❑ Wetlands
❑ Watershed District
❑ Water/Sewer
Address:L2
CONTRACTOR Name:
Identification Please Type or Print Clearly)
Phone:
Address: 35
q K • 6�, ,
q
Supervisor's Construction License: 03 --7 UCB Exp. Date: 411-7110
Home Improvement License: l OUe?Exp. Date:
?1 LP1 o I t C"IlCA
ARCHITECT/ENGINEER N/ 9 Phone:
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: $ -v7 0 FEE: $ ?q,&0
Check No.: v 2-J�P2.. Receipt No.: D- 1
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
signature of Agent/Owner Signature of contractor
Permit No#:
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
�, ttLHU �6t6NQ
1
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
S%t Coist uctloriLlcerise
Se rc > ❑ 1Nell
p
_
❑Floodplain Wetlands
Watershed District i
� C Water/Sewer _ .t
-
- —
DESGRIF I IUN UI- VVUMtX i u tst: rt:r<rumvnw.
Identification - Please Type or Print Clearly
OWNER: Name: � Phone:
ARCHITECT/ENGINEER Phone,. _ ,
Address: Reg. No.
FEE SCHEDULE. BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASED ON $125.00 PER S.F.
Total Project Cost: $
EE: $ .
Check No.: Receipt,No :
---NOTE-:--Persons cont"acting with -unregistered contractors- do -not have;access-to- the-guaranty_fund
Signature ofiAgent/.Own.er __ _.. Signature of contactor ._
r-
Contractor Name
P hone
s —.. r�
rc
Yo
Address
S%t Coist uctloriLlcerise
Date:` #�
a°rvisors
HQrrle IM_ royemen Lieense
Exp. _ "Q_
ARCHITECT/ENGINEER Phone,. _ ,
Address: Reg. No.
FEE SCHEDULE. BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASED ON $125.00 PER S.F.
Total Project Cost: $
EE: $ .
Check No.: Receipt,No :
---NOTE-:--Persons cont"acting with -unregistered contractors- do -not have;access-to- the-guaranty_fund
Signature ofiAgent/.Own.er __ _.. Signature of contactor ._
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Plans Submitted ❑
Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE,.' F SEWERAGE DISPOSAL
p1"blic 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
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
Reviewed On
Signature
Reviewed on Signature
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 Driveway Permit
DPW Town Engineer: Signature:
-,� _ Located 384 Osgood Street
FIRE DEPARTMENT Tem pure = ster on site
p p yes
Locatetl� at 12'.4 Mairi, Street
— - -
Fire Oepartment signature/date. �__
COMMENTS
Dimension
Number of Stories: Total square feet of floor area, based on Exter oT. dimensions.
Total land area, sq. ft.: To
ELECTRICAL: Movement of Meter location, mast or service drop requires::approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
No
Doc.Building Pennit 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
o Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o 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
Li Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
o Floor/Cross Section/Elevation Plan. Of Proposed Work With Sprinkler Plan And.
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
o 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
o 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
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
Location ta 2
No.
Date
�Z-j 1
Check # 6 -Z--
TOWN OF NORTH ANDOVER
Certificate of Occupancy $-
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee
TOTAL wr
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