HomeMy WebLinkAboutBuilding Permit #444-14 - 72 Elm Street 11/18/2013 i
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued: I I I 1
IMPORTANT: Applicant must complete all items on this page
LOCATION T__L l
T/Z I rV�Y�J 1.4w os v (t'r t r A`Ti OV4
PROPERTY QWNER�_ if _ __- �-�. �
Print .100-Year0ld Structure n0
.MAP NO -___ PARCEL:�� ZONING,DISTRICT: __�-.Historic District a no-
Machine ShopVillage es 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
❑ Septic ❑WellFloodplain+ D 1Netlarnds 1Natershed District
11 Water/Sewer_.
DESCRIPTION OF WORK TO BE PERFORMED:
,AIA/o-3 <.4Joe,4 Zip /-? A-Dv&-,J 'r)
Identification Please Type or Print Clear y)
OWNER: Name: i�`T�I?M j C'V5,-,1a A7o-, ' 0'2: . "4 Phone: 17� 6f 4T'Z
Address: ?
_r Phone:.
CONTRACTO Name: .
Adtlre
SS:
__s ' _ s
Supervisor's4Construction License. _ _ Exp Oate .
Home Improvement License, __- z_ - ._ _ __ _. Exp.
ARCHITECT/ENGINEER 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: $ 21�Oy FEE: $
Check No.: i o Receipt No.:
NOTE: Persons contrac 'n with unregistered contractors do not have access to the guaranty fund
SignatureLof Agent/Owne _ Sigature�of'contractor,:,
Plans Submitted Li Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
Location Elm S 1
No. Date
r '
• - TOWN OF NORTH ANDOVER--'
• Certificate of Occupancy $
Building/Frame Permit Fee c
Foundation Permit Fee $
,
Other Permit Fee $
TOTAL $
Check# J
27115
Building Inspector
i
Plans Submitted-0 -.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 11
Private(septic tank,etc.._ ❑- _ -Permanent Dumpster on Site ❑
IJ_ THE.FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE.APPR-OVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
`i
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH ' ' Reviewed on _ Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes- .-
Planning
es -Planning Board Decision: Comments
D
Conservation Decision: Comments
Water& Sewer Connection/Signature& Date Driveway Permit
DPW Tb`v ! Engineer: Signature: �
Located 384 Osgood Street
FIRE DEPARTMI==NT Temp Dumpster on site .yes no
Located at:124Mair Street
Fire De ' j r
part mei�t'signatureldate
COMMENTS F
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.Sectio n.21A-F and G min.$100-$1000 fine
NOTES and DATA— (For department use
,G� r y .
® Notified for pickup - Date
1
Doc.Building Permit Revised 2010
i
1
Building Department
The fol!'owing ig�a-list of the required.forms to be filled out for-the appropriate:permit to.be obtained.
Roofh,g, Siding, Interior Rehabilitation Permits
g,
❑ ' B%gilding 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)
❑ 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
1 ❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
In all cas<s if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the apw-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submAted with the building application
Doc: Doc.Building permit Revised 2012
NORTH
oven of � t E .. 1, Andov.IF..
No. * - 1
soh " ver, Mass,
COC NIC Nl MACK V�
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(D 1P
S V
BOARD OF HEALTH
Food/Kitchen
PE �� Septic System
VOill
THIS CERTIFIES THAT .... ...................... BUILDING INSPECTOR
..... . . . .... ....... ..
Foundationhas permission to ere .. .... ...... buildings on .. .
Rough
tobe occupied as ........ .. .. .... .... .... ......... .......................................................... Chimney
ery
provided that the person accepting this permit shall in evrespe onform to the terms of the application Final
on file in 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 CONSTRUCTIO STARTS Rough
Service
............. ..... . . ..... .............................. Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building 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.
Smoke Det.
NORTH
own o z *._ E ndover
0
No. 44q -14
_
�` zh ver, Mass
�s,9 A°RATE D P�,�•(5
S U
BOARD OF HEALTH
Food/Kitchen
PE MIT T
�* ft
Septic System
o*..
8-7!! L
THIS CERTIFIES THAT ,�. ��„� a,� ! ...... ., {� �;,�/1�1�„�h.. BUILDING INSPECTOR
.. ... .........
has permission to erect .......................... buildings on .... ..4'.... .IM.%wo...... ................. Foundation
Rough
to be occupied as .......... .....il.�.l�!� Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application Final
on file in 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
20 . PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCT S TS Rough
Service
................................................................................ Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building 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.
Smoke Det.
SEE REVERSE SIDE
s 47D �et J,60
Amin sw digsafe.com
Dig Safe Ticket# 2013 Date f I >3 IZyr:� Time 10! rel
Contr I.D. Caller's Name tVIL-t,.ij'►'► Title
Phone# 9-* (of 7 1 1 Fax# Alt# 1/'7j- &S 3 7
Email address b e4,wp5e mvLc4 s, • 1 Business Hours to
Company A)14 Cl uI-e-k
Address 47 Z Cl'P^ k
City 414>6dio C State 04- Zip G��FY1
State A4 Municipality
(optional) Latitude Longitude
P ,, c 5 c� G i q�iaGti E
Address/Intersection lX1O.,� JT' �,(-!�tRC�F 5 . . .� �9-1
Buffer Distance(Please circle): 500' 600' 700' 800' 900' 1000' 1100' 1200' 1320'
Nearest Cross St 1 C?,OsS
Nearest Cross St 2 (11 S-T a-9-�
Additional information c One-'b 6iinA -R7 12t+�� 2ata�1 �°. ittg2C.i
st CkU 1 h c)mu tu1oe6 i� 6--A
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Type of Work � � �S� l�(�'tc� Cf<Y11 �
YP
Area of Work A-Jog A Wil: :5 t c1e- i?�` %alt �6,UAA*inq W-141 ween OV-1 4�-P-
5iC3i-e— c z:i z +fl-e.. V i, L r roc
Area Premarked? Y N
Start Date 111 Up Time
Excavator Doing Workv�r� , �����Y"s , Sc -t s
Member Companies Notified:
• There may be non-member utilities in the area that you need to notify.
• Electric and other companies may not mark lines they don't own or maintain.
• The excavator is responsible to maintain marking placed by member utilities.
• Tickets expire exactly 30 days from today in NH and VT;60 days in ME and Rl.
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