HomeMy WebLinkAboutBuilding Permit #112-2017 - 864 CHICKERING ROAD 8/4/2016 ".- -A, 4 VW
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TOWN OF NORTH ANDOVER NORTH
APPLICATION FOR PLAN EXAMINATION °f s• �q"o
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Permit NO: � U"O Date Received
9SS�tHUS�S
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION � 6 `"1 Fc p i 1 vA 15! (L l
Print
PROPERTY OWNER M A-12_k �_- M 1Qk1P-e V\ L4-e V\' Z
Print
MAP NO.: PARCEL: � ZONING DISTRICT:
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non-Residential
❑New Building ❑One family
❑Addition ❑Two or more family ❑Industrial
❑Alteration No. of units:
KRepair,replacement ❑Assessory Bldg ❑Commercial
❑Demolition
❑Moving relocation ❑Other ❑ Others:
❑Foundation only (,
DESCRIPTION r\ .5 I� ON \ WO TO�BE RFFORMEDK V l I� td�Ge r Uva( �J
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�,A Identli�fication Please Type or Print Clearly)
OWNER: Name: {`'\1A a2 l�- (f4 f\AAQrAQ_V\ v`�Z Phone: I
Address: _ ttLQ (l._1 V1 I +��&tx"L.
CONTRACTOR Name: (�t �'� A-\V VL- Phone: �7 a U4 qi 3-1 1 L
Address: 2-k Lo- X ` ;T Ast 9�_ 1V� V"\1k l P-H�4
Supervisor's Construction License: C 5 - o8 (,�2 s 2- Exp. Date: Q
Home Improvement License: 13 '--( A- � Exp. Date: L 0 /I c, � Z 0 1 -7
ARCHITECT/ENGINEER Name: Phone: .J
Address: Reg.No.
FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000. 3F THE TOTAL ESTIMATED COST BASED ON$125 00 PER S.F.
Total Project Cost :$ ® Q . x12.00=FEE:$ L
Check No.: L b Receipt No.: .doy
Page I of 4
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BUILDING PERMIT o AtLED tb7 ti�
TOWN OF NORTH ANDOVER o
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APPLICATION FOR PLAN EXAMINATION
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Permit No#• Date Received �Rp�R 1TED C7
�SsgcHus�t
Date Issued: -
IMPORTANT:Applicant must complete all items on this page
LOCATION
Print
PROPERTY OWNER
Print 100 Year Structure yes no
MAP PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
El Addition El Two or more family El Industrial
El Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
D;Septi:c m®Wel � o dp�la'ina ®Weal r%ds Watersh_I D. ►strict
i
DESCRIPTION OF WORK TO BE PERFORMED:
Identification- Please Type or Print Clearly
OWNER: Name: Phone:
Address:
Contractor Name: Phone:
Email:
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date: '
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
Total Project Cost: $ FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to>the guarantyfund
Location
No. 2 — Z o Date
• TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ V�2 —
Foundation Permit Fee $ _
Other Permit Fee $
TOTAL $
y
Check#
? �, Building I pectorf /I
30596
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ [Tobacco
nning/Massage/Body Art ❑ Swimming pools ❑
Well ❑ Sales ❑ Food Packaging/Sales ❑Private(septic tank, etc. ❑ rmanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF A U FORM
PLANNING a DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on_ Signature
COMMENTS
WEALTH Reviewed ori Si nature
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Wafter& Sewer Connection Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTM%ENT TempADumpste on;site�.,yes r "
+.. x a..'s'1�a i_f saSlf�+rno 1
0eated a 12.4 Main Street ,�� ^� -
retp artmant-si nature/d� :r
� . u s`;.rr Ay s 'i't+et,14 X11*� „y
i.l - , Err?`t'`�.tsi- ,�•-�.5,•. Y"'1"'.sgl:.�"";3- "+s�! »'15;-t_77 y_ -
COMMENTS .e�: ► :-fir. r.t�.ts r,�., , n ? .; �
v
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
i
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)
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I
❑ Notified for pickup Call Email
Date Time Contact Name
Doc.Building Permit Revised 2014
r
Building Department
forms to be filled out for the appropriate permit to be obtained.
The following is a list of the required
9
Roofing, Siding, Interior Rehabilitation Permits
Building Permit Application
4� 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
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
Permit
Building Perm Application
Certified Surveyed Plot Plan
Workers Comp Affidavit
Photo Copy of H.I.C. And C.S.L. Licenses
1 �6 Copy Of Contract
Floor/Cross Section/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
OTE: 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)
46 Copy of Contract
2012 IECC Energy code
4� Engineering Affidavits for Engineered products
OTE: 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
1