HomeMy WebLinkAboutBuilding Permit #1 - 93 MAIN STREET 7/1/2008 NORTH
BUILDING PERMIT o� NOR00R
TOWN OF NORTH ANDOVER
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APPLICATION FOR PLAN EXAMINATION
Permit NO:o / Date Received o
opq cocw�i i�.K. 1'
��SSACHUS
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION
PROPERTY OWNER L esl,
Print
MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building One family
Addition Two or more family Industrial
No. of units: Commercial
Repair, replaceme Assessory Bldg Others:
Demolition Other
Septic Well Floodplain Wetlands Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
i
Ide tification lea a Type or Print Clearly)
OWNER: Name: LAS `e So�-1 Phone:
Address: 73 AU/&/, S fl/11 �i?v�✓ �'IZ j ,
x
CONTRACTOR Name: Phone:
y ,�- E'�f} r e- Phone:
Address: �T t
Supervisor's Construction License: '05 /00�' Exp. Date: ` v
Home Improvement License: Exp. Date:
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: $ FEE: $ 3
Check No.: 7 �s y Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to th ar fund
signature of AgentlOwrier y -�Signature of contract _ p
Plans Submitted 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
Private(septic tank,etc. Permanent Dumpster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed on Siqnature
COMMENTS
HEALTH Reviewed on Siqnature
F
f COMMENTS
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 - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS
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 PP 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
❑ 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:INSPECTIONAL SERVICES DEPARTMENTMFORM07
Revised 2.2008
Location f //y
No. l Date
�oRTh TOWN OF NORTH ANDOVER
t Certificate of Occupancy $
�•s ^°''<
Building/Frame/Frame Permit Fee $ �
s�►cMust 9
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # `�
2 , 291 Building Inspector
Invoice
TWOMEY& LEGAJW C0JffBACTrNGrNC,
Professional Building / Remodeling
P.O.Box 366
OMCE No.Andover,MA 01845 FqX
978-885-7447 978-685-7448
978-558-1547
NAME OF OWNER t F� IVVV
ADDRESS OF JOB
TEL. DATE: ✓ -i—
Description of Work
Total Amount -
Deposit -
Balance - < /
Customer Signature Date �`
I
✓!� (OOiIY[iI9ZQ%'/.C/JC2GGl2 o�..i�acltiaet�.a
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number, CS 055108
Birthdate::09/02/.1969
i
expires 09/Q2/20b8 Tr.no:,1974.0
Restricted: 00
DOUGLAS J LEGARE
79 GARY AVE
HAVERHILL, MA 01$30
Commissioner
46
I
I
` NORTIy '9
Town of Andover
No. (R
o dover, Mass.,
O .�__ �COCHICEWICK
ORATE D
4 BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT......ki.......l4�n./.. 91.1/.........................................................
.............................................. Foundation
has permission to erect........................................ buildingson ..�,,. .. .' ....VI/.:"............................................. Rough
p ..C ��< .' .f�'�4 .... 1� .. . Chimney
to be occupied as................. .. . .. . ........................................
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final
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 TARTS j
Rough
- --°.................... .......................... Service
BUILDING TOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR j
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
i
Street No.
SEE REVERSE SIDE Smoke Det.