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HomeMy WebLinkAboutBuilding Permit #672-2011 - 95 LACY STREET 4/5/2011Permit NO: TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION IMPORTANT: Applicant must QG,= 1q Lac Date Received all items on this 1 111 MAP N0:�2/!� I��PARCEL: ZONING DISTRICT:_ Historic District yes Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial El replacement ElAssessory Bldg ❑ Others: 0a olition ❑ Other ❑,Septic 0 Well' ❑ Floodplain ❑ W&I dsl ❑ Watershe&District 1i Water/,Sewer _ (Identification Please Type or Pri .t Clearly) OWNER: Name:ne c d r' Phone: Address: f 1�3 Z, r /��l` c ,►G�c /�-!'— /%2Cf CONTRACTOR Name:: Jo—)0, c �L �l'u Phone: Address: �� 6 �, /MSS Supervisor's Construction License: y�3 Exp. Date: 12—ZF OOIS Home Improvement License: & (a Exp. Date: %� ?✓Q�Z 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: $� Check No.: / Receipt No.: o 4/1 NOTE: Persons contracts R with unregistered contractors do not have access toth uaran fun �Signature_of Agent/Own nature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody Art ❑ Swimming Pools 0 Well ❑ Tobacco Sales ❑ Food Packaging/Sales El Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED PLANNING & DEVELOPMENT ❑ COMMENTS CONSERVATION Reviewed DATE APPROVED COMMENTS HEALTH COMMENTS Reviewed on Signature v Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comm Water & Sewer Connection/Signature & Date Driveway Permit V-' 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 2008mi 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 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 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 ❑ Building Permit Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o 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) o Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products MOTE: 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 Doe: Doc.Building Permit Revised 2008mi Location No. C---10 Date MOR,h TOWN OF NORTH ANDOVER O F R Certificate of Occupancy $ CM�st<�' Building/Frame Permit Fee $_ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # % 7 l y< Building Inspector 24U-, 1 i rA W cd co O w Co U) 0 O wngS ro w w' U w O O rx w O U w a wco w cn w C7 w' w w v m ° z cn Q cn C2 o c 5 :w O� C y M O QC� •c'a ` ,7� c.c ,A cc cv co Hm Ea :m Co o CL G !� U o o 0 V Of t� E "O � �% [ l ` m p U ca cc s_�aa = a c . .Em .� W cm cm U) �coa d C Z m o� C . � U `s :C=O c O a Q o : L- ®c •o = Co ® 3o N m r W CO y... C •co C.t O CZ ac •E w , 4 •y O ED U CD V2 a' o . O -0J4 2 A .0cmCD O O F— .0 ... 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