HomeMy WebLinkAboutBuilding Permit #753-2016 - 960 JOHNSON STREET 12/22/2015oL(a�Il� I-I&I -
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Permit NO: 76 � /w X�
Date
LOCATI
PROPERTY OWN
A
BUILDING PERMIT
TOWN OF NORTH ANDOVER °
APPLICATION FOR PLAN EXAMINAT
Date ReceivedqP . I — —
�'9 a•oRATeo I,PPt�S
'ANT: Applicant must complete all items on this
Print U
MAP NO:PARCEL:Z ZONING DISTRICT: Historic District yes
Machine Shop Villaae ves
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
C; Septic Well
Floodplain - Wetlands
Watershed District
❑ Water/Sewer
Identification Please Type or Print Clearly) ^�` a� �C ^�'
ra oe
OWNER: Name:
Address:
CONTRACTOR Name: Phone:
Address:
r
Supervisor's Construction License: Exp, Date:
Home Improvement License: Exp. Date:
.s
ARCHITECT/ENGINEER Phone:
Address: Reg. N
FEE SCHEDULE: BULDING PERMIT: MOO PER $1000.0 TAL ESTIMATE OST BASED ON $125.00 PER S.F.
Total Project Cost: $ ���� 'P -cc FEE: $ �
Check No.: 610 Receipt No.: 1
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
i nature of AgerltfOwrar Signature of contractor
Plans Submitted ❑ Plans Waived ❑ Certified Plct Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Signature
' A-4 Q-•
Public Sewer ❑
Tanning/Massage/Body Art ❑
Swimming Pools ❑
Well ❑
Tobacco Sales ❑
Food Packaging/Sales ❑
Private (septic tank, etc. ❑
Pennanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
VPLANNING & DEVELOPMENT
"COMMENTS kL4 Q U•
\V/ CONSERVATION
COMMENTS
Reviewed On
Signature
' A-4 Q-•
6- fn
Reviewed on
cam,
HEALTH Reviewed on 7v `� Sign atur
COMMENTS E.'\&
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Comments
Conservation Decision: Commen
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
FIRE DEPARTMENT - Temp Dumpster onsite yes_
Located.at 124 Main Street.
Fire Department signature/date
COMMENTS
Located 384 Osgood Street
no
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
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
❑ Building 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/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
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
o 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
No. !J_ -.2O/
Check #
2.850
Date %.2- 2 Z//5 -
TOWN
/s
TOWN OF NORTH ANDOVER
Certificate of Occupancy $$
Building/Frame Permit Fee
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
A
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