HomeMy WebLinkAboutBuilding Permit #CO - Suite 300 6/16/2011nit
Permit NO:(!.,()
Date Issued:
TOWN OF NORTH ANDOVER,
APPLICATION FOR PLAN EXAMINATION
Date Received
IWORTANT: Applicant must complete all items on &;_si�)age
&-, Nor-�h AtA6ver, M A
PROPERTY OWNER966 R LLC
Print
MAP NO: PARCEL: ZONINGDISTRICT: I-listoric District Yes no
Machine Shop Village yes no
FT—YPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
0 New Building
0 One family
[I Addition
0 Two or more family
0 Industrial
0 Alteration
No. of units:
11 Commercial
El Repair, replacement
0 Assessory Bldg
11 Others:
[I Demolition
0 Other
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DES CRI -11"T ION OF WORK TO 31EIPEjU ORME, D:
i Please Type or Print Clearly)
OVINER:
Address: 14A Par �_ n ve . / �Sjl u/v 1, N P n�w-7q
CONTRACTOR Name:
Address:
Supervisor's Construction License:
Home Improvement License:
Exp. Date:
gxp. Date:
ARCH ITECTIENGIN EER Phone:
.1461 -,q � 19
Phone: —
Address: Reg. No.
FEE SCHEDULE:BULDJJ�G PERMIT' $12-00 PER $1000-00 OF THE TOTAL ESTIMATED COSTBASED OJV$125.00 PER S.F.
( /2
Total Project Cost: $ FEE: $ 17)U
Check No.: 6) 3 (OA -Receipt No.:
NOTE: Persons contr4cting withunreglqqe-d_�ontr cto s do ot ave access to t e guaranty un
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Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAT,
Public Sewer
Tanning/Massage/Body Art
Swimming Pools
well
Tobacco Sales . El
Food Packaging/Sales
Private (septic tank, etc. El
Permanent Dumpster on Site El
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATEAPPROVED
PLANNING & DEVELOPMENT; El El
COMMENTS
CONSERVATION Reviewed on Si nature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decisionfreceipt submitted yes
Planning Board'Decision:
Comm
Conserv�tion Decision: Comments
Water & Sewer Connection Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FM DEPARTNMNT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COABMNTS,
Dimension
Number of Stories:— Total square feet of floor area, based on Exterior dimensions._
Total land area, sq. ft.:
ELECTRICAL: Movement of Me ter 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)
El Notified for pickup - Date
Doc:.Building Permit Revised 2008mi
Building Department
The following is a list of the required forms to be filled outfor 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 Perr
Addition Or Decks
Building �ermit Application
Certified Surveyed Plot Plan
Workers Comp Affidavit
Photo Copy of H.I.C. And C.S.L. Licenses
• Copy Of Contrac-�L
• Flo or/Crossectio n/E levation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (if Applicable)
• Mass check Energy Compliance Report (If Applicable)
• Engineering Affidavits for Engineered products
TIOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Perry
New Construction (Single and Two Family)
u Building Permit Application
E3 Certified Proposed Plot Plan
u 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 Perrri
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 I
Doc: Doc.Building Permit Revised 2008mi
CERT M--, CXTE G -F U S -E- & OCCUPANCY
WE to, M11 11199
Building Permit Number 61&2011 Date: June 1-7, 201-1
THIS-CERTIFIES-THATT
THE BUILDING LOCATED- ON 451- Andover Street, Suite -305- North Andover,
MA 01945
Priority Pain Relief Therapy
MAY BE OCCUPIED AS massage therapist IN ACCORDANCE WITH THE
PROVI$IONS()F THE MAS$A�C SET -T
S STATE BUILDING CODE AND SUCH OTHER
REGULATIONS AS MAY APPLY.
Certificate Issued tot
Fee: 100.00
Receipt: 24262
Helen Phillips
42-Fark Avenue
Salem, N.H. 03079
Buildmi'g Inspector
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