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Home My WebLink AboutMiscellaneous - 25 BAY STATE ROAD 4/30/2018 (2)N O U J BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR NAN EXAMINATION Permit NO: Date Issued: //o IM ORTANT: ® Dete Received �� l3 16 must co bete ahitems on this page G .LOCATION Print PROPERTY OWNER Print MAP 210 59 6 PARCEL: Q1 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 Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer OWNER: Nal�-- DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) .0-1._ CONTRACTOR Name,.. Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: ARCHITECT/ENGINEER Address: Phone: Reg. No r-ri1)0 FEE SCHEDULE. BOLDING PERMIT. $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ � a o b FEE: $ -elD Check No.: Receipt No.: 9 32/ -7 NOTE: Persons contracting with unregistered con , ctors do not have access to the guaranty fund Si nature of Agent/Owner ignature of contractor 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 a 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: Building Permit Revised 2008 ��fG�fFLocationX� No. 76 7 Date Si m f NaRTM • ♦ i Check # TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ J-- 232 7 �6 Building Inspector Y 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 `'5- 1 /T //20 Sianature COMMENTS 04nrZ J - 1'3D �,� 2 ,G v.�S (U �k �\^ %A \ (ln� HEALTH Reviewed on Signature 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 Drivewav Permit DPW Town Engineer: Signature: Located X84 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 2010 X W WD p x 04 N � E Q :w c OR ca W �t: CL N W4 O i O w vp V) z '0 c w O rx v C U C x C7 � GbD►a p rs: G ic. w W -� p cG ru, G cn tw 0 c7 .c w4' C w CL4 w " v CQ z cn o• v 0 cf) c v O C H O C `c° v :ate r c :Cam E ct N cm CDw C 7 m 0 c" C C N co t O Z 0 O ol f rz O O v Z O CL O y C C IO O5 O .E- m m CD _~ CDCDO O C O cvv o a CA C V CD C CD CL V CO O C C C d is 0 Ul U/ W W 19 W 0 N � E Q :w c OR ca �t: CL N om o s NO _R L O : L N Of m C :.m �.0 I 0 Q. CLC y O m 'O _ C p : Q p,C C m OIL y O ClCc 2 a t = m m : h m C ma t,,, p COD w +.' 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