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41 1y ON + �� BUILDING PERMIT o SLED ,-�
TOWN OF NORTH ANDOVER o2 h�'� °•'6
APPLICATION FOR,PLAN EXAMINATION ` y M
Permit No#: Date Received
DAITED I.4R1
9SSACHUS��
Date Issued:
ORTANT:Applicant must complete all items on this page
Ci -T
,PROPERTSY,®WNER'___ _ V 1 t`zf
Pnntr 1 CDwYeM ru�cfpre,
(MAP f � )A @E ZONING DISTRICT �:Historic:bistrict,
` ��� -� t -�' - • ` Machine�Shop Village'_ _ye
TYPE OF IMPROVEMENT PROPOSED USE
_ Residential Non- Residential
❑ New Building ❑ One family
❑Addition ❑Two or more family EKndustrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑ Well ❑ Floodplain o Wetlands Watershed Disfrid,
0 Water/Sewer: L :-
DESCRIPTION F WORK TO BE PERFORMED:
P6 01aj
50 k6 by't
Iden[�' c tion (91- 1� �Z(`se Tg�pe or Print Clearly'
OWNER: Name: �i�V ' Phone:
Address: �4 �(11 r
LL
Cdntractor Namea u cd GJIe7�d�+Phone :.. Q� (5.�? S
Address: J
,.Supervisor's Constr;uctonLicense: _ _ _ _ __' Exp. Date _ • � ; _ "
Horne Irriprov Ment Licen"se _ Exp pate
ARCHITECT/ENGINEER Phone:
Address: Reg. too.
FEE SCHEDULE:BULDING PERMIT.-$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
E
Total Project Cost: $ �6�' �� FEE: $ �
Check No.: Receipt No.:
NOTE: Persons contracting t unregistered cont actors do not have:access to the guaranty fund
°S`ignatu�e__of_Agent%Oe.r - Signature of contractor
Plans Submitted ❑ Plans Waived El. Certified Plot Plan ❑ Stamped Plans ❑
'Tw :-';&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
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on 1`{ (a S ig nature La�'
Tr
COMMENTS .
HEALTH Reviewed on Signature
r 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
COMMENT,S
i
limension
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 droprequires approval of
Electrical Inspector Yes No
®ANGER ZONE LITERATURE: Yes No
MGL Chapter 166 section 21A—F and G min.$10041000 fine
NOTES and DATA— (For department use)
❑ Notified for pickup Call Email
ate Time Contact Name
Doc.Building Pen-nit 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
o 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 Vf Contract
act
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
40TE: 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 t ` V`
1
No. 'd of -7
Date ��. /v. g 0! 6
. • TOWN OF NORTH ANDOVER
•
` � ' Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $ '
TOTAL $
Check# j� /
,Z
(Building Inspector
NORTh1
own of ndover
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rh ver, Mass,
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COCKIC„ewKK It.
RAreo ►•PP,`,�5
U BOARD OF HEALTH
PERMIT .T LD Food/Kitchen
Septic System
IIl
THIS CERTIFIES THAT ....... ... 1.k..... .. .�.. �.. .................................................
BUILDING INSPECTOR
.•. Foundation
has permission to erect .......................... buildings on .�0. .�.....MA.
k •••••
Rough
to be occupied as .... ....... ... ...... *•� .. � ......
... .. � . Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application Final
on file in 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
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit.
OVAL
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRU1 .0
AR Rough
................... Service
. .. .. Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building 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
Street No.
Smoke Det.
1 T f � fl28.0-00x3 ..
20 R"IYER.UIEW ST
Lawrence 0.72.0-001
z
028.0-0004'
` lU•RIUER1 MEW
,,� 4O NORTH MA`It� S7; �_•
�-. 11 RIYERI/I•EW ST
RINERW:EW S
028 0 0029 NORTH MSN ST
P3`
i
'� �*7 NORTH NIAINST
4
NORTH MAIN ST „
c 075:Or0003 '
,
u IQ-2 Oa01
t of►7.o—oodz ;°Ferry Streets ,; A _ �
,,.'`0.17.0-000116 FERRY ST 12 FERRY ST, � `"
017.0-000360 ASHLAND Sf 028.0-002 ).
60 ASHLAND ST r, Y �
• i i ` x,028.0-0019
017.0-002' ' '.4 '` 170 SUTTON ST
017.0-ofl22
017.0-0004 ,. � i
48 ASHLAND ST � e •'\V�,`. I
01►7.0-0005 :,��`.: ,; �
�f `
44 ASHLAND ST ! 028m'0=0007
Horizontal Datum:MA StalepWne Coordinate System,Datum NAD
83,
Meters Data Sources:The data for this map was produced by Merrimack _
f NQf47'k q Valley Planning Commission(MVPC)using data provided by the Town of
North Andover.Additional data provided by the Executive Office of
�OO` Environmental AffairslMassGIS.The information depicted on this map is
itsfor planning purposes only.it may not be adequate for legal boundary
_ {n definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER
f A MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING
THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY
• i +F
OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT
c ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
THIS INFORMATION
'A1{D
4Ss�cHus�t
1"=115 ft
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