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Home My WebLink AboutPermits - Permits - 99 TURNPIKE STREET (5) IY ' Building Department t BUILDING PERMIT TOWN OF NORTH ANDOVER The following is a list of the required forms to be filled out for the appropriate permit to be obtained. APPLICATION FOR PLAN EXAMINATION � � Roofing,Siding, Interior Rehabilitation Permits Permit No#: - Date Received cHus�se Date Issued: y y2 l ❑ Building Permit Application IMPORTANT:Applicant must complete all items on this page ❑ Workers Comp Affidavit � �� ❑ Photo Copy Of H.I.C.And/Or C.S.L. Licenses �C Li Copy of Contract P�2OPE O NER o Floor Plan Or Proposed Interior Work ID e trrlcit NINO D1ST$GT Into is D s rip.r e o ❑ Engineering Affidavits for Engineered products " �laclsho ti�ageyeS� Y o NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit TYPE OF IMPROVEMENT PROPOSED USE Addition Or Decks Residential Non-Residential ❑New Building ❑One family ❑ Building Permit Application ❑Addition ❑Two or more family D Industrial ❑ Certified Surveyed Plot Plan ❑Alteration No.of units: ❑Commercial ❑ Workers Comp Affidavit [I Repair,replacement ❑Assessory Bldg ❑ Others: Demolition ❑Other ❑ Photo Copy of H.I.C.And C.S.L. Licenses s�pttc We11 Mood lalni yvetlanaswaer ,ed �stnct�" ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And DESCRIPTION OF WORK TO BE PERFORMED: Hydraulic Calculations(If Applicable) ❑ Mass check Energy Compliance Report(If Applicable) t��-ter�, 1Jo 6 u�u.ey-t ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Identification-Please Type /m-Print Clearly New Construction(Single and Two Family) OWNER: Name: 2 vtf �' i�=s.�,�gjz�r nf� l Z Phone: Address: kv - Zo 2 o Building Permit Application ❑ Certified Proposed Plot Planra v _ mall ❑ 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 io pro emen. Icense rypDa e ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products ARCHITECTIENGINEERz-La::ir�. f + Phone: f7oay Cj_- 465 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit A)A Address: Ztf-{u kkf,'1 'PE_ 4LReg.No. In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals FEE SCHEDULE:BULDtNO PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Total Project Cost:$ f Sly FEE:$ E� Do Building PermitWe 4,d2014 Check No.: ! /f Receipt No.: a C 7 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Qwner Sigrtafure of contractor' Plans Submitted❑ Plans Waived❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Dimension Public Sewer ❑ TanninglMassagetBody Art ❑ Swimming Pools ❑ Number of Stories: Total square feet of floor area,based on Exterior dimensions. Well ❑ Tobacco Sales ❑ Food PackaginglSales ❑ Private(septic tank,etc. ❑ Permanent Dmnpster on Site ❑ Total land area,sq.ft.: THE FOLLOWING SECTIONS FOR OFFICE USE ONLY ELECTRICAL:Movement of Meter location,mast or service drop requires approval of INTERDEPARTMENTAL SIGN OFF-U FORM Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine PLANNING&DEVELOPMENT Reviewed On Signature COMMENTS NOTES and DATA—(For department use) CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed o 0 5 Signature COMMENTS \ I.t { ilj .`� 1�I - VP( }L r�I11 1', �a 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 ❑ Notified for pickup Gall Email DPW Town Engincex Signature Located 384 Osgood Street Date Time Contact Name [ Doc.Hniiding Permit Revised 2014 BUILDING PERMIT of Ao T"qko Building Department TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION MW " The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Permit No#: -�` Date Received a, `9R,rEo e4",f5 Roofing,Siding, Interior Rehabilitation Permits — �SSACHUS�t Date Issued: Building Permit Application :t1iT1PORTANT:Applicant must complete all items on this page Workers Comp Affidavit Photo Copy Of N.I.C. And/Or C.S.L. Licenses LOCATION t `*i r ! Copy of Contract PROPERTY OWNER fll � nt � Floor Plan Or Proposed Interior Work ZJ tint too Year Structure JyesnoEngineerin Affidavits for En ineered rOdUctS MAP PARCEL: ZONING DISTRICT: Historic District g g p Machine Shop Village OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit TYPE OF IMPROVEMENT PROPOSED USE Addition Or Decks Residential Non-Residential ❑New Building ❑One family Building Permit Application ❑Addition ❑Two or more family ❑Industrial Alteration No.of units: ❑Commercial Certified Surveyed Plot Plan ❑❑Repair,replacement ❑Assessory Bldg ❑ Others: Workers Camp Affidavit C Dema6tion ❑other 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 t t ` oESCRIPT N OF WORK TO BE PERFORMED: tr�l��t+�i� �r }�,4y � 1�4.� I�l/�• Hydraulic Calculations(If Applicable) Mass check Energy Compliance Report(If Applicable) Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Identification- Please Type or Print Clearly OWNER: Name: Phone: New Construction(Single and Two Family) i Address: * Building Permit Application i * Certified Proposed Plot Plan Contractor Name: hFkFVGtt JvM6 nc � r EAf�t Phone: 7 3AO �Kti' e , � 1 Photo of H.I.C.And C.S.L. Licenses Email: 7519114S iv i- M`itge Ctm .iy.than Address: Workers Comp Affidavit �:,tt�rL�s nt> . izi� tart_tsV-"4 r2lr ogl3• Two Sets of Building Plans(One To Be Returned)to Include Sprinkler Plan And Supervisor's Construction License: Exp. Date: Hydraulic Calculations(If Applicable) Copy of Contract Home Improvement License: Exp. Date: 2012 IECC Energy code Engineering Affidavits for Engineered products ARCHITECT/ENGINEER Phone: OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit Address: Reg.No. Hr all cases if a variance or special permit was required the Town Clerics office must stamp the decision from the Board of Appeals FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. that the appeal period is over.The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording 9 must be submitted with the building application Total Project Cost:$ ?AT 6 FEE:$ - Check No.: { Receipt No.: Doc:Banding Permit Revised 201d NOTE: Persons eonkt[ettng ivrttz xrmegistererl eontrrcetors do not have access to the gn rauty fund Plans Submitted❑ Plans Waived❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Dimension Public Sewer ❑ TanninglMassagelBodyArt ❑ Swin "gPools ❑ Well El Tobacco of Stories: Total square feet of floor area,based an Exterior dimensions. Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dwnpster on Site E] Total land area,sq.ft.: THE FOLLOWING SECTIONS FOR OFFICE USE ONLY ELECTRICAL:Movement of Meter location,mast or service drop requires approval of INTERDEPARTMENTAL SIGN OFF-U FORM Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.v100-$1000 fine PLANNING&DEVELOPMENT Reviewed On Signature_ COMMENTS NOTES and DATA—(For department use} CONSERVATION Reviewed on Signature COMMENTS 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 Connectiontsignature&Date Driveway Permit ® Notified for pickup Call Email I)PW Town Engineer:Signature: Located 384 Osgood Street Date Time Contact Name FIRE�DEPARTMENT -Temp.Dumpster on site yes no Located at 124•Main Street Doc.Building Permit Revised 2014 Fire Departmentsignaturefdate COMMENTS 1 BUILDING PERMIT Building Department 1#� �{� � TOWN OF NORTH ANDOVER The following is a list of the required forms to be filled out for the appropriate permit to be obtained. APPLICATION FOR PLAN EXAMINATION ' a Roofing,Siding, Interior Rehabilitation Permits Permit No#: Date Received�= � to � �SSAtN�s�` Date Issued: 7/ 7 } Building Permit Application IMP RTANT;Applicant must complete all items on this page Workers Comp Affidavit _ Photo Copy Of H.I.C.And/Or C.S.L. Licenses LOCATION �u u1 P nt y�N It t Copy of Contract PROPERTY OWNER��r( � V � LLC� Floor Plan Or Proposed Interior Work i cint 100 Year Structure yes no Engineering Affidavits for Engineered products MAP `x_I-_PARCEL: ZONING DISTRICT: Historic District yes no g g g p Machine Shop Village yes no OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit TYPE OF IMPROVEMENT PROPOSED USE Addition Or Decks Residential Non-Residential ❑New Building ❑One family Building Permit Application ❑Addition ❑Two or more family ❑Industrial Alteration No.of units: ❑Commercial a Certified Surveyed Plot Plan ❑Repair,replacement ❑Assessory Bldg ❑ Others: Workers Comp Affidavit ❑Demolition ❑Other Photo Copy of H.I.C. And C.S.L. Licenses Na ;k Copy Of Contract _ e ;ewe _ _ 0— ik Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And DESCRIPTION of WORK TO BE PERFORMED: Hydraulic Calculations(If Applicable) 4� Mass check Energy Compliance Report(If Applicable) �L Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Identification- Please Tyke or Print Clearly OWNER: Name: �-��61a P, New Construction(Single and Two Family) Phone: t�Jt� � Address: 4, Building Permit Application Certified Proposed Plot Plan Contractor Name: TAP Phone: Photo of H.I.C.And G.S.L. Licenses Email:( Address; Workers Comp Affidavit Two Sets of Building Plans(One To Be Returned)to Include Sprinkler Plan And ery Su isor's construction License:L'_ i. 6 I6fi) (�, Hydraulic Calculations(If Applicable) p Exp. Date; iL Copy of Contract Home Improvement License s"" Exp. Date: 2012 IECC Energy code Engineering Affidavits for Engineered products ARCHITECT/ENGINEER Phone: OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit Address: Reg.No. In all cases if a variance or special permit was required the Town Clerics office must stamp the decision from the Board of Appeals FEE SCHEDULE:BULDING PERMIT.'$12.00 PER$1000,00 OF THE TOTAL ESTIMATED COSTBASED ON$125.00 PER S.F, that the appeal period is over.The applicant must then get this recorded at the Registry of Deeds.One copy and proof of recording _-_ � .gyp - must be submitted with the building application Total Project Cost:$ ' ,- ) Z !L1f1 --FEE:$ --s pQo:Ba;tdinPe�dtRerised2o14 Check No.: �� Receipt No,: NOTE; Persons contracting with rairegistered contractors do not have ess&4he gYtarantyfund Plans Submitted❑ Plans Waived❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL, Dimension Public Sewer ❑ Tanning/Massage/Body Art ❑ Swi n ning Pools ❑ Number of Stories: Total square feet of floor area,based on Exterior dimensions. well ❑ Tobacco Sales ❑ Food Packaging/Sales El Private(septic tank,etc. El Permanent Dumpster on Site ❑ Total Land area,Sq.ft.: ELECTRICAL:Movement of Meter location,mast or service drop requires approval of THE FOLLOWING SECTIONS FOR OFFICE USE ONLY Electrical Inspector Yes No INTERDEPARTMENTAL SIGN OFF-U FORM DANGER ZONE LITERATURE: Yes No MGL Chapter 166 section 21A—F and G min.$100-$1000 fine PLANNING DEVELOPMENT Reviewed On Signature_ NOTES and DATA—{For department use) COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on7 Signature COMMENT S � L1� c✓ rd � 1z'�Ls Zorrng Board of Appeals:Variance,Petition No: Zoning Decisionireceipt submitted yes_ Planning Board Decision: Comments Conservation Decision: Comments Water&c Sewer Connection tsictnature&Date Driveway Permit ❑ Notified for pickup Gall Email DPW Town Engineer:Signature: Located 384 Osgood Street Date Time Contact Name FIRE�I?EPARTMENLT Temp Durnpster on site yes no Located at 124 Main Street Doa.HuildingPeirsut Revised 2014 Ftre Departinentstgrtature/date>; <; COMMENTS.. -