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Home My WebLink About- Permits - 79 EMPIRE DRIVE Building Department TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Permit NO: r-1 D t/ Date Received �! Roofing,Siding, Interior Rehabilitation Permits Date Issued �l /i� IMI pORTANT:Applicant must complete all items on this page t ❑ Building Permit Application ❑ Workers Comp Affidavit LOCATION '717 ❑ Photo Copy Of H.I.G.And/Or G.S.L. Licenses Print PROPERTY OWNER C` 6 C { �f� � I� � ,46&— ❑ Copy of Contract Print ❑ Floor Plan Or Proposed Interior Work MAP NO:10 ARCELJ ZONING DISTRICT;'/_ Historic District yes no ❑ Engineering Affidavits for Engineered products Machine shop village yes n:b 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 ew Building KOne family 0 Addition ❑Two or more family ❑Industrial ❑ Building Permit Application ( ❑Alteration No.of units: ❑Commercial ❑ Certified Surveyed Plot Plan ❑Repair,replacement ❑Assessory Bldg ❑ Others: o Workers Camp Affidavit 0 Demolition Li Other ❑ Photo Copy of H.I.C.And C.S.L. Licenses i7Septic r�Well ElFloodplain 13Wetlands" i];Wa�exshedDistiict ❑ Copy Of Contract Water/Sewer D ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And ` DESCRIPTION OF WORK TO BE PERFORMED: Hydraulic Calculations(If Applicable) ,�_ 1 �I d —�ctula>a'1�onl cY tltutelPA� ❑ Mass check Energy Compliance Report(If Applicable) t�e, `J <+ t E As tL r ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit (identification Please Type or Print clearly) / New Construction(Single and Two Family) OWNER: Name Address:j i_Ge&' &uo L),KtUe All , al:F I ❑ Building Permit Application CONTRACTOR Name: Phone:9 E -3/CZ- ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ,j ❑ Workers Comp Affidavit Address:�(7 i f L �t t� c3 f� � C�P�1 l o Two Sets of Building Plans(One To Be Returned)to Include Sprinkler Plan And supervisor's construction License: /QZ-`3 f Exp. Date: f Z- Hydraulic Calculations(If Applicable) - ❑ Copy of Contract Home Improvement License: �r�`-- Exp. Date: 1 �� LiMass check Energy Compliance Report ARCHITECT/ENGINEERL>~lyv,4 �Y"�-�� nn OLA1 r Phone: e9-3,5-Z- E 311 ❑ Engineering Affidavits for Engineered products '1OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg.Permit Address:l�� S+- G LLEDReg.No. to 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$125A0 PER S.F. that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording FEE:$ $ must be submitted with the building application Total Project Cost: '.. Check No.: Receipt No.: ✓��/r�/� Doc:Doe.Building Permit Revised 2008mi NOTE; Persons contracting ivith unregistered contractors do riot have access to the guaranty fund ,CSignature of Agent/Ownert-- Signature of contractor Plans Submitted Plans Waived❑ Certified Plot Plan Stamped Plans Nr TYPE OF SEWERAGE DISPOSAL Dimension Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools Q Well ❑ Number of Stories: Total square feet of floor area,based on Exterior dimensions. Tobacco Sales ❑ Food Packaging/Sales Q El Permanent land area,sq.fit.: Private(septic tank,etc. Permanent Dumpster an Site ❑ ELECTRICAL;Movement of Meter location,mast or service drop requires approval of THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No DATE REJECTED DATE APPROVED MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine PLANNING&DEVELOPMENT ❑ ❑ COMMENTS NOTES and DATA— For department use CONSERVATION Reviewed on J 1 Signature ' /l COMMENTS_Il1p F�1LA SSV ccl 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 ConnectionlSianature&Date Driveway Permit E DPW Town Engineer:Signature: l Notified for pickup- Date Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no —� Located at 124 Main Street Doc:.Building Permit Revised 2008mi Fire Department signature/date COMMENTS TOWN OF NORTH ANDOVER Building Department APPLICATION FOR PLAN EXAMINATION The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Permit No: Date Received Roofing,Siding,Interior Rehabilitation Permits Date Issued: _ 1 Il l _ _ I ORTANT:Applicant must complete all items on this page ❑ Building Permit Application ❑ Workers Camp Affidavit LOCATION print ❑ Photo Copy Of H.I.G.And/Or G.S.L. Licenses PROPERTY OWNER C� p>z1�_��I LL8 c` G-L-C- ❑ Copy Of Contract print ❑ Floor Plan Or Proposed Interior Work MAP NO: f� G PARCEL:0 r'1ZZONING DISTRICT Historic District yes ❑ Engineering Affidavits for Engineered products Machine Shop village yes no NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ` Addition Or Decks ,�+n� �One family ci Addition di Building ❑Two or more family ❑Industrial ❑Ad ❑ Building Permit Application ❑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 0Septie 11Well ❑Floodplaiir Wetlands ❑'WatersheflDistrict ❑ Copy Of Contract WaterLSewer t� d a Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And .DESCRIPTION OF Wolin To BE PERFORMED: Hydraulic Calculations(If Applicable) �mtlsF tC S'I SIP t4ml Dlucltl,u�� t�c��t2�- 2JL l ❑ Mass check Energy Compliance Report(if Applicable) uA tI IQic i Plat IAJII ter. d- N6durAc- t4-AS ❑ Engineering Affidavits for Engineered products NOTE_: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit r enafication lease Type or Pr;nt Clearly) OWNER: Name: I as ]ype (�� Phone Now Construction(Single and Two Family) #C��}T�r>NJa DhiVe � �zs� AAA 0)`W' Address: ff❑ Building Permit Application CONTRACTOR Name: ❑ Certified Proposed Plot Plan ❑ Photo of H.C.C.And C.S.L. Licenses Addres0Ll �Cint� �tlU� x� 1� C11 � ❑ Workers Camp Affidavit ❑ Two Sets of Building Plans(One To Be Returned)to include Sprinkler Plan And Supervisor's Construction License: /bJg3 ( Exp. Date: 31 hZ Hydraulic Calculations(If Applicable) _f ❑ Copy of Contract Home Improvement License: 1� of j� Exp. Date: (� ❑ Mass check Energy Compliance Report ARCHITECT/ENGINEER Phone: ��-3 � )� ❑ Engineering Affidavits for Engineered products t MOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg PermitAddress:� L jVitl!� t�'OWi%Q UJi� � dl �iReg.No.. 7 13ULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. In aIi cases if a variance or special permit was required the Town Clerics office must stamp the decision from t}re Board of Appeals FEE SCHEDULE: �•��U f p _ (� � Chat the appeal period is over.The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording Total Project Cost:$ -z tJ .T oo � d FEE:$ must be submitted with the building apphcation Check No.: Receipt No.: Doc:Doc.Building Permit Revised 2008mi NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund SigLiatgre'ofAgeni/Owner -tSCLC�� 5tgnafureof,contraetor G Plans Submitted I!- Plans Waived❑ Certified Plot Plan A Stamped Plans Fi * GE➢ISP SSAL Dimension Tannin iassa e/Eod Art ❑ Swimm�ingPools ❑ g v Number of Stories: Total square feet of floor area,based on Exterior dimensions. ❑ Tobacco Sates ❑ Food Packaging/Sales ❑ Total land area,sq.ft.: tc. ❑ Permanent Dempster on Site l ELECTRICAL:Movement of Motor 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 DATE REJECTED DATE APPROVED MGL Chapter 166 section 21A—F and G min.sloo-$1000 tine PLANNING&DEVELOPMENT ❑ ❑ NOTES and DATA— For department use COMMENTS CONSERVATION Reviewed on Signature COMMENTS 1 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/sic natura Datd Driven✓av Permit �J J ® Notified for pickup- Date DPW Town Engineer:Signature: j Located 384 Osgood Street FIRE DEPARTMENT -Temp Dump�A on site yes }, no ➢oc:.Suilding Permit Revised 2008 Located at 124 Main.Street . nn / Fire Department signature/date ` ____x COMMENTS