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HomeMy WebLinkAboutBuilding Permit #676-15 - Exception 2/26/2015�1z + TOWN OF NORTH ANDOVER t RTS{ APPLICATION FOR PLAN EXAMINATIO. SEP 3 0 2014 3 - TOWN OF NORTH AN c 1% HEALTH DEPART Permit NO: / _ / Date Received , CMOs Date Issued:2 6/ ! IMPORTANT: Applicant must complete all items on this page LOCATION 114.eIL X367 1 a-+'"/lpr��2.. pf Print PROPERTY OtiVNER 1%I 4c4 -c tt s 6'/ka LL (1 .9� .,qt st�7 Print MAP NO.: PARCEL: ZONING DISTRICT: 6079d-0 TYPE AND TJgR OF RU11,T)MG FTTSTCIRIC" DTCTRTCT VR.Q 1-1 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ❑ Addition ❑ Alteration ❑ One family ❑ Two or more family No. of units: ❑ Industrial ❑ Repair, replacement ❑ Demolition ❑ Assessory Bldg 0 Commercial ❑ Moving relocation Other ll) ❑ Others: ❑ Foundation only DENUtUPTION UF' WUR( TI'O 13E PREFORMED Identification Please Type or Print Clearly) OWNER: Name: VPLD --C Jb1 �0-1 Phone: yg Aesl lu/�1Aess: q 03 7 3 - CONTRACTOR Name:_, /� ; CAiCt. d— ` Phone: Address: 9 y% bn � ADCe ct ,11 Supervisor's Construction License: .2 % Exp. Date: �1111d-011 Home Improvement License: Exp. Date: Archdtc�ARCHITECT/ENGINEER Umbo -c -h Name Phone: (PDQ- 031V6 � Address: S Reg. No. FEE SCHEDULE.- B ULDhVG PERMIT: $12.00 PER $1000.00 OF 111E TOTAL ESTIMATED COST BASED OtV $.125.00 PER S.F. Total Project Cost :$ (PYOSC x #/,25-= W "/ IiL o x12.00=FEE:$9?W, 00 Check No.: Receipt No.: Page 10f ti n ar Permit No#: Date Issued: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received- IMPORTANT: eceived IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT:` HistoriG.0istrict 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' DESCRIPTION OF WORK TO BE PERFORMED: Identification - Please Type or Print Clearly OWNER: Name: Phone: ArirlrA—,S' Contractor Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: _ _ Exp:..Dater ARCHITECT/ENGINEER Phone:_ Address: Reg.v No. °: ' FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED: COST BASED ON $125.00 PER S; F. Total Project Cost: $ EE: $ Check No.: Receipt No. - NOTE: Persons contracting with unregistered contractors do not have, access to the guaranty fund Signature ofof Agent/Owner Signature of contractor - T rA Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE 017 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 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 IV 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 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 IVv 1 CJ ana UA I A — (I -or department use ❑ Notified for pickup Call Ema Date Time Contact Name 1 Doc.Building Permit Revised 2014 F 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 o Building Permit Application o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o 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/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) a 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) o 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 2014 Location No. 4, / b /r Check # I C/3o 1�. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ w Building Inspector TYPE OF SEWERAGE DISPOSAL Tanning/Massage/Body Art F]g Swimming Pools D Public Sewer Well ❑ Tobacco Sales El Food Packaging/Sales El Private ❑ Permanent Dumpster on Site (septic tank, etc. Electric Meter location to project iNU'1'E: Persons contracting with unregistered contractors do not have access to the guaran& fund Signature of Agent/Owner Signature of contractor Plans Submitted Plans Waived ❑ Certified Plot Plan Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPIVIENT COMMENTS DATE REJECTED ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other DATE APPROVED DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ 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 Temp Dumpster on site yes_no_ Fire Department signature/date Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost MOWN m $ - $ 960.00 Plumbing Fee $ 120.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 120.00 Total fees collected $ 1,300.00 2357 Turnpike Street 676-15 on 3/2/15 Poolhouse v C � N n a O C CD 0-0 CL �O CLa D cc. 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