HomeMy WebLinkAboutBuilding Permit #800 - Suite 306 5/21/2013TOWN OF NORTH! ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: 951ve Date Received
Date Issued:2,1
IMPORTANT: Applicant must complete all items on this page
10C AT, `
t1T
j b
P,ROPERTiYYQWNER<
100YearjO.ld'Structure• yes3 _
_.:PARCEL �1 Z®NING�DISIT_RICaT' _ Wistonc District 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
piFlood lain OVVetlar%ds
sry D%Watershed District;
�❑ �W,ater/Sewer.
DESCRIPTION OF WORK TO I t FtKt-UKMtu:
cvv�13 ek 'Fo vt_ b'-'Fti (.4 �
Identificati n Please. Type or Print Clearly)
OWNER: Name: v�1 Vo Is inti Phone:�b\�1'�
Address: -- ^v ,S Q r{ 6Yv1 ✓d
CONTRACTOR: Name: v. 'J - mak-- P:fione ,��q
Address: _�, �C�sWN'tJ .•
2.IZ,
'Supervisors,Construction License:.. _ ; -
Home Improyement'`License Ezp: Date`.'
ARCHITECT/ENGINEER /� - Phone:
Address: Reg. No.
FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
op
Total Project Cost: $l b FEE: $
� 1nn
Check No.: t a Receipt No.: �d-1
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
'---nure of contractor
Signature of Agent/Owri ,*� Si 9.. at.
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans
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. 1 ❑
Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
DATE REJECTED
El
DATE APPROVED
El
Reviewed on Signature
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes _
Planning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Tow ]Engineer: Signature:
Located 384 Os c
FIRE DEPARTMENT - Temp Dumpster on site yeas no
Located at'I24 Main Street
Fire Deparfimer t signatureldate
COMMENTS
od Street
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
Doc.Building Permit Revised 2010
Building Department
The folowing 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
❑ 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
NIOTE: 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
d®TE: 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 subm;tted with the building application
Doc: Doc.Building permit Revised 2012
--# S a".e.
Location D I �Z 1 T U4 0 n
2 e
No. " J3 DatI
Check #4;;Nr-ff
26429
TOWN OF NORTH ANDOVER r
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Building Inspector
Location
No. ��u` �� Date 3 13
Check #'�
26470
.TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $ ro
TOTAL $
Building Inspector
1
CERTIFICATE OF USE & OCCUPANCY
TOWN OF NORTH ANDOVER
Building Permit Number 800-13 on 5/21/2013 Date: June 3, 2013
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 21 High Street Suite 301A
MAY BE OCCUPIED AS a tenant fit up_tN ACCORDANCE WITH THE PROVISIONS
OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS
AS MAY APPLY.
Certificate. Issued to: RCG N.A. Mills LLC
21 High Street
North Andover, MA 01845
Building Ins ector
Fee: $100.00
Receipt: 26470
Check: 1286
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CERTIFICATE OF USE & OCCUPANCY
TOWN OF NORTH ANDOVER
Building Permit Number 800-13 on 5/21/2013 Date: June 3, 2013
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 21 High Street Suite 301A
MAY BE OCCUPIED AS.a tenant fit up_tN ACCORDANCE WITH THE PROVISIONS
OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS
AS MAY APPLY.
Certificate Issued to: RCG N.A. Mills LLC
21 High Street
North Andover, MA 01845
Building Ins ector
Fee: $100.00
Receipt: 26470
Check: 1286
Enter construction cost for fee cal -
North Andover Fee Calculation
Construction Cost
$ 10,000.00
m
$ -
$
120.00
Plumbing Fee
$
15.00
Gas Fee 100 comm.
$
100.00
Electrical Fee
$
15.00
Total fees collected
$
250.00
21 High Street Suite 301A
800-13 on 5/21/2013
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N O R T H A N D O V E R
Ik.010 �
21 High Street Suite 301 R 2-,900-sq�
RCG North Andover Mills LLC
N www.EastMillNorthAndover.com