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HomeMy WebLinkAboutMiscellaneous - Suite 150Location 4'sij Ait/�Odf.< ,Sf Ard No. .��� • /Z' Date NORTIy TOWN OF NORTH ANDOVER • • O L 9 Certificate of Occupancy $ DA'— MUs <�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 24695 B ildi g Inspector TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO:- Date Issued: to//tA1 IMPORTANT: ,R c/ Date Received must C�:9 itPme nn this Print rant MAP NO: 0 PARCEL: 2� ZONING DISTRICT: <I -e Historic District yes no Machine Shop Village yes no 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE ❑ New Building Residential 0 One family Non- Residential ❑ Addition 0 Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑Others: El Demolition ❑ Other (]'Septic ❑Well ❑ Floodplain 0Wetlands p Watershed District -Water/Sewer - DES CREPTION OF WORK TO BE PERFORMED: "r\r (ar-,0 -1%,0_.� A0J - t en _ - A/0 Xe IvaC11W o 0 7 ©ti _9� e-/" /� z ale/%re s s �'e� r It' OWNER: Name: `Address: � I or Print Clearlv) CONTRACTOR Name: - Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: 5&ol l Address: Reg. No. ' FEE SCHEDULE: BULDING PERMIT. • $92.00 PER $1000.00 OF THE TOTAL EST/MATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ FEE: r -a 1171,b Check No.: 6/ Receipt No.: J /_ NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of _ en wne ignature of cont�aeto�� r 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. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS DATE REJECTED DATE APPROVED ❑ ❑ 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: Com r aWater & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site yes. Located at 124 Main Street Fire Department signature/date COMMENTS Located 384 Osgood Street no 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 NOTES and DATA — For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi 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 (VOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permi 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 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 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: Doc.Building Permit Revised 2008mi TOWN OF NORTH ANDOVER lr - APPLICATION FOR PLAN EXAMINATION Permit N0:_3 /,:I " /� ! rr Date Received Date Issued: /0//, /// IMPORTANT: Applicant must compl( e 1 Jv.� Print MAP NO:PARCEL: 2� rrml --�— ZONING DISTRICT: TYPE OF IMPROVEMENT ❑ New Building ❑ Addition ❑ Alteration ❑ Repair, replacement ❑ Demolition - ®`Septc fl ;Water/Se PROPOSED USE Residential ❑ One family ❑ Two or more family No. of units: ❑ Assessory Bldg ❑ Other all items on this / Historic District yes Machine Shop Village yes 100 year-old structure yes wer - DESCRIPTION OF WORK TO BE PERFORMED: V ( dentificatio ease Tyl i WNER: Name: { ILV I Address: '\ 1 Non- Residential ❑ Industrial ❑ Commercial ❑ Others: I ID Watershed�Distiiet 0 ©ti or Print Clearly) CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: no no no �L 3 FEE SCHEDULE: BULDING PERMIT. • $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST B Total Project Cost: $ ASEDON$125.00PERS.F. FEE: $�`p, Check No.: � 6' �. . NOTE: Persons contracting with unregistered contractors do noRecet access to the uar atJ'.fund Signature of en vine' _ . A ti w O o w v V)u2 w O rD m b o o w 9 U co w w 064 t7 a Ra o a: wa a w a w . o w cx a w O Cl)CO o w —coG w z w cc] z cn v o cn S CD 0 • t o v C cv C �+ ^l: Amo h EE Cc! m c E cago i GO�go �V1 H Co as hCD� A�'z= o cm i cm _c 32 Om O CD CD o► ..: c a o c yam... ~ •H C.t C o Z .E _ v `� o •y o LU `- oc g h O' O , :e x ve " '� C $ C. � m S M, U 0 v 'am CD Q coL O CL Z � O CO) � C I CD cm C*) p 'a h c �E CO CO CD 0 co CL H_ o' 0 0 L cc eo a a cm< CO2 C Q cc C CCDCL Z V CO) C a