HomeMy WebLinkAboutBuilding Permit #280 - 125 LANCASTER ROAD 10/11/2006 jj
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TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION ttORTH,ED , qq,
t` 61 0
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Permit NO: cov Date Received ko
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: ear
Date Issued:
4 -/ '(, JP
9SSACHUS��
IMPORTANT: Applicant must complete all items on this page
LOCATION /2S 47A1CAS?'ee
Print
PROPERTY OWNER &c-t4AL-L d Le.sL,e- S t<LA 2
Print
MAP NO.: PARCEL: ZONING DISTRICT:
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non-Residential
❑New Building ❑One family
❑ Addition ❑ Two or more family ❑ Industrial
❑ Alteration No. of units:
❑ Repair, replacement ❑Assessory Bldg ❑ Commercial
❑ Demolition
❑ Moving(relocation) ❑ Other ❑ Others:
1:1Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
Identification Please Type or Print Clearly)
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OWNER: Name: Phone: 97k, 7�1-,370
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Address: �ZJ" L,¢�/C,gSiC/� 184—
CONTRACTOR Name: !)!.l��/Ls Phone• 7r- 7N 37
1
Address: ag-
Supervisor's Construction License:_ N I P. Exp. Date:
Home Improvement License: 1 l A Exp. Date:
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL EST/MATE OST BASED ON$125.00 PER S.F.
Total Project Cost :$ 4y. O� FEE:$ �
Check No.: a(y Receipt No.:
Page 1 of 4
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TYPE OF SEWERAGE DISPOSA Swimming Pools
L]Public Sewer Tanning/Massage/Body Art
Well
Tobacco Sales El Food Packaging/Sales L1❑
Permanent Dumpster on Site ❑
Private(septic tank,etc. ❑ Electric Meter location to
project
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner 04 UQW 0 Signature of contractor
Plans Submitted ❑ 11�nntaived ❑ Certified Plot Plan ❑ Stamped Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF-U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
_ A E REJECTED DATE APPROVED
CONSERVATIO
COMMENTS el a (Mt 0+Z- 1362e-I
DATE REJECTED DATE APPROVED
HEALTH F1 ❑
COMMENTS
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FIRE DEPARTMENT - Temp Dumpster on site yes �no
Fire Department signature/date
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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
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Building Setback(
Front Yard Side Yard Rear Yard
Required Provided Required Provides Required Provided
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
NOTES and DATA— For department use)
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Page 3 of 4
Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05
Created JMC.Jan.2006
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Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be
obtained.
i
Roofing, Siding, Interior Rehabilitation Permits
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❑ 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
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Addition Or Decks
❑ Building Permit Application
❑ 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)
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 BuildingPlans One To Be Returned to Include Sprinkler Plan And
( ) p
Hydraulic Calculations (If Applicable)
❑ Copy of Contract
❑ Mass check Energy p P Compliance Report
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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05
Page 4 of 4
�,,F �:�y� TOWN OF NORTH ANDOVER
AOFFICE OF
BUILDING DEPARTMENT
'A �!4;-.- - 1('00 Osgood Street Building 20, Suite 2-64
', No \-ndover, Massachusetts
cHu 1345
Gerald A. Brown
Telephone(9%,g)688-9545
[nspectorofBuildings Fax
19781688 9542
HO'�IEOVVNER LICENSE EXEMPTION
Please print
DATE: /D - 3. 06
JOB LOCATION:
Number Street Address � � "
;Viap;Lot
HOMEOWNER � �c.�A•I,'.��, 54!9S'K tAR p
Name 79,4 37H-o
Home Phone work Phone
PRESENT MAILING ADDRESS Z
LArS't'
ado✓ I"A
City Town State
Zip Code
The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and
to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner
acts as supervisor). State Building (Code Section 108.3.5.1)
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to
be,a one or two Family structures. A person who constructs more that one home in a tw•o-year period shall not be
considered a homeowner.
The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other
Applicable codes, by-laws, rules and regulations.
The undersigned"homeo� ner"certifies that he,she understands the Town of North Andovcr Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
110-NIEOW-N'ERS SIGNATURE
URE_
\PPROV,1I.OF RCIL.DING OFFICIAL
11C� "nrrs F:\121111-,(
.ENERAL SPECIFICATIONS
SIDE Z�} . `xg j_ DEPTH 3 TO �
AAREti 7Zo j)ArD' PERIMETER ldr
SHAPE �iR�E Fa�►'1
iQL.'CAPAC`ITY cva GALS
t=iCfiER MQDEL
tvJOfiOR MODEL 2A61A3 2'�t H P
'Ui R.CAPACITY
1ANgUEfl 4 bdv.�'t S HRS "
�U"MMER MODEL . PQc._ �g
MA1N {RAIN MODEL Iw�Ari
=N6 RAi"N � � (d L • ,�L
ETIIA I's
Ax-
POOL CLEANER ho4AI7.lS
BCFSWASH TO Lr�ti.�,Sc.q,p� id
CC>A'ING t3iZ►c.�. h1�cPTl..-ice'
Tll.ir.COLOR
LADDER SINIMOUT 6 '
BOARD SIZE
1�1G#iT u1J 300W"D SOO1Y 1,0'
C 1 iD j, SHORT Ed LONG
QT?E
RINGS rs w ROPE i7jFLC]AT5
EI` ATER.MODEL 3Zs w•► Ldx►ii� 8TU
YP
TURAL GAi' PROPANE O
Efl FU- L'
y£tTEO BY: 0 y,�srl G'ASLIfJ,E BY: Ow��f2
CRAFT DNERTER YES d NO d`
EcrRIC BY Ptd JE C'd#I,o'
EL"JC;4L eotr�DING BY.
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Pt"". 4 d-4-f- Co'4A
CLfJRINATOR .y
u METES I
MarYES NO C]
Tla'&COPING ASAPOTN :0
C�AADING �`�s
FMPING. ETC.
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COMM: SP,,,E ATIQNS
atir en:durn Date:
Town of Andover
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No. W180 - =,,,
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0 - ' dover, Mass.,A) 0
COC MIC.�'W'
0RATED Cl
BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT........M!14441...........C.kto. ............................................... .........
Foundation
has permission to erect.....................................1. buildings on ../d?.r......to.a4ca-H&,-o, .......... Rough
to be occupied as.62fl/0......4i0Q-tr^&.-&%... lkl�................................... Chimney
provided that the person accepting this permit shall in e�?�tspect conform to the terms o'f*'t*he'application* ''**' ** ...on*f*il*file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
qdo - PERMU EXPIRES IN 6 MONTHS Final
ELECTRICAL INSPECTOR
UNLESS CONSTRUI N A1'0� Rough
R Service
................. .......... ........ ........... .....................................mwmm�..
BUILDING INSPECTOR Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.
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Location_1
No. cgfo Date
NORTIy TOWN OF NORTH ANDOVER
fAimgldftw
D
Certificate of Occupancy $ c
CHU <� Building/Frame Permit Fee $
Foundation Permit Fee $ !
Other Permit Fee $
TOTAL $
Check #
19672
Building Inspector