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HomeMy WebLinkAboutBuilding Permit #843 - 127 WAVERLY ROAD 6/23/2006 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ,SSACHUSEI Permit NO: Date Received: 23 -0 6O Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION (Al� A IOCai' Print r^ PROPERTY OWNER d 4'1 Print MAP NO.: 14PARCEL: ��� 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 a Assessory Bldg S,.Commercial Demolition r Moving(relocation) G Other ❑ Others: Foundation only DESCRIPTION OF WORK TO BE PREFORMED �-- ti n y P L o e A 1d cT- LA v f�n 6,1rh taw)' 1 Identification Please Type or Print Clearly) OWNER: Name: jo d h A q—; _ G"(C 18 Phone: 'f7J'- 66rj"6.?/ Address: 6 q sae CONTRACTOR Name: Phone:-Cj78-r- -1'�'G��11 Address: / q 5d 13!r Iq 4/- ovt� S PC o ob �}c/f L( G ,.`< Supervisor's Construction License:`moi .S" ei :2 Exp. Date: Home Improvement License: Exp. Date: ARCHITECUENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERM T. 510.00 PER$1000.00 OF THE TOT-IL ESTIMATED COST BASED ON S125.00 PER S.F. Total Project Cost :$ �,5- 0 O„CSD x 10.00=FEE:$ Check No.: / 6 f 7i Receipt No.: Page I o 1'4 ■ TYPE OF SEWARGE DISPOSAL - Tanning/Massage,/Body PoolsBody Art .J Public Sewer x _ Tobacco Sales Food Packaging/Sales Well Permanent Dumpster on Site Private(septic tank,etc. Electric Meter location to project NOTE: Persons contracting ►v' unregistered c nt actors do not have access to the guaranty fitnd Signature of Agent/0 Aner t4,0--Signature of Contractor Plans Submitted !J Plans Waived Certified Plot Plan LI Stamped Plans THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL,SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ []Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED COISSERVATION ❑ ❑ CONDIMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decisionircceipt submitted ,yes Planning Board Decision: _ __Comments ■ Conservation Decision: Comments Building Setback ( Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Water & Sewer connection signature& date - Tcmp Dumpster on site yes—no— Fire Department signature/date Building Pennit Approved and Issued by: - Page 2 of d 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) f i Pace 3 of d _ 1 Doc:INSPE'I]ONA1.SP.RVICE.S DEPART MP:NTA31'FORMU5 ('rc.ilr.l I�iC.Lin.:006 � – r 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 o Floor Plan Or Proposed Interior Work 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 Li Photo of H.I.C. And C.S.L. Licenses o 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 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 DEPARTMENIAPFORM05 Page 4 o 1'4 Location No. � Date ORT1y TOWN OF NORTH ANDOVER r Certificate of Occupancy $ s►CMusgt� Building/Frame Permit Fee $ Foundation Permit Fee $ E. Other Permit Fee $ r TOTAL $ Check # � 4 6 O Bui ding Inspector o`tro orN syoL IUWiv Uk 1NUR1H ANDOVER OFFICE OF ° p BUILDING DEPARTMENT o e 400 Osgood Street . North Andover, Massachusetts 01845 SSACHUS� Gerald A. Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE: G A- ` Zt7 G JOB LOCATION: d c'y Number Street Address Map/Lot HOMEOWNER �IDZn "c cu)c , 2YWSA72 Name Home Phone Work Phone PRESENT MAILING ADDRESS ( q .S /- 46 /-yrcl S� Ad P-Th 1�n dd jJe /-�Yq o © / J�- Lf 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 two-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"homeowner"certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. _f r HOMEOWNERS SIGNATURE aa,+Y APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Farm Hoincowncis Exemption BOARD OF APPEALS 6830541 CONSERVATION 633-0530 HEALTH 6R8-9540 PLANNING o88- Q535 NORTIy Town of 2 4Andover 0 No. :. 943 - _ - -- dower, Mass. ; Y Q Zs LA E 1 ' COCHICMEWICK ORATED BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT................. ......... '�' .......... . ..... Foundation has permission to erect........................................ buildings on .../40.9.........&iR. ... . .. .....!�i............ Rough A*r to be occupied .®I.., I�........ ...�in . 4.40.4.. .. ..................................... Chimney e provided that the person accepting this permit shalleveryrespect conform to the terms. e application on 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 Final PERMIT EXPIRES IN 6 MONTHS UNLESS T ELECTRICAL INSPECTOR V 1 v I✓ESS CONSTRUC �S Rough 3 Service B DING 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.