The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #514-12 - 138 LACY STREET 1/3/2012 TOWN OF NORTH ANDOVER lJ APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: ..5 /Y ORTANT:Applicant must complete all items on this pLge LOCATION L4cV 5 . Print --- PROPERTY OWNER c.11 C�/ asp - Unit# Print MAP NO: /6`� ARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building Kbne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic D Welly ObFloodplainti OjWetlancls3 0?WateshedlDistrct DESCRIPTION OF WORK TO BE PERFORMED: (Identification Please Type or Print Clearly) OWNER: Name: are a rAduse Phone: Address: i 3a Lac;z 1/n/o A A/ldouer /Va . 0/S-4--r— CONTRACTOR Name: /' iu 1n r Phone: <7*r — WJ �Ss� Address: TAsS s r r 4/93 6 Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ G� FEE: $_� ( O U Check No.: Jam/y Receipt No.: 62 G/ NOTE: Persons contracting with unregistered contractors do not have access tot a guaranty fund Signature of Agent/ + carie _..; . : - _ $ Signature oft htracfor _ I 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS -Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Z Planning Board Decision: Comments Conservation Decision: Comments 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 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 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 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: Doe.Building Permit Revised 2008mi Location 1-37f^ G C Sr No. jZ Date01 L NORTh TOWN OF NORTH ANDOVER P Certificate of Occupancy $ CHUSE<�' Building/Frame Permit Fee $ 7� w Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 7 Q � f 24923 �Iding Inspector NORTF{ Town of No. o 1 10 , dover, Mass., COC MICME WICK y,1. DQATED pPP�,�Gj S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System / BUILDING INSPECTOR THIS CERTIFIES THAT*........... ..�G�� 4� i9c� .......�...... .......................��....................................................................................... Foundation has permission to erect...........'............................. buildings on ..1. ....�� .W.. (/..................................................... Rough to be occupied as ; ./� / / im • • • Ch' ney provided that the person accepting this per lt shall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final 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 ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONARTS Rough �r��....�ffiJ•. ..... Service •.•..• 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 Until Inspected and Approved by the Building Inspector. FIRE_DEPARTMENT Bumer Street No. SEE REVERSE SIDE Smoke Det. F y°RTH TOWN OF NORTH ANDOVER 0='Leo,`eH�0 OFFICE OF A BUILDING DEPARTMENT a1600 Osgood Street Building 20, Suite 2-36 wy�ssono,'�iy North Andover,Massachusetts 01845 gCHUS Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNERLICENSE EXEMPTION BUIDING PERYHT APPLICATION Pleaseprint DATE:_ Oh,� JOB LOCATION: / 6f, . Number Street Address Map/Lot I10MEOWNER oaf) y Narrj6 Home Phone �33C Work Phone PRESENT MAILING ADDRESS_ /3 Laces �Otl-r1 ft11G�e�lPr /� CU/ �+� City Town StMrw. . Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeovTlers 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 Awns 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 responsibilityfor 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. HOMEOWNERS SIGNATURE _,O�IV APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form HOmeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535