HomeMy WebLinkAboutBuilding Permit #380 - 1478 GREAT POND ROAD 11/7/2006 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION of No oT;'fti
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Permit NO: VO Date Received 4L i
Date Issued: l ScNUSEt
IMPORTANT: Applicant must complete all items on this page
LOCATION 141-7 7
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PROPERTY OWNER �CG C- / Pnz6 p � J2
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MAP NO.: 2- PARCEL: 2 ZONING DISTRICT:
TYPE-AND USE OF BUILDING --- ----—HISTORIC DISTRICT__ -YES ❑
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑New Building 500ne family
❑Addition ❑ Two or more family ❑ Industrial
❑ Alteration No.of units:
P Repair, replacement ❑Assessory Bldg ❑Commercial
❑ Demolition
❑ Moving(relocation) ❑Other ❑ Others:
❑ Foundation only
DESCWPTIOOF ORK TO BE PREFORMED
Identification Please Type or Print Clearly)
OWNER: Name: U/-4e �O/G✓(f(/c. Phone: 7971,5X�d�
Address: P,01701 11V A71011"6K_
CONTRACTOR Name: Phone:
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COT BASED ON$125.00 PER S.F.
Total Project Cost :$ r;,J� FEE:$
Check No.: �k7� Receipt No.: Z�V5'
Page I of 4
Building Department
The following is a list of the required forms to be filled out for theappropriate ermit to be
P
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
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 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 DEPARTMENT:BPFORM05
Page 4 of 4
T - -
Location A/
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No. Date /
NORTH TOWN OF NORTH ANDOVER
Oft �•o ,•,h
Aw*10- 9
Certificate of Occupancy $
SACNUs<� Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ —�
Check # ,
1978 ,
/B06ing Inspector
TOWN OF NORTH ANDOVER
OFFICE OF
ti BUILDING DEPARTMENT
1600 Osgood Street Building 20, Suite 2-64
North,\-ndover, Massachusetts 01845
U5
Gerald A. Brown Telephone(978)688-9545
Inspector of Buildings Fax (978)688-9542
HONIFOW\rFP I "'SE EXE,"OPTION
Please print
DATE://
JOB LOCATION:
Map/Lot
HOMEOWNER C/
Name Home Phone Work Phone
PRESENT MAILING ADDRESS 17
City Tow�n 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 fie,she understands the Town of North Ando,,cr Building Departmen
minimum inspection procedures and requirements and that he/she will comply with said procedures and t
requirements.
APPROVAL.OF RUILDING 0FFICI,kL_____
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