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Home My WebLink AboutBuilding Permit #615 - 148 WAVERLY ROAD 4/2/2006 Of NO DTH 7 4 10 TOWN OF NORTH ANDOVER * APPLICATION FOR PLAN EXAMINATION 9SS.ICHUSE4 Permit NO:-10 Date Received: t/,,a - Date Issued: IMPORTANT: Applicant must complete all items on thispag e I LOCATION 144 raver ( 4 <-o( 4 , b'tndnyo� Print PROPERTY OWNER e-,,,UZA r, Q v Print MAP N 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 0 Industrial 0 Alteration No. of units: ❑ Repair, replacement ❑Assessory Bldg 11 Commercial 0 Demolition 0 Moving(relocation) ❑Other ❑ Others: 0 Foundation only i DESCRIPTION OF WORK TO BE PREFORMED cn � ✓1 e�Prn � � n , r�- �'b,��P r��rng S�17 r14 QQR r✓\ AiviviMA ra 2 �e_a Identification Please Type or rint Clear y�) OWNER: Name: Phone: Signature Address: CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.•$10.00 PER SI000.00 OF THE TOTAL ESTIMA TED COST BASED ON 5125.00 PER S.F. Total Project Cost x10.00=FEE:$ 0 -ter Check No.: X01 Receipt No.: Iq 0 f Page I of 4 �- I TYPE OF SEWARGE DISPOSAL Swimming Pools ❑ ❑ Tanning/Massage/Body Art ❑ Public Sewer ❑ Tobacco Sales Food Packaging/Sales ❑ Well ❑ El 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/Ow Signature of Contractor Plans Submitted ❑ Pla s Waiv d ❑ Certified Plot Plan ❑ Stamped Plans ❑ T E 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 CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes i Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer connection signature&date Temp Dumpster on site yes no_ Fire Department signature/date Building Permit Approved and Issued by: Page 2 of 4 Building Setback(ft.) 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. II Total land area,sq. ft.: I NOTES and DATA—(For department use) II I� 1 f II 1 f II 1 I Page 3 of 4 i Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan.2006 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Rooring, Siding, Interior Rehabilitation Permits I ❑ 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 ) 1 ❑ 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) it ❑ Mass check Energy Compliance Report (If Applicable) i New Construction (Single and Two Family) 1, ❑ 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 Location/ - No. / Date �ORT� TOWN OF NORTH ANDOVER , � w A � i • • t ; , Certificate of Occupancy $ ;�J'•• E<�' Building/Frame-Permit Fee $ ncMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ " Check # 19 -179 Building Inspector µpRTt� TOWN OF NORTH ANDOVER p tato pL OFFICE OF ° BUILDING DEPARTMENT + 400 Osgood Street �,4 pOgnTfo�pP,�RS 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: I (� JOB LOCATION: Number Street Address Map/Lot HOMEOWNER( 11A �s t�e-Kl C, Q: Name Home Phone Work Phone PRESENT MAILING ADDRESS + 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 Persons who owns aP arcel 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. HOMEOWNERS NAT APPROVAL OF BUILDING ,, FFICIAL Revised 10.2005 Fonn Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688- 9535