HomeMy WebLinkAboutBuilding Permit #850 - 16 PERLEY ROAD 6/28/2006 TOWN OF NORTH ANDOVER tAORTH
APPLICATION FOR PLAN EXAMINATION 0 V-So #
•6 0
L
o A
Permit NO: O Date Received
Date Issued: G �9ssgcH rop 00, Cl
IMPORTANT: Applicant must complete all items on this page
LOCATION ( Pe rest In Aovc r
Print
PROPERTY OWNER C-0 -Cc fl e-
� Print
MAP NO.:� PARCEL: 1/0 ZONING DISTRICT:
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑New Building ieOne family
❑ Addition ❑Two or more family ❑ Industrial
❑ Alteration No. of units:
Repair, replacement ❑ Assessory Bldg ❑Commercial
❑ Demolition
❑ Moving(relocation) ❑ Other ❑ Others:
❑Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
�v e V3 dao
Identification Please Type or Print Clearly)
OWNER: Name: Ca Cen Cc-,c> Phone:
Address: e �-e tia gu_. N . a a.a Ver' Y`4s-
i
CONTRACTOR Name: `�i S e . Phone: q?cf'-
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$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost :$ 5 900, o o x10.00=FEE:$
Check No.: Receipt No.:
Page 1 of 4
i
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
Addition Or Decks
❑ Building Permit Application
❑ Surveyed Plot Plan
o Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
o 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)
o 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
Noe 4 of 4
TYPE OF SEWARGE DISPOSAL Swimming Pools 11Tanning/Massage/Body Art ❑
Public Sewer ❑
Well
Tobacco Sales El Food Packaging/Sales El❑
❑ ❑
Private(septic tank,etc. Permanent Dumpster on Site Electric Meter location to
project
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner b Cc, � Signature of contractor
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE.USE ONLY { ,
INTERDEPARTMENTAL SIGN OFF- UYORM
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
Planning Board Decision: Comments
Conservation Decision: Comments
Water& Sewer connection/Si nature& Date Driveway Permit
Temp Dumpster on site yes_no_ Fire Department signature/date
Building Setback (ft.)
Front Yard Side Yard Rear Yard
Required Provided Required Provides Required Provided
DIM
ENSION
Number of Stories: Total square feet of floor area,based on Exterior dimensions.
Total land area, sq. ft.:
NOTES and DATA—(For department use)
I
i
I
I
i
r
i
I
I
I
Page 3 of 4
Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05
Created 1MC.Jan.2006
Location //0 e
No. �� t r Date p �b
NpR,►, TOWN OF NORTH ANDOVER
Certificate of Occupancy $
s i
��s •E� Building/Frame Permit Fee $
sACHus
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # 3 DGS
.10477 1
Building Inspector.
NORTH
Town of
0
. . .........
No.
_ � fie" 2A
Z - over, Mass.,____
T 0 � LA E
COCHICNE WICK
�A0RATED PPS\ �y
�`s E BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
/� BUILDING INSPECTOR
THIS CERTIFIES THAT......�� �...C�.......Pt.......A.C.O. .... Foundation
............. ..............................)..................
has permission to*PM.....���.yoof... buildings on ......I.G er ��e OSI Rough
to be occupied as �.196
�.. ' Chimney
...S "�`t1114.�. Lr�. -to . . .. . .. .. . . . . . .. .. . . . y
provided that the personpting this permits in every res ect co to the terms of the application on file in Final
this office, and to the provisions of the Codes an By- ws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. S37/;/; PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION STARTS Rough
"-�.w.:..,.......... ..... .. 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 FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.
KOt0 TOWN OF NORTH ANDOVER
32�gyy`e. ."1•ir0 OFFICE OF
BUILDING DEPARTMENT
= � 400 Osgood Street
North Andover, Massachusetts 01845
QS$aCHUS�{
Gerald A. Brown Telephone(978)688-9545
Inspector of Buildings Fax (978)688-9542
HOMEOWNER LICENSE EXEMPTION
Please print
DATE: ��� D(0
JOB LOCATION: 16 Pe f Ve-� � � All 40yc
Number SSttreet Address Map/Lot
HOMEOWNER t e•� I' ' c� ����(0�6 I"�C'b9
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
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
j 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 SIGNATURE__
APPROVAL OF BUILDING OFFICIAL_
RevisLd 10.2005
Form Honximie s Exemption
I
I
BOARD OF APPEALS 683-9541 CONSERVATION 038-0530 HEALTH 638-9540 PLANNING 088-
Q515
I
I