HomeMy WebLinkAboutBuilding Permit #708-2011 - 1782 SALEM STREET 4/21/2011TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: 0 - ,�2o C/ Date Received ,
Date Issued:
IMPORTANT: Applicant must complete all items on this bane
LOCATION 9ree-�
Print
PROPERTY OWNER //�h�o�%J�•�c��✓/`J
Print
MAP NO: 106 4.) PARCEL: A8 ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ One family
❑ Addition
❑ Two or more family
❑ Industrial
0 Alteration
No. of units:
❑ Commercial
❑ Repair, replacement
0 Assessory Bldg
0 Others:
❑ Demolition
❑ Other
D Septic D'Well'
D Floodplaini 0- Wetlands
D Watetshed&District
-[!Water/Sewer
ON OF WORK TO BE PERFORMED: )
xoaG/ cam/ /6' .rim' n)ecl-- cmc/ 9SSc�c�si
2l�-c�r )'C
(Identification ease Type7�,-,
rint Clearly)
OWNER: Name: ', /"Is 1- / �151C .
Address: / -7 g -e!
CONTRACTOR Name:
Address
Supervisor's Construction License:
Home Improvement License:
ARCHITECT/ENGINEE
Address:
Exp. Date:
Exp. Date:
Phone:
Reg. N
,7£s' 8-'2r,
FEE SCHEDULE; BULDING PERMIT: $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F.
Total Project Cost: $ FEE: $ 7
Check No.: Receipt No.: _;;Z L/ e�� b
NOTE: Persons contracting with unregist3rfd contractors do not have access to the guaranty fund
nature of Agent/Owr
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
COMMENTS
Reviewed o
Si
0
jmat" 1- —kis 6
HEALTH Reviewed on /-// / % //
MENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
N
Planning Board Decision:
Co
Conservation Decision: Com
Water & Sewer Connection/Signature & Date Driveway Permit
IVDPW 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
LJ Notified for pickup - Date
Doc:.Building Permit Revised 2008mi
FM-
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: Doc.Building Permit Revised 2008mi
1 nrafinn/ /-7 SZ -- C' -, j_
No. / C) �; - -2 c, /,-
Date y 2
MORTM
TOWN OF NORTH ANDOVER
O'.•`O
9
°
Certificate of Occupancy
$
�� s'•^°' Eta
4CMU5
Building/Frame Permit Fee
$ Z
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
$
Check # �D ~
246
f/ Building Inspector
N,
rA
W
cd
OE:
GO
w°
U
cin
a
. d
w°
P2
x
U
G
w
0
a
o
a'
x
0
w
°°
C2
cn
u.
O
°�
w
`°
w
W
a
2
C/)
Q
o
cn
O
z.
. c c
as c
O
C2
co
O C
r+ O
V_ V
CL C
O cla
O C
�:= O
. O coL
to =
Ea
L
ca
\V 'Ci S c
: H
li E c
c�
c
o c E
0.= L
�C CD a
c a
:o m '
N
H O O
cm
co
aim
H m
��= O 07
J: 1\ CM Go
m
:mcg
ROi N O G
Z
L O C
H O. h O C •C
CD CD
OCOD
e+ d� m r•+
W . .�
� ��_ .�
.6 C *'
F -H a= Z
ac •E :3 ;;•yLU CM
C3 CD
CD
o
COD d m� O:
_t02 NON � y •O O
0..., m=S
.W
a
LLI
LLI
U)
W
W
19
W
U)
a� Cm
o
CO2
FE
m m
L-
0 CD
H
♦..r
CD
0
0 �
0
i
cc
O a
E:
cma
c
C2
c
cc
as
C
Z s
CL
V
y
c
G
G
G
a
.y
Cl
LLI
LLI
U)
W
W
19
W
U)
Gerald A. Brown
Inspector of Buildings
Please print
DATE: f/ / 3// I
JOB LOCATION
HOMEOWNER
TOWN OF NORTH ANDOVER
OFFICE OF
BUILDING DEPARTMENT
1600 Osgood Street Building 20, Suite 2-36
North Andover, Massachusetts 01845
HOMEOWNER LICENSE EXEMPTION
7
Number Street Address
')9 // 1J.a�,, // IF7j--
Name Home Phone
Telephone (978) 688-9545
Fax (978) 688-9542
0-6,611y9
Map/Lot
PRESENT MAILING ADDRESS Z �1�,
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 v4th said procedures and
requirements.
HOMEOWNERS
APPROVAL OF BUILDING OFFICIAL
Revised 10.2005
Form Homeowners Exemption