HomeMy WebLinkAboutBuilding Permit #249 - 18 HARKAWAY ROAD 10/4/2007 BUILDING PERMIT c* r100RTF1
TOWN OF NORTH ANDOVER 3� '` ` ~ �z-
APPLICATION FOR PLAN EXAMINATION
Permit NO: b `� Date Received
��SSACHUSE��
Date Issued: Caa
IMPORTANT:Applicant must complete all items on this page
,LOCATION,
.�11 �tt li i-„ ,- Y
PROPERTY OWNER
N. ",Print
.MAP NO.:' PARCELLJrV, ZONING DISTRICT-lHistoric"District -" 'yes" no
-
Machine Shop Village des no,
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building One family
Addition Two or more family Industrial
Alteration No. of units: Commercial
Repair, replacement Assessory Bldg Others:
Demolition Other
Septic W-611 Floodplain Wetlands Watersfied District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
Identification Please Type or Print Clearly)
OWNER: Name: /! 4Phone:
Address: l�Q�i ���LSA 1664 "t/o or t
CONTRACTOR,Name; Phone:
Address:
Supervisor"s Construction:License: . Exp. _Date:
µ ;
Horne Improvement License Exp. ;Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost:
Cost: $ _p �, o FEE: $
Check No.:el�V�L— Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent%Qwner' �nature of contractor"'
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer Tann Swimming Pools
Tanning/Massage/Body Art g
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
DATE REJECTED DATE APPROVED
CONSERVATION
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH
COMMENTS
r
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature Date Drivewav Permit
Located at 384 Osgood Street
FIRE DEPARTMENT Temp Du.mpster on site yes no
Located at 124 Main Street
Fire_Department signatureldate
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 2007
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 permits dumpster p p its 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
lication
Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2007
Location
No.
TOWN OF NORTH ANDOVER
3?O�,f`,o I•,hO
O
f R
Certificate of Occupancy $
sA�NUs Building/Frame Permit Fee $
Foundation Permit Fee $ k
Other Permit Fee $
TOTAL $
Check # r..i
20657
Building Inspector
AORTM
Town of
0
.. V :
No.
- o w- LAKE o dover, Mass.,
40
COCMICMEWICK
�A0RATED p'P �
BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
a ... ����' BUILDING INSPECTOR
... ...... Foundation
THIS CERTIFIES THAT....
has permission to erect................................ . buildings o ... ... ..... . Y
....�.......................... Rough
V
to be occupied as teiO44.".W.'
........1M. ..... .................................. Chimney
provided that the person acceptingrmit shall in every respect conform to the terms of the application on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
PERMIT EXPIRES IN 6 MONTHS Final
ELECTRICAL INSPECTOR
UNLESS CONSTRU S TS Rough
Service
.... ................................................
... ...
BL7ILDING 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.
�ORT1� TOWN OF NORTH ANDOVER
OFFICE OF
BUILDING DEPARTMENT
1600 Osgood Street Building 20, Suite 2-36
�►'b�,:,::� �+ North Andover Massachusetts 01845
�sswc►ws�t
Gerald A.Brown Telephone(978)688-9545
Inspector of BuildingsFax (978)688-9542
d.
HOMEOWNER LICENSE EXEMPTION
Please mint
DATE: /0
JOB LOCATION:
Number Street Address Map/Lot
HOMEOWNER ,/ °fl t� !r�a-c !� V /� d 5'
Name Home Phone Work Phone
PRESENT MAILING ADDRESS
J
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)
DEF NMON 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 with said procedures and
requirements.
HOMEOWNERS SIGNATURE `
APPROVAL OF BUILDING OFFICIAL
Reviwd 10.2005
Form Homeowners F.xemoon
BO:\RD OF \PPE:\I.S 633-95=11 CONSERVNFION 633-9530 HEALTH 683-95.30 PLXNNING 688.9535
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