HomeMy WebLinkAboutBuilding Permit #Exception - 19 BEAVER BROOK ROAD 5/1/2018 NORTH
BUILDING PERMIT °�t�``°
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
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Date Received
Permit NO: DR�TFD �5
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Date Issued:
IMPORTANT Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building I COne family
Addition ❑Two or more family . ❑ Industrial
El Alteration No. of units: Q Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
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DESCRIPTION OF WORK TO BE PREFORMED:
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OWNER: Name: c11�°��M �t''k_v ' �!�s Phone:
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ARCHITECT/ENGINEER () 3 C 24- AAc9-f'0-Af-S Phone: `�7C q QLl -
Address: 9 ° 96-4-ALL2' -(1-kik\ 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: $ FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signaturef AgenfOwner Signature of contractor k ..,_ .'h:,� . -_
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
LANNING & DEVELOPMENT ❑ Eli
COMMENTS
DATE REJECTED DATE APPROVED
CONSERVATION ❑ 1 -2
COMMENTS ��
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DATE REJECTED DATE AP OVED
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HEALTH ❑
COMMENTS
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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
DEPA_RMENTs Temp Durnpset onsite des E ;� no 4, Y
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WE+ NTWORT�I 17 Malcolm Not Drive 151 Water Street
W Suite 2 PO Box 2285
PARTNERS&ASSOCIATES Newburyport,MA 01950 Skowhegan,ME 04976
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A Gold Standard Companp V. 478.462.5822 V. 207.399A900
Faunde 2009 t F 978,462.5823 F. 207.692.1020
FINAL AFFIDAVIT
STATEMENT OF PROJECT COMPLETION
Project Number: APA# 036-12 Project Title: Sunroom Addition
Project Location: 19 Beaver Brook Road North Andover MA
Scope of Project: 300 square foot addition to single-family dwelling
Date of Final Inspection: August 9, 2012
I
In accordance with Section 116.0 of the Massachusetts State Building Code I, Kenneth
Dennison Registration No. 8669 being a registered professional engineer have prepared or
directly supervised the preparation of all design plans, computations and specifications
concerning:
Entire Project Architectural Structural X Mechanical
Electrical Fire Protection Other
for the above named project. These plans, computations and specifications meet the applicable
provisions of the Massachusetts State Building code, acceptable engineering practices, and
applicable laws and ordinances for the proposed use and occupancy.
I, or my qualified representative, have done the following:
1. Reviewed shop drawings, samples and other submittals of the contractor as required by
the construction contract documents as submitted for building permit, and approved them
for conformance to the design concept.
2. Reviewed and approved the quality control procedures for all code-required controlled
materials.
3. Been present at intervals appropriate to the stage of construction to become generally
familiar with the progress and quality of critical construction components requiring
controlled materials or construction specified in the accepted engineering practice
standards.
I visited the site during the construction process, and/or sent other appropriately qualified design
professionals, and determined to the extent possible that the work was done in accordance with
the documents submitted with the building permit application, and the applicable provisions of
the Massachusetts State Building Code.
JH OF M�s9
Signed: KENNETH
ftp c� DENNISON
STRUCTURAL y
Date: W —I`� — �.Z NO.8669 cr
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