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Home My WebLink AboutBuilding Permit #253-13 - 1939 GREAT POND ROAD 10/1/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received b Date Issued: Q / IMP RTANT:Applicant must complete all items on this page = — — i L®CATIONt:. P PROF.ERTYr®1IVIVER 4Pnnt 100Year,0ldIStrucfu�e: MzAFNO' :3 _:PARG:EL ��4 ZONINGDIS�TRICT rHistonc,Distnctyes achme�Shopvillagej yes; TYPE OF IMPROVEMENT PROPOSED USE Resid tial Non- Residential ❑ New Building W6ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septici �Wellr ❑1Floodplam;� ®Wetlands r 0 § r -7 titer/Sewer Q �J DESCRIPTION OF WORK TO BE PERFORMED: )2C- C: �pIt .1 ex -re e e w 4eK c oc-CesSdIl IdentificatioPlease Type or Print Clearly) OWNER: Name: �K�.. �C -7-- iL2 G N e S�� Phone: 9 7 " 79 Address: / 7 3 9 G.�.�a� �✓-^� Q� 5 'CONTRACT®:R'.,Name.: � �_ �..� _ h Pone Address SupervisorFs�,CorstructornLicense*, Exp , gate _- I � Expo Date Home..lmprovement License , - i ARCHITECT/ENGINEER Phone: Address: Reg. No. ti FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ /b6� FEE: $ 16— Check No.: Receipt No.: 26 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund *q � , -yr — •� 't;•�.'.'-� ,i..;......n++.,y' a.� .w•rR.:,.�.`�' � A.,p k- .r; c. r .. Signaturet''of-A'gent/OwnerF . - 'n ' _ i nature of contractors y __ _ i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ 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 o Building Permit Application u Workers Comp Affidavit u Photo Copy Of H.I.C. And/Or C.S.L. Licenses u Copy of Contract u Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks u Building Permit Application u Certified Surveyed Plot Plan u Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses a Copy Of Contract u Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Li Mass check Energy Compliance Report (If Applicable) u 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) Li Building Permit Application u Certified Proposed Plot Plan Li Photo of H.I.C. And C.S.L. Licenses Li Workers Comp Affidavit u Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) u Copy of Contract u Mass check Energy Compliance Report a 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 2012 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 Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments c 1 Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW 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: Z Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: I 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 I NOTES and DATA— (For department use ® Notified for pickup - Date I S Doc.Building Permit Revised 2010 i Location 119 J- 1 A)" d No. Date * • TOWN OF NORTH ANDOVER .ate .; • Certificate of Occupancy $ Building/Frame Permit Fee $ .3 "" Foundation Permit Fee $ k, 711 Other Permit Fee $ TOTAL $ Check# �2%j i w` Y: 25768 13V ding I spector Y 1 NORTH - r ve" 'o 0 No. T kO IANE h ver, Mass, /'- COCMICNEwICK 1' A04ATEo S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THATBUILDING INSPECTOR ............................................................................................................................ 4 , 117 has permission to erect ........................... buildings on .. .��..G1.... °c4. .�! . :....................... Foundation Rough to be occupied as ............ .C,,e�Jl.le.L: ...s �°.F.::... ..,'4E�!: .../..�:'a: :.......................................... chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST RTS Rough Service .................. .... '�' ......................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. SEE REVERSE SIDE f D, TO"OF NOR TO NORTH ANDOVER 7LEo, o y -,=• OFFICE OF BUILDING DEPART • � MENT ::,1600 Osgood Street Building 20, Suite 2-36 9q sA� � North Andover,Massachusetts 01845 Gerald A.Brown Inspector of Buildings Telephone(978)688-9545 HOMEOWNER-LICENSEMP EXETION Fax (978)698-9542 BUIDING PERMIT APPLICATION Please print DATE: lo JOB LOCATION: Number3 S s 1 Street Address Map/Lot ROMEOWNER _T' � ��s t 9��-�g y yy�a •� Name Home hone Work Phone PRESENT MAILING.ADDRESS / 739 - i✓d••�--�'l, ,Q•�.Flo v��• • M4 , a• .4,* • Stwty. lip Code The currento, rs to for"homeowners"was exten boTDP to allow such neded to include owner-occupied dwellings to two units-or less and ol=,veengage an i ldividual.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 gwns a parcel of land on be,a one or two family structures. A Person cwho constru he t s moes or re that one hometends to �in a two On which there er eis, osis intended to considered.a homeowner. Y p hall not be The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and Applicable codes,by-laws,rules and regulations, g other The undersigned"homeowner"certifies t • ' that he/she understands the T minimum ' own of No ms rth pectionproceduresandre Andover Building Department quirements and that he/she will comply with,said procedures and p ent requirements, - HOMEOWNERS SIGNATURE APPROVAL OF 13UMDING OFFICIAL Revised 7.2009 Foran Homeowners Exemption BOARD OF APPEALS 688-9541 CO7\r SERZ ADON 688-9530 HEALTH 688-9540 PLANNING 688-9535