HomeMy WebLinkAboutBuilding Permit #669-2011 - 20 HAROLD STREET 4/5/2011TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: 66f-,2011 Date Received
Date Issued: f/
IMPORTANT: Applicant must complete all items on this page
LOCATION o?D IlWolb S/ A. 1417dQ vic- 4
Print
PROPERTY OWNER 0140J 'T
' l Print
MAP NO: /S, OPARCEL: 00 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
❑ Alteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
Septic ❑Well:
q FloodplaWetlands
0; Watershed3Dstrict
11 Water/Sewer
DESUFJP 1UN OF WORK TO BE PERFORMED:
(Identification Please Type or Print Clearly)
OWNER: Name: %14V/b J , L 10- 0 /�4 r%Z /�> r Phone• 97P-.332�-3 qW
Address:
CONTRACTOR Name:
Address:
Supervisor's Construction License:
Home Improvement License:
ARCHITECT/ENGINEER
Exp. Date:
Exp. Date:
Phone:
Address: Reg. No
Phone:
FEE SCHEDULE: BOLDING PERMIIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED Ohl $925.00 PER S.F.
Total Project Cost: $ 01,500 FEE: $
Check No.: SD2— Receipt No.:_��/o �-6
NOTE: Persons contracting with u Vegas eyed contractors do not have access to the guaranty fund
� � ,�< -
a
R
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
PLANNING & DEVELOPMENT
COMMENT
DATE REJECTED
Ell
DATE APPROVED
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
Conservation Decision: Comme
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
FIRE DEPARTMENT - Temp Dumpster on site
Located at 124 Main Street
Fire Department signature/date
COMMENTS
Located 384 Osgood Street
yes no
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
Ll Notified for pickup - Date
Doc:.Building Permit Revised 2008mi
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
o 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
90TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Permit
I all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
iat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
lust be submitted with the building application
Doc: Doe.Building Permit Revised 2008mi
Location At-, "', 0
No. 6,6,j– --"6
Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ -30—
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # 15"25.2
2 4
0
dilding Inspector
�I
O
�A
u
o
w°
ci
a
cin
w
z
w°
toob
w�'
G
U
w
w
C7
w°'
i�
w
0
a
W
W
a�'
CA
w
OWZ
W)
rL
.
u.
A
W
-
C.
w�
z
U)cn
Q
o
ui
am
W V•
CO2
O
CD•�
LA O O
'0 m m
CD CD
CD R�
3.0
O
O O
L
O d
CL C Q
o ��
c
cc
CJ J .O
C Z CD
G3 H
c
C
C
c
CO)
0
0
LLI
U)
19
W
LLI
19
W
CO)
c c
m c
o �
C L
O CA
t„ C
N CS
C
MCL
R R
C _
CA
Ea
L
C
O:
V
c
y
c� E C
m
O
Co
s
c
E
Q
CD
ca
V :
Lir CA R
O
m
CD o
=C.3 L:m
N CCt 4
1�
o
"
cm
C
� S Oa
`
a C=
mom
m
y
C3 Z
R
O
O
v
•r
Cccd0
cm
C
_
m
i Is 3
IV
+O+
C o
CA CCI
y
W
CO
�O. D
� t m
..0
C
.0
w
.y
�
R
.E
C36= 5
-y
Z
�
W
_.0 'CO.,
v� C
O
V
O
®
F -
y
CL
H
2
. .o- Cr=..rm
i
W V•
CO2
O
CD•�
LA O O
'0 m m
CD CD
CD R�
3.0
O
O O
L
O d
CL C Q
o ��
c
cc
CJ J .O
C Z CD
G3 H
c
C
C
c
CO)
0
0
LLI
U)
19
W
LLI
19
W
CO)
OtiORTFI TOWN OF NORTH ANDOVER
t�.,�eo .6 •y0
•:° 0 OFFICE OF
BUILDING DEPARTMENT
o ,p� 1600 Osgood Street Building 20, Suite 2-36
yygO^+no°"y1y North Andover Massachusetts 01845
Gerald A. Brown Telephone (978) 688-9545
Inspector of Buildings Fax (978) 688-9542
HOMEOWNER LICENSE EXEMPTION
BUIDING PERMIT APPLICATION
Please print
DATE:'y S
JOB LOCATION:
Number
Street Address
HOMEOWNER 7)&/ 1J 1_ lc e• / lei ,61 I
Name Home Phone
PRESENT MAILING ADDRES SOP a 1114101b 5
City Town
State .
Map/Lot
Work Phone
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. 11
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 co ply with said procedures and
requirements. ^ w� /•i /� .
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Revised 7.2009
Form Homeowners Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530
HEALTH 688-9540 PLANNING 688-9535