HomeMy WebLinkAboutBuilding Permit #471 - 22 BOXFORD STREET 12/19/2006Permit NO:
Date Issued:
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received ZZ- �f
IMPORTANT: Applicant must complete all items on this page
LOCATION 01% 14'ox Fo" W
Print
PROPERTY OWNER Q fibQ" ^ND
Print
MAP NO.:, -Z/ 6� *ARCEL: ; Z o 6 ZONING DISTRICT:
TYPE AND IISE OF BUILDING l bG . #4 HISTORIC DISTRICT YES ❑
MORTN
OE �t�su �•�40
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CM16
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
U New Building
U Addition
U Alteration
W.One family
U Two or more family
No. of units:
U Industrial
U Repair, replacement
U Demolition
U Assessory Bldg
U Commercial
U Moving relocation
U Other
U Others:
U Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
1*4S'TA14- Wc+o9 61dY4 IN AIT1 S14 ID 601"Wee To 0XIS'T1N4 04IM861
Identification Please Type or Print Clearly)
OWNER: Name: Phone: q7 Q� 4 418
Address: 0:7 g�XfvtLo S�, C Si8'� 687
CONTRACTOR Name: Phone:
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License:
ARCHITECTIENGINEER Name: Phone:
Address: Reg. No.
Date: `
FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project /Cost :$ goo x12.00=FEE:$ �c�
Y
Check No.: o Receipt No.: � P S�
Page lof 4
Location '.91",gwwi —
No. / Date
TOWN OF NORTH ANDOVER
O w
f 9
+ : Certificate Occupancy
$
of
cMusE�� Building/Frame Permit Fee
$ y
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
$
Check # vof3
19885
Building Inspector
TYPE OF SEWERAGE DISPOSAL Swimming Pools U
Public Sewer '
U Tanning/Massage/Body Art U
Tobacco Sales U Food Packaging/Sales U
Well ❑
Permanent Dumpster on Site U
Private (septic tank, etc. U Electric Meter location to
project
NOTE: Persons contracfing with unreewered contractors do not have access to the guaranty fund
Signature of Agentl4er " Signature of contractor
Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION
COMMENTS
DATE REJECTED
❑ ❑
❑Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
DATE APPROVED
DATE REJECTED DATE APPROVED
❑ ❑
DATE REJECTED
HEALTH ❑
COMMENTS
Zoning Board of Appeals: Variance, Petition No:.
Zoning becision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
9
DATE APPROVED
Water & Sewer connection/Signature & Date Driveway Permit
Temp Dumpster on site yes—no— Fire Department signature/date
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Town of North Andover
Building Department
400 Osgood Street
North Andover MA 01845
Tel: 978-688-9545
HOMEOWNER LICENSE EXEMPTION
Please print.
DATE ^l-7 X ��q O Jc
JOB LOCATION ��
Number Street Address Section of Town
"HOMEOWNER A�t 91 T G " 413 487
Number Home Phone Work Phone
PRESENT MAILING ADDRESS JL d)kfaR CC
t4o(r" 4WIDegn, V4A 0184x'
City Town State Zip Code
The current exemption for "homeowners" was extended to include owner -occupied dwellings
of sic 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 109.1.1)
DEFINITION OF HOMEWOWNER:
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 to six family dwelling, attached or detached structures ac-
cessory to such use and and/or farm structures. A person who constructs more than one home in a
two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official,
a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the
building permit. (Section 109.1.1)
The undersigned "homeowner" assumes responsibility for compliance 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 No. Andover
Building Department minimum inspection procedures and requirements and that he/she will
comply with said procedL
HOMEOWNER'S SIGNA
APPROVAL OF BUILDING OFFICIAL
Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with
State Building Code Section 127.0 Construction Control.
G�
WOOD STOVE INSTALLA VION CHECKLIST
F. N I W* Sh. L M
HEARTH
CHIMNEY HEIGHT
Hearth (non-combustible) �_ _:• _ _ _ _ _ _ _ _ I_ �_ _ _ _ �_ _�__
A. Materraisrt.•
B." Slltrfioor a
canstruction
C. Minimum dimensions (refer to diagram)
Clearances and Wall Protection (see stove installation dea�ances chart) �"} , r . ,�, a E . :..�
A. Type of wall prtitectionprovided. - _ • -
j B. Clearances (refer to diagrams) ��. r _w� ,a�� ' •i ��fr ��ts _....'jl'
Permit
A building permit is required for the installation of any sofid. fuel burning appliance. The building permit and
installation Inspection are limited to the stove installation and not to the stove construction.
stove 14012PIX101"
3U:r:+ '.)(^,(s' :Irl 37!i`. i' :11%1.', ("1,
A. New X
Used
B. Typetradiant
Circulating
C. Manufacturer
_. ^ r - Lab. No.
Name/Model N W
-•• Cnnar•size
Dimerlsions/Height _36j. 1
_Length Width
Chimney
•
Wit, c
A. New - ''
''' `— ' `Existing X
EL Size fflu a egj E -Aly 151
wyj•_-�i �r �r 41 C' f7 ti
C. Oiher',Jpplianc+es attached to flue (Number
and flue si2ej._ _AI4M
D. -Ptefab (Manufact&er=name and type)
• �!*- 'r
. IKI t'• 3, 1
y w..
E. Masonry/Unad y `
.ter .. .
- Flue Brier CLOP
Unlined
— type 3 matwfanurnr)
F Height (refer to diagrams)
cap
F. N I W* Sh. L M
HEARTH
CHIMNEY HEIGHT
Hearth (non-combustible) �_ _:• _ _ _ _ _ _ _ _ I_ �_ _ _ _ �_ _�__
A. Materraisrt.•
B." Slltrfioor a
canstruction
C. Minimum dimensions (refer to diagram)
Clearances and Wall Protection (see stove installation dea�ances chart) �"} , r . ,�, a E . :..�
A. Type of wall prtitectionprovided. - _ • -
j B. Clearances (refer to diagrams) ��. r _w� ,a�� ' •i ��fr ��ts _....'jl'
j
.tHr. ..1 4. i.• t.
�nY, FIREPLACEii �.4.,�Ft '
..,,CORNER, 9t.r ,'' �'.AALUCENTEFi,r
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in•t
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�nY, FIREPLACEii �.4.,�Ft '
..,,CORNER, 9t.r ,'' �'.AALUCENTEFi,r
780 CMR: STATE BUILDING CODE COMMISSION
Figure 2149-4
CLEARANCES FOR SOLID FUEL BURNING APPLIANCES
C FACTORY-RUILT CHIME"
OP
.nosy @u►►o[r .
WALL
a aunoRr aalc,cer
NON-CONOUSTIOLE 8
A
A ® j,
1°
AIN SPACE
f1�y Ir, L 18'
NON-COMUSTIOEE . .
FLOOR PROTECTION
STOVE INSTALLATION CLEARANCES
T, vronti rue+ or *in access sive.
2. TMmlble required for passage through combustible construction-.
), Non-combustible spacers required.
i. Clearances on each side of a radiant -stove with a heat shield shall be measured as If a eirculatfng type.
CoelMntlbie
I" Asbestos Miliboard-
ConeretelNasonry
4nBrick Veneer
Stove Cangonents
Materlel
Spaced otit 11[ 3
Foundetlon wellqnae^d
chit „
Iladlant Store 1•
36[.
-F
CSrculetIng Stove
--Front
A. Radlent Stovi
j6..
16.0
6"
lip,
Ids i k
.'Circuleting Stow
120
60 .
6n.
6n.
—Slde/eack
e. Single vett 2•
lip,
it'n
6'• .
e"
Connector Fire
li+snilited
Zt l
2"
211
211
Connector Pipe
Chimney Height
Three (3) f t above od)aient roof and
(Metal or Mason ):
dtwo (2) Ise .above anX roof rldge within 10 feet
It.a damper s not nc u n An* stove construct on.
eamger
It 'l!mist be Installed In the cofinector pipe.
T, vronti rue+ or *in access sive.
2. TMmlble required for passage through combustible construction-.
), Non-combustible spacers required.
i. Clearances on each side of a radiant -stove with a heat shield shall be measured as If a eirculatfng type.