HomeMy WebLinkAboutBuilding Permit #735 - 22 HAMILTON ROAD 6/12/2008TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:
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6
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I IMPORTANT: ADDlicant must complete all items on this Daae I
LOCATION 2_2 4AM ILroN N . "WV R_
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PROPERTY OWNE+ �Ql�ri 6
Print
MAP NO.:_z6_ PARCEL: 1 r ZONING DISTRICT:
TYPE AND USE OF BUILDING
HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT
PROPOSED USE
p e(ri do
J:)Vnba y- Phone:9i$ 6SS '7939
Residential
Non- Residential
11New Building
❑ Addition
Iteration
ROne family
❑ Two or more family
No. of units:
❑ Industrial
❑ Repair, replacement
❑ Demolition
❑ Assessory Bldg
❑ Commercial
❑ Moving (relocation)
❑ Other
❑ Others:
❑ Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
Please Type or Print Clearly)
OWNER:
Name:
p e(ri do
J:)Vnba y- Phone:9i$ 6SS '7939
Address:
12-2-
RAMI LI -00
12d
CONTRACTOR N
Address:
Supervisor's Construction License:
Phone:
Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Name: Phone:
Address:
Reg. No.
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost :$ 6, 000 •--- 00 FEE:$ 7_2
Check No.: � 2 d � Receipt No.:�a ,? 21,
Page I of 4
TYPE OF SEWERAGE DISPOSAL
Tanning/Massage/Body Art ❑
Swimming Pools 11Public
Sewer
Well ❑
Tobacco Sales ❑
Food Packaging/Sales ❑
Private (septic tank, etc. ❑
Permanent Dumpster on Site ❑
Electric Meter location to
project
iv v i r,: versons contracting with unregistered contractors do not have access to the guarantyfund
Signature of Agent/Owner Signature of contractor
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
❑Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
COMMENTS
CONSERVATION
COMMENTS
c
HEALTH
COMMENTS
DATE REJECTED DATE APPROVED
❑ ❑
DATE REJECTED
DATE APPROVED
Zoning Board of Appeals: Variance, Petition No:
Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer connection/Si2nature & Date Drivewav Permit
Temp Dumpster on site yes_no Fire Department signature/date
Building Setback(
Front Yard Side Yard Rear Yard
Required
Provided Required
Provides Required Provided
Dimension
Number of Stories:
Total land area, sq. ft.:
Total square feet of floor area, based on Exterior dimensions.
NOTES and DATA — (For department use)
Page 3 of 4
Doc: INSPECTIONAL SERVICES DERARTMENT:13PFORM05
Created JMC. Jan.2006
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
Addition Or Decks
❑ Building Permit Application
❑ 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)
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
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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM05
Pa -e. 4 of 4
Location
No. -2Z Date 6 2 b_
2 1 232,z
Building Inspector
TOWN OF NORTH ANDOVER
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Certificate Occupancy
of
$
s�ust
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Building/Frame Permit Fee
$
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
$
Check # o2 �2 Go
2 1 232,z
Building Inspector
of #ORT" TOWN OF NORTH ANDOVER
OFFICE OF
BUILDING DEPARTMENT
1600 Osgood Street Building 20, Suite 2-36
North Andover, Massachusegs 01845
ss,C
p
Gerald A. Brown Telephone (978) 688-9545
Inspector of Buildings Fax (978) 688-9542
HOMEOWNER LICENSE EXEMPTION
Please g[i g
DATE: 6 2 p �/
JOB LOCATION:
Number Street Address.
&4&4g (I �R 9-5 713 S' (q 79) 261E� 64? / c7
Name Home Phone work Phone
PRESENT MAILING ADDRESS yam/ Lj�h j ,QED.
Ayw)ovF-�e IV# I C!�l 9,4 �
City Town Stats 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 Budding (Code Mien 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 imended
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 helshe understands the Town of North Andover Building Departmem:
minimum inspection procedures and requ% and that belshsh e will comply with said procedures and
ements. 11•
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Revised 10.2005
Form Homemm s Exemption
BOARD OF \PPE.0-S 699-9541 CO SERN'.YtInN F3R-953) [iEAL11i 688-9540 PL.L\V[NG 688_9535
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I CERTIFY THAT
THE OFFSETS
SHOWN COMPLY
WITH THE ZONING
BYLAWS OF
NORTH ANDOVER
WHEN 8UILT
CERTIFIED PLOT PLAN
LOCATED IN NORTH ANDOVER, MASS.
SCALE:1 "=20' DATE:6/13/2006
Scott L. Giles R. P. L. S.
Frank. S. Giles R. P. L. S.
50 Deer Meadow Road
North Andover, Mass.
100.0'
HAMILTON
OFFSETS SHOWN ARE FOR THE USE
OF THE BUILDING INSPECTOR ONLY
AND SUCH USE IS FOR THE
DETERMINATION OF ZONING
CONFORMITY OR NON -CONFORMITY
WHEN CONSTRUCTED.
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