HomeMy WebLinkAboutBuilding Permit #525 - 240 SUTTON HILL ROAD 3/7/2005N
Location _ lJ
No.� f l/ Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
... ,s .�
It9
'7b'�•�°'''t�' Buildin /Frame Permit Fee $
s.�....ab
Foundation Permit Fee
Other Permit Fee
TOTAL
Check #
$
1 B L 4 U ioe Building Inspector
1.1 Property Address:
' '' 1C UI SInct: (23 �!D
1.2 Assessors Map and Parcel
o 6
Map Number
Number:
O
d
Parcel Number
/Information: (J
1.3 Zoning
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Area
Frontage ft
1.6 BUILDING SETBACKS ft
ACTION 3 - CONSTRUCTION SERVICES
Front Yard
Side Yard
3.1 Licensed Construction Supervisor:
Licensed Construction Supervisor:
Address
Signature Telephone
Rear Yard
Reclaired I Provide ReqWred
Provided
ReqWred
Provided
3.2 Registered Home Improvement Contractor
Not Applicable ❑
1.7 Water Supply M.G.L.C.40., 34) 1.5.
Public ❑ Private 0 ,� 3._ a Zone
Flood Zane Information:
Outside Flood Zone ❑
1.8
Municipal
Sewerago Disposal System:
❑ On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
' '' 1C UI SInct: (23 �!D
2.1 Owner of Record
Name (Pri
Address for Service:
Signature Telephone
2.2 Owner of Record:
Name Print
Address for Service:
SignatureTele0one
ACTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Licensed Construction Supervisor:
Address
Signature Telephone
Not Applicable ❑
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
Not Applicable ❑
Con pany Name
a
Registration Number
Address
Expiration Date
Signature Telephone
SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 f 2506)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes .......0 No ....... 0
SECTION 5 Description of Proposed Work cheuck a8
■ ble
New Construction 0
Existing Building 0
Repair(s) ❑
Alterations(s) ❑Pdditi
on 0
Accessory Bldg. ❑
Demolition ❑
Other ❑ Specify
Brief Description of Proposed Work:
�` .Z�/1�aL� lei �oGOGP/i�Pr. i G��►��u/ j
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollar) to be
Completed by permit applicant
OFFICIAL USE ONLY
1. Building �D D
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) x (b)
4 Mechanical 0A0
5 Fire Protection
6 Total 1+2+3+4+5
Check Number
SECTION 7a OWNER AUTHO TION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
I, ,as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are Lrue and accurate, to the best of my knowledge
and belief
Print Name
Si ture of Owner/Agent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIlvIBF.RS isr2 NLJ 3
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DUVENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS _
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDJNG CONNECTED TO NATURAL GAS LINE
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
c 11, S 150 A.
The debris will be disposed of in:
(Location of Facility)
nature of Permit Applicant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
3'
D. Robert Nicetta,
Building Commissioner
Please print
TOWN OF NORTH ANDOVER
OFFICE OF
BUILDING DEPARTMENT
400 Osgood Street
North Andover, Massachusetts 01845
HOMEOWNER LICENSE EXEMPTION
DATE: 3-7-0
S
Telephone (978) 688-95454
Fax (978)688-9542
JOB LOCATION: . 02�O f6l7iOXI OL6
Number Street Address Map/Lot
HOMEOWNER NAv IQ Gli��se 9 � �ViI " 6 /9 I)?' 7q1.
Name Home Phone Work Phone
PRESENT MAILING ADDRESS oZ civ J 1,T1 j ail/tt A0
NMN AjdVelt IIIA
City Town State 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.
The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building Department
minimum inspection procedures and req}� rements and that he/she wil comply with said procedures and
requirements. //7 1 _ / J
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING OFFICIAL
130AR:)OF.UPIALS688-9541 CONSF.R.VATION698-9530 iw,u,ri168H.-9540 PLANNING 688-9535