HomeMy WebLinkAboutBuilding Permit #362 - 250 ANDOVER STREET 11/26/2008 BUILDING PERMIT OF poRTH
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TOWN OF NORTH ANDOVER
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APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued: //h,6 �y
IMPORTANT:Applicant must complete all items on this page
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LOCATION ,:?—�Q
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PROPERTY OWNER Q0 C)a. 1�?'
Print
MAP NO: 7 PARCEL:3 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 Floodplain Wetlands Watershed..District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
Identification Pleas=Jat—
or Print Clearly)
OWNER: Name: /I/`('���'J c% f D Phone:TTI 1) 1 -9
Address:
CONTRACTOR Name: Phone:
Address:
Supervisor's Construction Licens . Exp. Date:
Home Improvement Licens Exp. Date:
ARCHITECT/ENGINEER 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: $ / _f�c��, 6 C, FEE: $ 4)
Check No.: ���� Receipt No.: 21 717
NOTE: Persons contracting rith unregistered contractors do not have access to the guaranty fund
$Ji
gnature of Agent/Owne - f Signature of contractor '
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Alq u(/,
Location
No. -3 6 2 Date 4 s F/
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Mp"T" TOWN OF NORTH ANDOVER
Of • o ,�,q•0
49
' Certificate of Occupancy $
Building/Frame Permit Fee $ 0
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ 1'2 D
Check 0
2s77 . �
L/ Building Inspector
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
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: 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)
❑ Notified for pickup - Date
........_......---............................................__—.. __..__.._................_—
Doc.Building Permit Revised 2008
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
❑ 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
t ❑ Mass check Energy Compliance Report
❑ 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:Building Permit Application
Revised 2.2008
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NORTH
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l - A K E O dower, Mass.,
COC MI C ME WICK
�lqs RgTED BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT......................... ./l ./.... �' v�a� �-
l �
.............:........................................................................ Foundation
has permission to erect........................................ buildings on ...!Z. ....�. r ��.�1r.'. .........�.. " "
................. Rough
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to be occupied as............................... . Chimney
.. ...........,......................................................................................................................
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final
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 CONSTRUCTIO TARTS Rough
t h....... ....... .... :.. !r.-- ..................................... Service
�: ..
BUILDING INSPECTOR
. Final
Occupancy Permit Required to Ocmpy,r�Building GAS INSPECTOR
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.
SEE REVERSE SIDE Smoke Det.
pORTM TOWN OF NORTH ANDOVER
OFFICE OF
F BUILDING DEPARTMENT
1600 Osgood Street Building 20 Suite 2-36
�,"•,nn. �� North Andover,Massachusetts 01845
SSACNUSt
Gerald A.Brown Telephone(978)688-9545
Inspector of Buildings Fax (978)688-9542
HOMEOWNER LICENSE EXEMPTION
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DATE: Xvlm6le
JOB LOCATION:_ Z<V
` Number Street Address Map/Lot
HOMEOWNER /r"/Q�IGt
Name Home Phone Work Phone g ��
PRESENT MAILING ADDRESS
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 requirements and that he/ will comply with said procedures and
requirements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Revised 10.2003
Form Homemom Eamon
ROARD OF \PPEA1.S 6,"`)541 CONSERV_\T ON 688-9530 11E.0 1'H 688-9540 PL.L\"\I\G 69340535