HomeMy WebLinkAboutBuilding Permit #792 - 254 GREENE STREET 6/14/2006,10RTN
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Permit NO:
Date Issued: C�
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received: 4� �7` �� 6
I I. IMPORTANT: ADDlicant must complete all items on this r)ue I
LOCATION
G
r Print
PROPERTY OWNER CkCi ��S Ea�
Print
MAP NO.: PARCEL: ZONING DISTRICT:
TVPF. AND iTQF, OF RITIF,DlNG
HISTORIC DISTRICT VF,S F1
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ Addition
❑ Alteration
9 One family
❑ Two or more family
No. of units:
❑ Industrial
Repair, replacement
❑ Demolition
❑ Assessory Bldg
❑ Commercial
❑ Moving (relocation)
LI Other
❑ Others:
❑ Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
Identification Please Type or Print Clearly)
OWNER: Name: Ckcc—
t..,) / pi C to
Address ,,�2.5V C !�. /-V, Mq 01 Yc(.5
CONTRACTOR Name:
Address:
Phone:
Supervisor's Construction License: Exp. Date:
Home Improvement License:
Exp. Date:
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No
FEE SCHEDULE: BULDING PERMIT.• $10.00 PER $1000.00 OF THE TOTAL ESTIMATED COS ASED ON $125.00 PER S.F.
Total Project Cost S OC,)0,00 x10.00=FEE:$ G,DO
Check No.: 02? Receipt No.: ( t'
Page lora
TYPE OF SEWARGE DISPOSAL
Tanning/Massage/Body Art ❑
Swimming Pools ❑
Public Sewer F-1
Well ❑
Tobacco Sales El
Food Packaging/Sales G
Ell
Permanent Dumpster on Site ElPrivate
(septic tank, etc.
Electric Meter location to
project
NOTE:
rer3ons cantructtng wtut unregtsterea contractors do not have access to the guaranty fund
Signature of Agent/Owner �Signature of Contractor
Plans Submitted ElPlans Waived ❑ �/�,,s Certified Plot Plan ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
Zoning Board of Appeals: Variance, Petition N
Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
DATE REJECTED
Q
❑ Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
DATE REJECTED
El
DATE REJECTED
C
Comments
Comm
1-1
C
Stamped Plans ❑
DATE APPROVED
DATE APPROVED
DATE APPROVED
Water & Sewer connection signature & date
Temp Dumpster on site yesXno_ Fire Department signature/date
Building Permit Approved and Issued by:
Page 2 44 t
Building Setback (ft.)
Front Yard
Side Yard
Rear Yard
Required
Provided
Required
Provides
Required
Provided
DIMENSION
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
NOTES and DATA — (For department use)
Page 3 of 4
Doc: INSPECTIONAL SERVICES DEPARI'MENT:BPFORM05
Creased 1MC. 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 DEPARTNIENT: MORN105
Page 4 of 4
Location ? /"o'".-W r -V�
Nor Date
"NORT1y TOWN OF NORTH ANDOVER
L
•
Certificate of Occupancy $
.�...,Building/Frame /Frame Permit Fee $
�sstE 9
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # C-) 27 /
1 ~•
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Building Inspector
E�rcwn by
Eheryl Eoton
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254 5reene Street
"N Andover, MA 01045
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�204c+�orN OyoL 1VW04 Ur INUK1tl AIN VUVLK
ry.. • o OFFICE OF
° p BUILDING DEPARTMENT
\*� ��s� 400 Osgood Street
North Andover, Massachusetts 01845
Gerald A. Brown Telephone (978) 688-9545
Inspector of Buildings Fax (978) 688-9542
HOMEOWNER LICENSE EXEMPTION
Please print
DATE:
JOB LOCATION: (;)- .Sq V f e_Q_n f A,.
Number Street Address Map/Lot
HOMEOWNER C�cAc S&4,-,
Name Home
PRESENT MAILING ADDRESS
City Town
2 r_o_�e (
S tate
r
M&
Work Phone
01911-5
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/she will comply with said procedures and
requirements. DL�A4�"S
APPROVAL OF BUILDING OFFICIAL
Rcv ise(1 10.2005
Form Homomiers Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-')530 HFALTH 6S8 -V40 PLANNING o>8S-
(615
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