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Home My WebLink AboutBuilding Permit #597 - 26 PEMBROOK ROAD 2/10/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION - Permit N0: 1 Date Received &,� lo a o 12 Date Issued: 2/ IWORTANT:Applicant must complete all items on this page LOCATION �erM, Iorao�'C ICy - - �"l�V � lfheqlS��l� Print PROPERTY OWNER Unit# Print MAP NO: PARCEL:�ONING DISTRICT: Historic District yes Machine Shop Village yes no 100 year-old structure ye ne TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential .. ❑ New Building ❑One family ❑Addition ❑Two or more family _ ❑ Industrial ❑Alteration No.of units: ❑ Commercial 0 Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other �P a Wa`t�er edMR ® Septic ®Well Wetland91` 0 ater/ e � � rHir= e .2 :i DESCRIPTION OF WORK TO BE PERFORMED: (Identification Please Type or Print Clearly) OWNER: Name: 0 Iyoya"GC Phone: 31a Address:_ G I�ew► �rov� Rel, k/rwk A.,14L/v, I/L Its- CONTRACTOR Name: Phone: Address: b I :Supervisor's Construction License: - Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: �6oU FEE: $ Yq Check No.: (10 Receipt No.: �� Z NOTE: Persons contracting with a re i dered ontractors do not have access to the guaranty fund lSi natur.`e ofA`'`ent/Owrier e Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Swimming Pools ❑ Tanning/MassageBody Art ❑ 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 feetof 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 —N o DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine y NOTES and DATA- For department use i i i C' s ® Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi 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 o 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) o Engineering Affidavits for Engineered products MOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Neter 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 Li Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o 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 I 1 Doc: Doc.Building Permit Revised 2008mi i i � Locatioj b fid( Datea'•'� • TOWN OF NORTH ANDOVER Certificate of Occupancy $ a Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee $' 3 TOTAL $ Check# 25021 Building Inspector O NRrH - TOANM Of Andover �O t- LAKE 0 d.®Ver, 1-Bass., V - �� • t coC HI CHE WICK V 0R ATE D a 7 BOARD OF HEALTH Food/Kitchen tPE R MIT T DSeptic System BUILDING INSPECTOR THIS CERTIFIES THAT.......... .. ........ Foundation has permission to erect...........:............................ buildings on .... �. ................ ..............��-+ — �.C �—..... Rough _ r to be occupied as........... .....�.d- ..... -�--o 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 i ELECTRICAL INSPECTOR, UNLESS CONSTRUCTI T . TS Rough .................. ......... .........._...................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy 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. XAORTH do - er -0VM of `` _ _' v An 0 No. - o - t� • � , dover, Mass., LAKE ISO `COCHIC EWICK 7�ADRATED PP��y S BOARD OF HEALTH � I r Food/Kitchen PERMIT Septic System DING INSPECTOR BUIL - " THISCERTIFIES THAT................. ..... �"'�.............V�.• 1....�L'..............:................................................................... Foundation has permission to erect........................................ buildings on....cPL.(v................ Rough to:' ioccupied as..:........ L.d�-..... --� ................................................................................ . .............. Chimney provided-that the person accepting this permit shall in every respect conform to the terms of the application on file in Final- this inalthis 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 UNLESS CONSTRUCTI T TS RoughELECTRICAL INSPECTOR - .. ......... ...L ............................................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy 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. TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO:. Date Received Fe� 10 201 Date Issued: _ 2/ IllZPORTANT:Applicant must complete all items on this page LOCATION �. �e rh. row�'� r v �L'V`�'�1h�a✓��/ Ol�� Print PROPERTY OWNER Unit# Print MAP NO: PARCEL:_q)�16NING DISTRICT: Historic District yes . Machine Shop Village yes no 100 year-old structure ye 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 S 1 yip Septic ®well ` � ®Fdoodpl7,6 aruu4`g7®Wetlands `° ® 1aWbMrshed l istnct ' ` � t®��i?aterlSewer .��.'}K_w�$�.� ._§` � �z��`, ��,�� •t�.,,�¢, � ,_,.�, � ,: �yyY�y� � �. DESCRIPTION OF WORK TO BE PERFORMED: (Identification Please Type or Print Clearly) OWNER: Name: 64-i�,v, N cya-ff- Phone: ,7 3 i a C Address: Pe,N, Kook 9,1, / � L, ��y l�►.11�- �J%�!-/ CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Nddress: Reg. No. FEE SCHEDULE.BULDING PERMIT.•$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. ratal Project Cost: y �� FEE: $ Yq heck No.: (d(d Receipt No.:. 0 Z dOTE: Persons contracting with i re istered ontractors do not have access to the guaranty fund MQ. ` *."'' F ��ignature:of Agee_ Ownerrir ::t.. ature of�contractor� - ,. _ µ°RTH TOWN OF NORTH ANDOVER Gf�T�ec �6�N 32 GE':F ksp� OFFICE OF BUILDING DEPARTMENT g d Street Building 20, Suite 2-36 600 North Andover,Massachusetts 01845 Sq�Hus Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER'LICENSEFXEMPTION BUIDING PERNQT APPLICATION Please pnnt DATE: JOB LOCATION: oZ,6 Number Street Address Map/Lot UOMEOWNER ail I�Jc�a `�r�- �35�1I�S— 7�l 37 a�63 Name Home Phone Work Phone PRESENT MAILING ADDRESS_ C re ", rOo`C 6` ko -�( " Sflv-P✓ C'+v Town Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeovmers 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 Awns 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 Applicable codes,by-laws,rules and regulations. uilding Code and other 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.. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535