HomeMy WebLinkAboutBuilding Permit #97 - 30 MAPLE AVENUE 8/7/2003TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
82202,
BUELDING PERNUT NUMBER: DATE ISSUED:
(?/7 1
SIGNATURE: A9 ((uttu
Building Commissioner/Inspector fff Buildings Date
SECTION 1- SITE INFORMATION
LI Property Address:
L-
1.2 Assessors Map and Parcel Number:
-0- Al L --W7.
Ma—p-gumber Parcel Number
y-
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Area (sf) Frontage (ft)
1.6 BIJUDING SETBACKS (ft)
Front Yard Side Yard
Rear Yard
Required Provide Required :�=Provided
Required Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information:
Public 0 Private 0 Zone Outside Flood Zone 0
1.8 Sewerage Disposal System:
Municipal 0 On Site Disposal System//
SECTION 2 - PROPERTY OWNERSIIIP/AUTHORIZED AGENT
Historic District: Yes _No,
2.1 Owner of Record
I A -j -j -c1 ----,-h oL �e L3,e L --e ki,
46me4Pfint) Address for Service
P
7 5� 61 IF -3
Signature Telephone
.2.2 Owner of Record:
Name Print Address for Service:
0
Signiture Telephone
SECTION 3 - CONSTRUCTION SERVICES
i
3.1 Licensed Construction Supervisor:
Licensed Construction Supervisor:
Address
Signature Telephone
Not Applicabt—Ll—�
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
Not Applicable 0
Company Name
Registration Number
Address
Expiration Date
Signature Telephone
T
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0
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SECTION 4 - WORKERS COMPENSATION (MLG.L C 152 § 25c(6) I
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 o Proposed Work (check applicable)
New Construction 0 E xisting Building 0 Repair(s) 11 Alterations(s) 0 Addition 0
Accessory Bldg. 11 Demolition 0 Other 0 Specify
Brief D!s!c��n�on of Proposed Work:
z?
'� k /I
x � // '.' r', � "
I rurTION 6 - F.qTTMATF.D C0NqTRlTrTT0N r.OqTq I
Item Estimated Cost (Dollar) to be
Completed by permit applicant
OF1qCIA'LUSE0NtY_
I Building 00
k 0 0
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
Plumbing
Building Permit fee (a) x (b)
-3
Mechanical (HVAC)
-4
Fire Protection
jd�gr/,
-5
-6 Total (V�2+3+4+5) - io CC)
Check Number
SECTION 7a OWNER AUTH(WIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPIJES FOR BUILDING PERMIT
as Owner/Authorized Agent of subject property
Hereby authorize to act on
this building permit application
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
1, as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are tme and accurate, to the best of my knowledge
and belief
Print Name
Signature of Owner/A ent Date
'HEM73 1111111IM11
NO. OF STORIES SIZE
BASENENT OR SLAB iST ND RD
SIZE OF FLOOR TEVIBERS 2 3
SPAN
DINENSIONS OF SILLS
DINIENSIONS OF POSTS
DINIENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING x
MATERIAL OF CHB4NEY
IS BUUDlNG ON SOLID OR FILLED LAND
IS BUILDING 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 properly
licensed solid waste disposal facility as defined by MGL Chapter I 11, S, 150 A.
The debris will be disposed of in:
/111/v
(Location ot Facility)
Signature of Permit Applicant
3
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for this project
through the Office of the Building Inspector
FA9
Town of North Andover
Building Department
27 Charles Street CHUS
North Andover MA 01845
Tel: 978-688-9545
HOMEOWNER LICENSE EXEMPTION
Please print.
DATE K/ -,) Z 0 S
7
JOB LOCATION 30 U
Number Street Address Section of Town
"HOMEOWNER Q MAPLC-4Uel OT I S Z)
Number Home Phone Work Phone
PRESENT MAILING ADDRESS dVbg,-
City Town State Zip Code
The current exemption for "homeowners" was extended to include owner -occupied dwellings
of six 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 109. 1. 1)
DEFINITION OF HOMEWOWNER:
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 to six family dwelling, attached or detached structures ac-
cessory to such use and and/or farm structures. A person who constructs more than one home in a
two-year period shall not be considered a homeowner. Such "homeowner* shall submit to the Building Official,
a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the
building permit. (Section 109.1.1)
The undersigned "homeowner" assumes responsibility for compliance with the Stat e Building Code and other
Applicable codes, by-laws, rules and regulations,
The undersigned "homeowner" certifies that he/she *understands the Town of No. Andover
Building Department minimum inspection procedures and requirements and that he/she will
comply with said procedures and regp,4ements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING OFFI
Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with
State Building Code Section 127.0 Construction Control.
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DATE:
FROM:
ADDRESS:
TOWN OF NORTH ANDOVER
OITICE OF
COMMUNITY DEVELOPMENT AND SERVICES
27 Charles Street
COMPLAINT FOR INVESTIGATION
1.9a 2-2
ap,
Complaint Against: A� 4 rf 1��e
Telephone (978) 688-954
FAX (978) 688-954
Tel #: ib'ro -,1 3-5
ELECTRICAL: w,00 a/
-P od po v
PLUNIBING: will
GAS: a OPQ RECEIVED
BUILDING CONTRACTOR: JUN 1 1.2002
BUILDING DEPT,
PROPERTY OWNER:
OTBER:
0
Signed: 2VII
'3) le
4
4
Location -30 MAPUS
No. - (�/,/) Date a-cqy-
TOWN OF NORTH ANDOVER
"WNW
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ op
Check #
'16 6 4 0"
'M /U , ( 1-,,,
Buildi—ng Inspector