HomeMy WebLinkAboutBuilding Permit #275-2012 - 30 MIFFLIN DRIVE 10/31/2011 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued: �� t
IMPORTANT:Applicant must complete all items on this page
LOCATION 3o M` . Ald-) 141"
Print
PROPERTyo ER d Ca�J 0')V_JL- Unit#
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MAP NO: PARCEL: 2 Z ZONING DISTRICT: Historic District yes
Machine Shop Village yes
100 year-old structure yes
TYPE OF IMPROVEMENT PROPOSED USE
Resi ential 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 D Watershed0istrict
OWater/Sewer _
DESCRIPTION OF WORK TO BE PERFORMED:
�xf£2� en -r., s3& 77- �owr1 AND
�I RAQ[.A cZ c,, i LL e log K6,0 !> 1�6,C el
fr• 4AU r
(Identification Please Type or Print Clearly)
' Phone:
OWNER: Name: �A�i GL cam ^��u'
Address: 3
CONTRACTOR Name: Phone:
Address: 13 f re6V Lctc.sa 0tZD �� (_L_E/L1Cf1
supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Tota! Project Cost: $
70o FEE: $ /US ov
Check No.: V V 4 Receipt No.:
NOTE: erso'f ontr with unregistered contractors do not have access to the guaranty fund
F :. .,.... :._ Si .nature of con racto[
.pinna i PrP:6f.AaentlOWne[ —g_ -
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)
a 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
o 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
❑ Engineering Affidavits for Engineered products
VOTE: 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
nust be submitted with the building application
Doc: Doc.Building Permit Revised 2008mi
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
F
EWERAGE DISPOSAL
r ❑ Tanning/MassageBody Art ❑ Swimming Pools ❑❑ 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
t 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
LI Notified for pickup - Date
Doc:.Building Permit Revised 2011 June/mi
Location -30 �`I' ��1/'y
No. 2. Date
NORTq TOWN OF NORTH ANDOVER
3? ,. • O
F w
9
}�o Certificate of Occupancy $
�ss,KMusEt�' Building/Frame Permit Fee $ Za
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
F
Check # 2 'Ll
246,
dil, ing Inspector
NORTH
Town of : Andover ..
LAKE O dover, Mass.,
COCHICHE w ICK �.
5 RATEo y
USWIM BOARD OF HEALTH
PERMIT T U
Food/Kitchen
Septic System
r BUILDING INSPECTOR
THIS CERTIFIES THAT.......... .1/ .................... 5`. 1..................................................................................... Foundation
has permission to erect........................................ buildings on ... �!.� ........................................................... Rough
o �v c �I r-24i-0-r1r� Chimney
to be occupied as.................. .. .. .0J.r . . .......... .......................................yy.. ......................................................................
provided that the person accepting this permit shall in every respect cc arm 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 CONSTRUCTION STA
RTS Rough
.......... E..trT... �.. ...._................................ 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.
NORTF{
Town of
Yy= ... . ...�, r.
�,o = A K E o , dover, Mass., �� f
COCMICHEWICK y�.
ADRATED SP�t-`C,
P�
S V 4 BOARD OF HEALTH
Food/Kitchen
EnMIT T D Septic System
BUILDING INSPECTOR
THISCERTIFIES THAT.........1 l./ .................... '.�/.................................................................................. Foundation
has permission to erect........................................ buildings on ..- lJ... Jl. 7' :y.................................................... Rough
er v
Chimney
to be occupied as..................�r..C�o�v.�?��...�. ... 1......................... ......................................................................... y
provided that the person accepting this permit shall in every respect c form 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 CONSTRUCTION ST TS Rough
................................... Service
I
BUILNGZIVSPECTOR
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.
t4DRTH TOWN OF NORTH
ANDOVER •
= 6 �- �; o OFFICE OF
BUILDING DEPARTMENT
;1600 Osgood Street Building 20,-Suite 2-36
Qp{C(.1[Mwt V
4 01° �<5 S North Andover,Massachusetts 01845
A�HU
Gerald A.Brown Telephone(978)688-9545
Inspector of Buildings Fax (978)688-9542
HOMEOWNER-LICENSE EXEMPTION
BUIDING PERMIT APPLICATION
Please print
DATE: /p 3— �el1
JOB LOCATION: J--Dx t ✓E
Number Street Address Map/Tot
HOMEOWNERN F.. 1. OCA wl N E G L ?7 -?-7
Name Home Phone Work Phone
PRESENT MAILING ADDRESS 36 rh, FFG. � -2)2t VE
Ala . 4,-jt>0V6t
City Toti=m
�--� Zip Code
The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and
to allow such homeoj=.rners 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 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,
HOMEOWNERS SIGNATURE b
APPROVAL OF BUILDING OFFICIAL
Revised 7.2009
Form Homeowners Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 685-9530F
HEALTH 688-9540 PLANNING 688-9535