HomeMy WebLinkAboutBuilding Permit #400-11 - 33 GREEN HILL AVENUE 11/10/2010 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: /0 -Date Received
Date Issued:
IMPORTANT:Applicant must cohpletiS alf items on this page
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LOCATION ) ( VC v
Print
PROPERTY OWNER
�- Print
MAP NO: Z2 PARCEL:�J ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
El Addition El Two or more family
❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
Ill,g® Se tics ®1Welli; ®'Floodplain �� ® Wetlands �' +Water dD'istri�ct.:a $ F w'
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0water/.S ewer
DESCRIPTION OF WORK TO BE PERFORMED:
A S e tU C�� � EI�?4 4-t
Identification Please Rpe or Print Clearly)
OWNER: Name:) '� � Phone: '�
, � �� a Z D
Address:
CONTRACTOR Name: Phone:
Address:
i
Supervisor's Construction License: Exp. Date: I
Home Improvement License: 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: $_ O0o FEE: $ �D
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Si nature of A" ent/Owner .t .• Cc!t�eSignatu�e ofconfra�ctor
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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
❑ Mass check Energy Compliance Report
o 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: Doe.Building Permit Revised 2008mi
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
d
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 r-I b Signature
Gq
COMMENTS q"�'&A _ .— 1V 6 c,�1 i�A L
EALTH Reviewed on Signature 7c&
r
COMMENTS G1�
i
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
u
Planning Board Decision: Comments
Conservation Decision: Comments
Waiter & 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
i
I
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
I
Location 67 ldld
No. U Date _
i
o�tM00Th,h TOWN OF NORTH ANDOVER
9
i
• > ; ; Certificate of Occupancy $
Building/Frame/Frame Permit Fee $
s kwusE 9
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
�w 4
2 679 Building Inspector
ORTH
Tovm Of
0 .
No.
L A K E O " dover, Massj1Wty ' • n
COCMICMEWICK
ADRA-rED
S BOARD OF HEALTH
Food/Kitchen
.PERM IT T D Septic System
BUILDING INSPECTOR
THISCERTIFIES THAT..........MA. 4'.4%. ....... ..... ....04.................,.............................................. ............... Foundation
p . buildings on ......
has permission t0 erect... 3 ...... ... ..... ......... .................... Rough
...............
to be occupied as.......... .. ... , ,5 .......................................................... Chimney
. ............ . . . .. . . . . .. . . .
provided that the person epti 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
low PERMIT EXPIRES IN 6 MONTHS
UNLESS CONSTRU TARTS ELECTRICAL INSPECTOR
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.
_ _'_zip"c.3s'S�S�✓'Y�a:�f�. .. .....,a-«..... .a. .csYa�1�" '.x..b._.,�,.... - - w..w RA-v::J.YEL"+1kF�7i'�. .. .. .r
F HaRTH TOWN OF NORTH ANDOVER
?°tt,�eo °� OFFICE OF
"
BUILDING DEPARTMENT
1600 Osgood Street Building 20, Suite 2-36
"yes^,�� North Andover,Massachusetts 01845
sgc►+us
Gerald A.Brown Telephone(978)688-9545
Inspector of Buildings Fax (978) 688-9542
HOMEOWNER LICENSE EXEMPTION
BUIDING PERMIT APPLICATION
Please Print
DATE:
JOB LOCATION:_Ai C—_-j Y @,Q Ll
Number Street Address Map/Lot
v-,?
I O1vIE0WNER 1Nl U>;�1 �. �.(� 1�� �( Z `Z5�f
Name Home Phone Work Phone
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/she will comply with said procedures and
requirements. ,
HOMEOWNERS SIGNATURE ( LQL
APPROVAL OF BUILDING OFFICIAL
Revised 7.2009
Form Homeowners Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 685-9535