HomeMy WebLinkAboutBuilding Permit #625-14 - 397 FARNUM STREET 3/12/2014TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:
Ll�
IMPORTANT: Applicant must complete all items on this page
LOCATION
PROPERT`
MAP NO:/
PARCEL:_ ZONING DISTRICT: Historic District
Machine Shop Village,
no
yes no
TYPE OF IMPROVEMENT.
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑One family
El Addition
❑ Two or more family
El Industrial
El Alteration
No. of units:
❑Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other.
El Septic El Well
11 Floodplain ❑ Wetlands
11 WatershedDistrict;
❑ Water/Sewer
_
DESCRIPTION UI -PKK I U tst rr_mrur<mr_u.
Identification Please Type or Print Clearly)
OWNER: Name
A-1r____.
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: $ oov FEE: $ �50• aC)
Check No.: '7,?l Receipt No.: 7-3
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Sgnature„of A'6
ent/Owrier. to ureof"contractor y __ _
Plans Submitted ❑ '� Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
3
s
Location 7
No. Date
k2 z/Y
If z
Check#
TOWN OF NORTH ANDOVER
Certificate of Occupancy $-
Building/Frame Permit Fee $ 36 0
Foundation Permit Fee
Other Permit Fee
TOTAL $
Z?
j3ruifing Inspector
Plans Subm itte6 ❑ Plans Waived ❑ ' _Certified Plot Plan ❑ Stamped Plans ❑
TYPEOF:SEWERAGEDiSPDSAL" `
Public Sewer ❑
Tanning/MassageBodyArt ❑ ..
Swinuning Pools ❑
Well ❑
Tobacco.Sales ❑
Food Packaging/Sales ❑
Private (septic tank, etc:: ❑ • .
-------------
� Permanent Dumpster on Site ❑
THE. FOLLOWING SECTIONS FOROFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
::- DATE REJECTED DATE :APPR.OVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
Reviewed on Signature
Reviewed on Signature
` Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer Connection/Driveway Permit
DPW Tow.! Engineer: Signature:
Located 384 Osgood Street
FIRE DEP;gRTtlll, NT. = Temp Dumpst�r on s'it'e --'yes no
Located-at!124jMair Street
Fire Department signature/date
COMMENTS ::t
-:Dimension -
Number of Stories:
Total- land area, sq. ft.:
ELECTRICAL: Movement of Meter..locatFon, niast or service drop requires approval of
Electrical Inspector Yes No
Total square feet of floor area, based on Exterior dimensions.
DANGER ZONE LITERATURE: - Yes No
MGL -Chapter 166 -Section 21A —F and G min.$100=$1000.fine
NU I t5 and UA I H — wor ae
® Notified for pickup - Date
Doc.Building Permit Revised 2010
nt use
Building Department
-The fo6wing is=a list of the required.forms to be filled out'for the appropriate. permit to .be obtained.
Roofivg, Siding, Interior Rehabilitation Permits
B;%ailding Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L Licenses
❑ Copy of Contract
o 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
❑ 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 apur>al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be subm.tted with the building application
Doc: Doc.Building Permit Revised 2012
TO" Off` i%RTR ANDOVER
OFFICE OF
BUILDING DEPARTMENT
.:1600 0400dStreet BOding20,•Suite 2-36
North Andover, Massachusetts 01845
Gerald A. Brown Telephone (978) 698-9545
TnspeetorofBuildings - Fax (978) 688 9542
HONM NER-LICENSE PMA pTION
j!MDJNpEMTT APPLICA'i'TOIY
pleaseyrini -
DATE: z ni4c
JOB LOCA_ TION: S
Number
• StzeetAddress MapJLot '
• 1JOMEOMNER _
Nameg�-5 l'
Homephone Work phone
PRESENTMAILINGADDRESS
lip Code
The current exempfion for `$omeowners" was extended to
to allow subh homacmm r x g b uclude owner -occupied dwellings to UVO units 'or less and
ue�s �o en aye an i idividual•forhire who does notpossess a license, provided that the owner
acts as supervisor). StafeBuilding (Code Section 108.3.5.1)
DEFIMIYON OFHOMEOWNER
Person(s) who awns a parcel of land on which helshe. resides or intends to reside, on which there is, or intended to
be, a one or fwo family strucfuz es. A person who consfntcis mote that one home in. a iwa yearperi' shall not be
considered a homeowner.
The undersigned "homedwner" assumesresponsibifityfor comphances 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 Bnilding Department
Miai=m inspection procedures and requirements and that he/she will
requirements comply with,said procedures and
RONMOWNERS SIGN"URE
APPROVAL OF BUILDING OFFICIAL
Revised 7.2009
Form Homeowners Bxdmgon
'130A1tD OF APPEALS 688-9541SER�4 r r
CO ATION 688-9530 HEALTH 688-9540
PLANNWG 688-9535
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