HomeMy WebLinkAboutBuilding Permit #683 - 43 MARBLEHEAD STREET 4/27/2006Of ,ORTH 1ti
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Permit NO: 69-15
Date Issued: 1,41
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received: 446A—
IMPORTANT:
"L 6
IMPORTANT: Applicant must complete all items on this page I
LOCATION 7� fn/+'A,4 Lr– NL5M S7–
Print_
PROPERTY OWNER ST�/�)46A e ,
Print
MAP NO.: X PARCEL:
TYPE AND USE OF BUILDING
ZONING DISTRICT: t\--7
HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ One family
❑ Addition
❑ Two or more family
❑Industrial
Iteration
No. of units:
❑ Repair, replacement
❑ Assessory Bldg
❑ Commercial
❑ Demolition
❑ Moving (relocation)
❑ Other
❑ Others:
❑ Foundation only
DESCRIPTION OF WORK TO BE PREFORMED,�D �. ,� L A-r7®�J
7Oj/JG c,J}FC.t�s, ,8W E ,86AM CC-1c,/AK, c,/AKf �1J/1�iN� A *14A tofTN .SHF 1.v��4
Identification Please Type or Print Clearly)
OWNER: Name: 's- 1 EPhEr3 -CsM t'T I -F Phone • 9 0 %'-/W 3 gn c-�-
Address: 'M i'YAML&-Ab 57 -
CONTRACTOR Name:
Phone:- --
Address:
Supervisor's Construction License:
Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT: $10.00 PER 57000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S. F.
Total Project Cost :$ Ob //oo xI0.00=FEE:$ 0
Check No.: Apo Receipt No.:
Page Iof4
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
Addition Or Decks
❑ Building Permit Application
❑ 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)
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(IfApplicable)_
❑ Copy of Contract
❑ Mass check Energy Compliance Report
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: INSPECTIONAL SERVICES DEPARTNIENTMFORh105
Page 4 of 4
TYPE OF SEWARGE DISPOSAL Swimming Pools El�] Tanning/Massage/Body Art ❑
Public Sewer
Well
Tobacco Sales El Food Packaging/Sales 11❑
Permanent Dumpster on Site ❑
Private (septic tank, etc. ❑ Electric Meter location to
proj ect
NOTE: Persons contracting with unregiste ontractors do not have access to the guaranty fund
Signature of Agent/Owner Signature of Contractor
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
Zoning Board of Appeals: Variance, Petition No:
Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Water & Sewer connection signature & date
DATE REJECTED
❑ ❑
❑Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
DATE APPROVED
DATE REJECTED DATE APPROVED
❑ ❑
DATE REJECTED DATE APPROVED
❑ ❑
Comments
Comments
Temp Dumpster on site yes—no— Fire Department signature/date
Building Permit Approved and Issued by: �Y
Page 2of4
Building Setback (ft
Front Yard
.-A Provided
DIM NSION
Number of Stories:
Side Yard
luired Provides
I
Rear Yard Provided
aired
M
Total square feet of floor area, based on Exterior dimensions._
Created J�1C. Jmr. ,,,,"
i
Location
No. & 0�1 Date
�oRTM
TOWN OF NORTH ANDOVER
L
w
A
Certificate of Occupancy
$
ssACNUs t�
Building/Frame Permit Fee
$
Foundation Permit Fee
$ '
Other Permit Fee
$
TOTAL
$
Check # oee-)
'� v Building Inspector
Gerald A. Brown
Inspector of Buildings
TOWN OF NORTH ANDOVER
OFFICE OF
BUILDING DEPARTMENT
400 Osgood Street
North Andover, Massachusetts 01845
HOMEOWNER LICENSE EXEMPTION
Please print
DATE: 1-1 a 7 pc.,
JOB LOCATION: /yl �a�gu�"/� D S
Number Street Address
Telephone (978) 688-9545
Fax (978) 688-9542
Map/Lot
HOMEOWNER-4�TEPNEI) SrAa-14 9-9 $ LO8 -39') a 91)� - /)/)/_Iz� S_L6
Name Home Phone Work Phone
PRESENT MAILING ADDRESS %3 ,57'
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
APPROVAL OF BUILDING 01
Revised 10.2005
Foran Homeowners Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-
9535
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