HomeMy WebLinkAboutBuilding Permit #680 - 438 SUMMER STREET 4/26/2006Of NORTH
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p TOWN OF NORTH ANDOVER
APPLICATION FOR,PLAN EXAMINATION
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Permit NO: 6 Date Received: �`►'b�
Date Issued: Czl
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IMPORTANT: Applicant must complete all items on this page
LOCATION
not
PROPERTY OWNER
Print
MAP NO.: /O'/& PARCEL:
TVD-` AN" 7TQ "17 RiTii .D1 Nf'
ZONING DISTRICT:
HISTORIC DISTRICT YES ❑
1 1 1 LJ Al \ L v v.aJ v
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
90ne family
❑ Addition
El Two or more family
❑Industrial
RAlteration
No. of units:
❑ Assessory Bldg
❑ Repair, replacement
❑ Commercial
❑ Demolition
❑ Moving (relocation) _
❑ Other
❑ Others:
❑ Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
'N A - - -Cf-
Identification Please Type or Print Clearly)
.7
OWNER: Name: �� �U� Lrq�� �� Phone:
Address: 4 3 9 S01 -111144L S%aPK e! c--
CONTRACTOR Name: (:��Z /74 Phone:
Address:
Supervisor's Construction License:
Exp. Date:
Home Improvement License:*AL Exp
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No.
Date:
FEE SCHEDULE: BULDING PERMIT. $10.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost :$ X5 u�- x10.00=FEE:$
Check No.: X/ 3 [ Receipt No.: S-3
Page Iof4
iA
TYPE OF SEWARGE DISPOSAL
Public Sewer F1Tanning/Massage/Body
Art ❑
Swimming Pools ❑
Well ❑
Tobacco Sales ❑
Food Packaging/Sales El
Private (septic tank, etc. ®
Permanent Dumpster on Site ❑
Electric Meter location to
project
NOTE: Persons contracting with unreg' er d contractors do not have access to the guaranty fund
Signature of Agent/Owner:.
gent/Owner ignature of Contractor
Plans Submitted El Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
❑ Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
Zoning Board of Appeals: Variance, Petition No:
Zoning Decision/receipt submitted yes
DATE REJECTED DATE APPROVED
❑ ❑
DATE REJECTED DATE APPROVED
❑ ❑
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer connection signature & date
Temp Dumpster on.site yes_no-k Fire Department signature/date
Building Permit Approved and Issued by:
Page 2 of 4
Building Setback (ft.)
Front Yard
Side Yard
Rear Yard
Required
Provided
Required
Provides
Required Provided
DIMENSION
Number of Stories:
Total land area, sq. ft.:
Total square feet of floor area, based on Exterior dimensions.
NOTES and DATA — For department use
Page 3 of 4
Doc: INSPECTIONAL SERVICES DEPARTMENT RPF0RMM
Created JMC. )an 2006
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
o Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o 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
a 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
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
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 DEPARTMENT:BPFORM05
Page 4 of 4
Location 61 1''
No. 4 Date
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�aRTM TOWN OF NORTH ANDOVER
t.
s Certificate of Occupancy $
CHuA Building/Frame Permit Fee $ -�
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ .3d
Check #
.� Building Inspector
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tAORT,4
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TOWN OF NORTH ANDOVER
OFFICE OF
00
BUILDING DEPARTMENT
*
400 Osgood Street
y^ Pay
North Andover, Massachusetts 01845
Gerald A. Brown Telephone (978) 688-9545
Inspector of Buildings Fax (978) 688-9542
HOMEOWNER LICENSE EXEMPTION
Please print
DATE: 04 2a 06
JOB LOCATION:3�
Number Street Address Map/Lot
HOMEOWNER—Uc�ypJ`p.a-�CGZ,i-6,e a�_�Irz =:Q/
Name Home Phone
PRESENT MAILING ADDRESS
Work Phone
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 willcotes} with said procedures and
requirements. /1 f
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Revised 10.2005
Fonn Homeowners Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-
9535
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