HomeMy WebLinkAboutBuilding Permit #825 - 52 BREWSTER STREET 6/20/2006Permit NO: /7 f
Date Issued:
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
IMPORTANT: Applicant must complete all items on this page
LOCATIO
Print )
PROPERTY OWNER
Print
MAP NO.: PARCEL:
TYPE AND USE OF BUILDING
ZONING DISTRICT:
HISTORIC DISTRICT YES ❑
No DTH
OF ria .��NO
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9SSACHUSF4
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ A Idition
Iteration
❑ One family
Two or more family
No. of units:
❑ Industrial
❑ Repair, replacement
❑ Demolition
❑ Assessory Bldg
❑ Commercial
❑ Moving (relocation)
❑ Other
❑ Others:
❑ Foundation only
DESCRIPTION OF WORK TO BE PREFORMED 2!�L
IDbo,,L
Identification Please Type or Print Clearly)
OWNER: Name: (3�Lrz� �) ✓ Phone: ��11— `� y—I V)
Address:
CONTRACTOR Name:�t, p Phone:
Address:
,7A A -L --c
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No
FEE SCHEDULE: BULDING PERMIT. 810.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $115.00 PER S.F.
Total Project Cost :$ x10.00=FEE:$
Check No.: �/� �/ C Receipt No.: 410
Page 1 of 4
Location S� sl
No. Date >
MORTM
TOWN OF NORTH ANDOVER
0�..•° ,•aha
3? ' Oc
'
Certificate of Occupancy $
�'�S'^••° • t<
s�cMus �
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
�J
Building Inspector
TYPE OF SEWARGE DISPOSAL
Tanning/Massage/Body Art F]Public
Swimming Pools El❑
Sewer
❑
❑
Tobacco Sales
Food Packaging/Sales ❑
Well
11Permanent Dumpster on Site
Private (septic tank, etc. ❑
Electric Meter location to
proj ect
NOTE: Persons contracting with unregistered contract s do of have access to the guarantyjuna
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 N
Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
DATE REJECTED
❑ ❑
❑Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
DATE APPROVED
DATE REJECTED DATE APPROVED
❑ ❑
DATE REJECTED
❑ ❑
Comments
Comments
DATE APPROVED
Water & Sewer connection/Signature & Date Driveway Permit
Temp Dumpster on site yes_no_ Fire Department signature/date
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, wast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$10041000 fine
NOTES and DATA — (For department use
D Notified for pickup Call Email
Date _ Time Contact Name _
Doc.Building Permit Revised 2014
Of 4, oto �°11,
SS^cmO A
Gerald A. Brown
Inspector of Buildings
Please print
DATE: G j2�01a G
avrriq v1' IIv1R1HA14UVVLK
OFFICE OF
BUILDING DEPARTMENT
400 Osgood Street
North Andover, Massachusetts 01845
HOMEOWNER LICENSE EXEMPTION
Telephone (978) 688-9545
Fax (978)688-9542
JOB LOCATION:_ 5-� 9"
Number Street Address Map/Lot
HOMEOWNER
Name Home Phone Work Phone
PRESENT MAILING ADDRESS q �,) L c,,_ &,, e /fix
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. in
HOMEOWNERS SIGNATURE AO V7
APPROVAL OF BUILDING OFFICIAL
Revised 10.2005
Form Hoinxwners Exemption
BOARD OF APPEALS 683-9541 CONSE..RV,ATION (,38-0530 HEALTH 688-9540 PLANNING o88-
9535
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
o Building Permit Application
o Workers Comp Affidavit
o Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o Copy of Contract
o Floor Plan Or Proposed Interior Work
o 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
o Copy Of Contract
❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o 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)
o Building Permit Application
o Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
o Two Sets.of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Copy of Contract
o Mass check Energy Compliance Report
a 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: Building Permit Revised 2014
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