HomeMy WebLinkAboutBuilding Permit #782 - 57 MAPLE AVENUE 6/9/2006pORTL/
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Permit NO: 0 y
Date Issued: &/I/,, P
LOCATION
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received: /Vct—Y
IMPORTANT: Applicant must complete all items on this page
PROPERTY OWNER
MAP NO.: I v'/ PARCEL:
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ZONING DISTRICT:
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TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ O e family
F-1AdditionXwo
or more family
❑ Industrial
❑ Iteration
No. of units:
Repair, replacement
❑ Assessory Bldg
❑Commercial
❑ Demolition
❑ Moving (relocation)
❑ Other
❑ Others:
❑ Foundation only
DESCRIPTION OF W UKK t U tStJ rtct✓r vtuvir li a,-
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Identification Pl
OWNER: Name: C'_ i ._ .
Address:
CONTR,
Address:
VhwG 70
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Supervisor's Construction License: �- 4w Exp. Date:
14.5- /,Vow" cv/'
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Name: Phone:
Address:
Reg. No
FEE SCHEDULE: BULDING PERMIT: $10.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $12.5.00 PER S.F.
Total Project Cost :$ ,D a x10.00=FEE:$ a
Check No.: LO Receipt No.:'m C16_57—
Page I of 4
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 (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 DEPART\IENT:BPFORN105
Page 4 of 4
TYPE OF SEWARGE DISPOSAL
Public Sewer
Tanning/Massage/Body Art ❑ Swimming Pools ❑
Well Tobacco Sales ❑ Food Packaging/Sales
,.
Permanent Dumpster on Site ❑
Private (septic tank, etc. ❑ Electric Meter location to
project
NOTE: Persons contracting witl unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner. . 4
Signature of Contractor
Plans Submitted ❑ ans Waived ❑ Certified Plot Plan,
❑ Stamped Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT n - ❑
[]Water Shed Special Permit
❑'Site Plan Special Permit
❑ Other
COMMENTS
_. DATE REJECTED DATE APPROVED
CONSERVATION'
U U ,
COMMENTS
DATE REJECTED _ DATE APPROVED .
,HEALTH ❑ ❑
ti --------------
COMMENTS
Zoning Board of Appeals: Variance, Petition No: '
.,Zoning Decision/receipt submitted yes `
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer connection signature & date
Temp Dumpster on site yes—no— Fire Department signature/date
Building Permit Approved and Issued by:
Page 2 of 4
Building Setback (ft.
EFront Yard
Provided
DIMENSION
Number of Stories:
Total land area, sq. ft.:
Xfn'rro __ . - . - .
Side Yard
quired Provides
/ /
Rear Yard'
uired Provided
Total square feet of floor area, based on Exterior dimensions.
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Location 5"/ 6
No. -7 f ?--- Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $-
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #[�
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9
Gerald A. Brown
Inspector of Buildings
Please print
DATE: Q G
JOB LOCATION:
HOMEOWNER
TOWN OF NORTH ANDOVER
OFFICE OF
BUILDING DEPARTMENT
400 Osgood Street
North Andover, Massachusetts 01845
HOMEOWNER LICENSE EXEMPTION
Number Street Address
Home Phone
PRESENT MAILING ADDRESS
City Town
S tate
Telephone (978) 688-9545
Fax (978)688-9542
Map/Lot
Work Phone
Zip Code
/"S --
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 OI
Revised 10.2005
Form Hoincowners Exemption
BOARD OF APPEALS (AS -9541 CONSERVATION 688 0530 HEALTH 688-9540 PLANNING o�s8-
0535