HomeMy WebLinkAboutBuilding Permit #828 - 58 FERNWOOD STREET 6/21/2006GE NORTH 1ti
° p TOWN OF NORTH ANDOVER
.= ." APPLICATION FOR PLAN EXAMINATION
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Permit NO: Date Received:
Date Issued: 6-M 21 Avg&
IMPORTANT: Applicant must complete all items on this page
LOCATION
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Print
PROPERTY OWNER `-- ¢ `� 0-f1 �--
MAP NO.:
PARCEL:
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ZONING DISTRICT: /% ••
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TYPE OF IMPROVEMENT
--- - ----- - --
PROPOSED USE
Residential
Non- Residential
❑ New Building
?`One family
❑ Addition
❑ Two or more family
❑Industrial
❑ Alteration
No. of units:
❑ Assessory Bldg
\ !
Wkepair, replacement
❑ Commercial
❑ Demolition
0 Moving (relocation)
❑ Other
❑ Others:
❑ Foundation only
DESCRIPTION Or WUKK I 13t VK-tvutcivlhlJ
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Identification Please Type or Print C arty)
OWNER: Name:
01,
r. � C— IFo 6'�,� Phone: -73 U - l l
Address: J21 C x W n o ) S-�
CONTRACTOR Name: \ �' �� i r, g Phone: 33 3
Address: Id. L 'F4kNy r", S -t' /VQ • ►9rvi�, evti►il !�
Supervisor's Construction License: d JrGT /� Exp. Date: 05�0���
Home Improvement License: I � ��'�' � �'` Exp. Date:
Aa�167
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT: $10.00 PER $1000.00 OF THE TOTAL ESTIMATED COSI
Total Project Cost S x10.00=FEE:$_
Check No.: "' 0 000— Receipt No.: awm
ha. -v Ikea rt r
1500 e S. F.
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Location
No. Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
OTAL
Check #
19452 Building Inspector
TYPE OF SEWARGE DISPOSALS
Tanning/Massage/Body Art
Swimming Pools ❑
Public Sewer uY/
❑>>
Tobacco Sales ❑
Food Pack ing/Sales 11Well
❑
Permanent Dumpster on Site ❑
"'
Private (septic tank, etc.
Electr, c N1etgr location to
r
project %
NOTE: Persons contracting, i unregister d cor trac r lave access to the guaranty fund
Signature of Agent/Owner -nature of Contractor
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
� THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
1�
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
[]Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
DATE REJECTED
DATE APPROVED
i
DATE REJECTED DATE APPROVED
❑ ❑
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 Dempster on site yes no Fire Department signature/date
Building P,,:rmji-(Approved and Issued by:
F Page 2 of 4
Building Setback (ft.)
Front Yard
Side Yard
Rear Yard
Required
Provided
Required
Provides
Required Provided
■%lr% fT ATC1i/11�T
Ll ITJUL, III 011"1 14
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
NU I ES and DATA — (For department use)
Page 3 of 4
Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM05
. -- —.u. Jan._VVO
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: INSPF.CrIONAL SERVICES DEPARTMENTMFORN105
Page 4 of 4
a Noszrr� �a
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Gerald A. Brown
Inspector of Buildings
Please print
FOW1N OF NORTH ANDOVER
OFFICE OF
BUILDING DEPARTMENT
400 Osgood Street
North Andover, Massachusetts 01845
HOMEOWNER LICENSE EXEMPTION
DATE: 6 Z/
JOB LOCATION: ,�� /, "eNWU�
Number Street Address
HOMEOWNER eo^j -0 Qootz
Name
PRESENT MAILING ADDRESS
City Town
Home Phone
Telephone (978) 688-9545
Fax (978)688-9542
Map/Lot
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State
Work Phone
S+
Pyr- -
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 requi ents and that he/she will comply with aid procedures and
requirements.
IIOMEOWNERS SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Revised 10.2005
Form Homeowners Exemption
BOARD OF APPEALS 688-0541 CONSERVATION 633 0530 HEALTH 08-9540
Q535 PLANNING 08-
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