HomeMy WebLinkAboutBuilding Permit #658 - 59 CHURCH STREET 4/9/2007BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO:� Date Received
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION UtL ct;r boat -� P1\y1SG0e r A-- bk-
Print
PROPERTY OWNER 4-i
Print
MAP NO: PARCEL: ZONING DISTRICT: HISTORIC DISTRICT yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
PYOne family
❑ Addition
❑ Two or more family
❑ Industrial
Alteration
No. of units:
❑ Commercial
4 -Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
[I Other
7 Septic s' Well
t Floodplain Tetlands
F] Watershed District
—1.4 Water/Sewer
DESCRIPTION OF WORK TL) BE PKEFOKmtu:
✓� C ��' r� tE��r D COT
Please Type or Print Clearly)
OWNER: Name:
Ariririm cc -
CONTRACTOR Name: ' Phone:
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
-,� o�— 7RLS
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ �� ��
FEE: $
Check No.: Receipt No.:�,(all-7
NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund
Signature of Agent/Owner cxzc7 Signature of contractor
r
Location /,/ & 4 x 1—
No. (�- Date
0 4 &OXT" I TOWN OF NORTH ANDOVER
4,
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee
TOTAL
Check #
201 k
Building Inspector
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer U
Tanning/Massage/Body Art ❑
Swimming Pools Ll
Well U
Tobacco Sales ❑
Food Packaging/Sales Ll
Private (septic tank, etc. ❑
Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT ❑
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
r
J
DATE REJECTED
DATE APPROVED
DATE REJECTED DATE APPROVED
IN
DATE REJECTED DATE APPROVED
❑ ❑
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Water & Sewer Connection/S
Located at 384 Osgood Street
Comments
Comments
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
NOTES and DATA — For department use
❑ Notified for pickup - Date
......................................................................................................................................................................................................................................................................................................................... _.................................................................
..................................................................................
Doc.Building Permit Revised 2007
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
❑ 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
❑ 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)
❑ 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)
❑ 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
❑ 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2007
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Proposal Submitted To:
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Melch
Home Improvement
978-979-2511
25 years experience
*Licensed & Insured*
Free estimates
Job Name
Job #
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Address k S I Job Location 1,
Date
Phone Fax #
We hereby submit specifications and estimates for:
Architect
Date of Plans
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Any aneration or deviation from above specifications kwoNft extra C08% will be Respectfully
executed only upon wrltien order, and will become an extra charge over and submitted
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above the estimate. AN agreements continperd upon strikes, aocidents, or delays
beyond our control. Note — this proposal may be withdrawn by us B not accepted within days.
&rgtmut of Propomal
The above prices, specifications and conditions are satisfactory and are Signature
hereby accepted. You are authorized to do the work as specified.
Paymertts will be made as outlined above.
Date of Acceptance Signature
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Propool Page#
Melch
Home Improvement
978-979'2511
25 years experience
*Licensed & Insured*
Free estimates
Proposal Submitted To: ^ ��� Job Name
Address It, (0 ` �� J �`� S C— Job Location
'N • �A.> s z� V
Phone #1
We hereby submit specifications and estimates for. _
Date I Date of Plans
Architect
Of
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We propose hereby to furnish material and labor —
with payments to be made as follows:
Any aneration or deviation from above specifications involving extra costs will be
exeaAed orrly upon written order, and will become an extra charge over and
above the estimate. AN agreements contingent upon strikes, aadderds, or delays
beyond our control.
in accordance with the above specifications for the sum of:
Dollars
Respectfully
submitted
Note — this proposal may be withdrawn by us tl not accepted within days.
Zurptame of Propogal
The above prices, specifications and conditions are satisfactory and are Signature
hereby accepted. You are authorized to do the work as specified.
Payments will be made as outlined above.
Date of Acceptance Signature
Vropomd
Melch
Home Improvement
978-979-2511
25 years experience
*Licensed & Insured*
Free estimates
Cc,
of
Proposal Submitted To: Job Name Job # �2
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AddressO \ c 4` *LC- � ST_ Job Location
` Date
Phone # C,, Q - �� _ -� x Fax #
We hereby submit specifications and estimates for:
Architect
Date of Plans
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with payments to be made as follows: • 3co- &. os � r �o—
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executed only upon written order, and wig become an extra charge over and submitted
above the estimate. AN agreements contingent upon strikes, acolderds, or delays
beyond our cordrol. Note — this proposal may be withdrawn by us N not accepted within 7 days.
&aptaw of Vropoml
The above prices, specifications and conditions are satisfactory and are
hereby accepted. You are authorized to do the work as specified.
Payments will be made as outlined above.
Signature
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Date of Acceptance Signature
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We propose hereby to furnish material and labor — complete in accordance with the above specifications for the sum of:
'moo.: --CLi. L .� ►a� R Dollars
with payments to be made as follows: • 3co- &. os � r �o—
C,%, Cv— 00
Any anerabw or deviation from above specifications invotvq; extra costs will be Respectful<-�2&
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executed only upon written order, and wig become an extra charge over and submitted
above the estimate. AN agreements contingent upon strikes, acolderds, or delays
beyond our cordrol. Note — this proposal may be withdrawn by us N not accepted within 7 days.
&aptaw of Vropoml
The above prices, specifications and conditions are satisfactory and are
hereby accepted. You are authorized to do the work as specified.
Payments will be made as outlined above.
Signature
�•�.:%-�
Date of Acceptance Signature
O� � ��� Page # � of —�— pages
Melch
Home Improvement
97"79-2511
25 years experience
*Licensed & Insured*
Free estimates
Proposal Submitted To: JO Name is"
C';4& i 1"42-.C. v Q -r-c_ .
Address
V .C:
Phone #
Fax #
We hereby submit spedfications and estimates for.
Job Location
Date I Date of Plans
Architect
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We propose hereby to fumish material and labor — complete in accordance with the above specifications for the sum of:
$ Dollar---
with
ollarewith payments to be made as follows: _
Any attention or deviation from above specrkabons involving extra costs will be Respectfully
exearted orgy tpon written order, and will become an extra charge over and submitted
above the estimate. AN agreements contingent upon strikes, accidents, or delays
beyond our control. Note — this proposal may be withdrawn by us 9 not accepted within days.
&Mtm ue of Propofat
The above prices, specifications and conditions are satisfactory and are Signature`�'`'^��'"`�
hereby accepted. You are authorized to do the work as specified.
Payments will be made as outlined above.
Date of Acceptance Signature
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
1600 OSGOOD ST
BUILDING 20 SUITE 2-36
NORTH ANDOVER MA 01845
978-688-9545
978-688-9542 Fax
HO 1MWNER LICENSE, EEMPTION
Please print
DATE le'll
JOB LOCATION
Number
Name
PRESENT MAILING ADDRESS
City/Town
ct Address Mapli.ot
q2Z �I�
Phone
State
Work Phone
Zip Code
The current exemption for "homeowners" was extended to include owner -occupied dwellings of
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, one or two family dwelling, attached or detached structures attached or detached structures
accessory to such use and/or farm structures. A person who constructs more than one home in a two-year
period shall not be considered a homeowner.
The undersigned "homeowner" assumes responsibility for compliance 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 andremireme that helshe will comply with said
procedures and requirements. �� / _�
HOMEWOWNER'S
APROVAL OF BUILDING OFFICIAL