HomeMy WebLinkAboutBuilding Permit #643 - 59 SANDRA LANE 4/11/2006Of .+• oT� 1ti
~ TOWN OF NORTH ANDOVER
�,'. ,>' •' APPLICATION FOR PLAN EXAMINATION
9SgACHUSEt
Permit NO: Date Received: el ld -dk
Date Issued:
IMPORTANT: Applicant must complete all items on this Date
LOCATION E � �Qnd �'0. LOA r9
PROPERTY OWNER_ KQ aO \ � 0.r _ c, sr a e, Vn 0
Print
MAP NO.: C-Oj i I PARCEL: 07/, ZONING DISTRICT:
TYPE AND USE OF RITHMING
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TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ Addition
Alteration
,One family
❑ Two or more family
No. of units:
❑ Industrial
❑ Commercial
)(Repair, replacement
❑ Demolition
❑ Assessory Bldg
❑ Moving (relocation)
I ❑ Other
❑ Others:
❑ Foundation only
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Identification Please Type or Print
OWNER: Name:
7-7 G Y 3 /7/ r
Signature
Address: Scj �a�.c� r� La" P'J.' -t
CONTRACTOR Name: /1/
Address:
Supervisor's Construction License:
Phone:
Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Name: Phone:
Address
g. No.
FEE SCHEDULE: BULDING PERMIT: $10.00 PER SI000.00 OF THE TOTAL ESTIMATED COST BASED ON 5125.00 PER S.F.
Total Project Cost :$ L,— /Dz p o x10.00=FEE:$ « '
Check No.: �N-3 N, t, Receipt No.:
Page 1 of 4
TYPE OF SEWARGE DISPOSAL
Art ❑
Swimming Pools 11
Public
Public Sewer
Well F1Tobacco
Sales ❑
Food Packaging/Sa U
❑
r
❑
Permanent Dumpster on Site
Private (septic tank, etc.
•..'@.1
R.
NOTE: Persons contracting with un a istered contractors do not have access to the guaranty fund
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
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION
COMMENTS
❑Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
DATE REJECTED DATE APPROVED
❑ ❑
DATE REJECTED DATE APPROVED
HEALTH ❑ ❑
COMMENTS
.Zoning Board of Appeals: Variance, Petition No:
tZoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer connection signature & dates~
Temp Dumpster on site yeJ no 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.
NO I ES and DATA — (For department use)
Page 3 of 4
Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM05
Created JMC. Jan.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
❑ 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
o 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 DEPARTMENT:BPFORM05
Page 4 of 4
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Gerald A. Brown
Inspector of Buildings
Please print
DATE:
TOWN OF NORTH ANDOVER
OFFICE OF
BUILDING DEPARTMENT
400 Osgood Street
North Andover, Massachusetts 01845
HOMEOWNER LICENSE EXEMPTION
JOB LOCATION: 59 Sljra La v% e
Number Street Address
HOMEOWNER u N- +,A o � 7F `93 17 /5 :
Name. Home Phone
PRESENT MAILING ADDRESS
Telephone (978) 688-9545
Fax (978) 688-9542
Map/Lot
i?? as'? as 9
Work Phone
�30r
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. . �/// a
HOMEOWNERS SIGNA
APPROVAL OF BUILDING OFFICIAL
Revised 10.2005
Foran Homeowners Exemption
Location,-,--s—
No. Date
TOWN OF NORTH ANDOVER
0
Certificate of Occupancy $
CHU
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL
7zj
Check #
119109
e) Building Inspec 0/
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