HomeMy WebLinkAboutBuilding Permit #795 - 595 SALEM STREET 6/4/2007BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
X One family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
)'Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
DESCRIPTION OF WORK TO BE PREFORMED:
Z4 zo-.e�- A�� C' 1�
Identification Please Type or Print Clearly)
OWNER: Name:'It4i C/ila2l f rare----- Phone: 'F%fs 3�f
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ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ ko e C.) FEE: $�—��
Check No.: l rosy Receipt No.: 0'. w�
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
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
p -Affidavit
LlLicenses
ontract
❑ 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
a," Building Permit Application
Certified Surveyed Plot Plan
❑ P nses
❑ Floor/Crossec 'on/Elevation Plan �Proposed Work With Sprinkler Plan And
Hydraulic Calcula I s-{1# A-pplicab-le)
❑ 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
v
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
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑
Well ❑
Tanning/Massage/Body Art ❑
Tobacco Sales ❑
Swimming Pools
Food Packa m /,; ale� ,
g � g xS _y
Private (septic tank, etc. ❑
Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
V_CONSERYA
COMMENTS
kj�JTE REJECTED DATE APPROVED
DATE REJECTED DATEAPPROVED
HEALTH /� ❑
COMMENTS /�- i(r lv 19Q4a kk
Zoning Board of Appeals: Variance, Petition No: _ Zoning. Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer Connection/Signature & Date Driveway Permit
Located at 384 Osgood Street
0
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 No
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
Doe.Building Permit Revised 2007
Location
No. 79 Date
TOWN OF NORTH ANDOVER
f A
t Certificate of Occupancy $
• orb+„ r—• ' ' ��' _...+•
ISS �cNusEs� Building/Frame Permit Fee. $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
20261
Buiidirig Inspector
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I CERTPFY THAT TH13 LOT 13 NOT IN THE frjA
FL LOO HAZAItD ZONE. TH13 CERTFICATION_13_DA3.ED
ON THE SURVEY MARKT*it3-OF`OTFER3, AND it NOT
A PROPERTY SURVEY, FOR IMORTCAGE PURPOSES ONLY.
CERTFY THAT THE OLM- IG3 ARE LOCATED A3 3HOWN.
AND THAT THEY CONFORD TO THE ZONMVG DY -LAWS
OF THE CITY, TOWN Of �Io�TN ZO C l9r cz
WMH CONSTRUCTED. - -
SCALE 1" 17
DEED BOOK PAGE
AREA 151 ?,d.5 OF
PLAN 29,613 ,
ASSESSOR MAP Tj Fj P.
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LOT
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CERTIFIED PLOT PLAN
OF LAND IN
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AS DRAWN FOR
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R.A.M. ENGINEERING
160 MAIN STREET
HAVERHILL, MA.
508-372-0449
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TOWN OF NORTH ANDOVER y9s •,_�<�
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BUILDING DEPARTMENT
1600 OSGOOD ST
BUILDING 20 SUITE 2-36
NORTH ANDOVER MA 01845
978-688-9545
978-688-9542 Fax
HOMEOWNER LICENSE EXEMPTION
Please.print
DATE
JOB LOCATION
Number
Street Address
4-6e%5 j
HOMEOWNER .AI i L G k? / a
r,, � e � 4; S- ��y2A?y
Name —k F7Home Phone Work Phone
PRESENT MAILING ADDRESS l /( S-9 s ,Sq
0 A /]h_"y
City/Town
r�
State
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 and requirements and that he/she will comply with said
procedures and requirements.
�e'��HOMEWOWNER'S SIGNATURE/
APROVAL OF BUILDING
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