HomeMy WebLinkAboutBuilding Permit #484-15 - 64 SECOND STREET 11/18/2014BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#: " J Date Received
Date Issued: 1 1h 9 1q
o,tt%.eD '6*•N O
°t
9 1.
IMPORTANT: Applicant must complete all items on this page
LOCATION (o 6C 0A) t7
Print.
PROPERTY OWNER ,_ ,/�:
Print 100 Year Structure; yesno
MAP _PARCELRt t ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ One family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑ Septic ❑ Well
❑ Floodplain ❑ Wetlands
❑ Watershed District
❑ Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
Identification - Please Type or Print Clearly
OWNER: Name:A� Jj I g L E Y SS rA R R Phone: q `7
Address: 6,Y SE C 6 n)b ST r%o 6-rq firop6vcR, MP 0 1 8 Lr`S
Contractor Name: ;hone:
Address: I k) N
Supervisor's Construction License: Exp. Date:
Home Improvement License:._ _. . _ _ _ Exp. Date
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: $ L,17� r FEE: $ -3a
Check No.: 2631 Receipt No.: 2_0-Z 8-_�
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
nature of Agent/Owner ,J
nature of contractor
a
ti
Plans Submitted ❑ Plans Waived 0 Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑
Tanning/Massage/Body Art ❑
Swimming Pools ❑
Well ❑
Tobacco Sales ❑
Food Packaging/Sales ❑
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
Reviewed o
Reviewed On Signature,
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Commen
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
FIRE DEPARTMENT - Temp Dumpster on site yes
Located at 124 Main Street
Fire Department signature/date
COMMENTS
uocatea 364 Usgood Street
no
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
NU I t5 and UA I A — (For department use
❑ Notified for pickup Call Emai
Date Time Contact Name
Doc.Building Permit Revised 2014
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
o 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/Cross Section/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: Building Permit Revised 2014
Location &4 f)e Cyj
No. 4*K Date t �O
Check #26:51
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $��L
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ i
-
Building Inspector
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Q4� ear/a•sy .ROYYIV OFj9d.RTffAND oY Ltd,
OFFICE OB . .
BUMDING ))+
• ' o•� :I600•'DsgoodStreet Building 0,�T 6
1Vorth Az�.dovex
? .r a•
7 a$ 30 F5 S , Massachusetts 01845
,
Gerald A. Brown Telephone (978) 688-9545
I;nspecforof$uildings -Fax (978) 688 4542
HQMEOW RER•LICENSE EyEN&TIOI�1
11111D1I�1 G ZCcTON
Please�rint - '
r011 LOCATfON: G 0 A) P
Number S:treef Address
map/Lot
II OAMDWNER F
• Name
Home Phone WorkPhone
PRESENT MAILING. ADDRESS to SEC o iv p
S-1
C;.V Tnvm Ntate . lip C e
The current exemption for "homeowners" was extended to
%o allow su h �?omeo;, - ��1Lide owned DC�upied dwellings to two units-oX Toss and
ue�s to On anbdividual.forhire.w:no clop noipossess a license, provided that the owner
acts as suparvisor). state DO, cling (Code Section 108.3.5.1)
DEFMTION 0FH0,kM0V ER
Persons) who gwns a parcel ofland on which lie/slze resides or intends to reside, on which There is, or zs intended to
be, a one or two f'amHY stzucfares. A person who contracts more that one home . yearperiod shall not be
considered a homeowner. in a iwa
The undersigned `°homeowner" assumes responsibility forcbmpliauces with the State Building Code and other
Applicable codes, by-laws, nu es andzegulatiom.
The undersigned "homeownez" certifies that he/she undersfan.ds the Town ofNorth Andover$uilding De�arfinent
minimum' spection procedures and requirements and that be/she Will comply wxfhtsaid pxocedures and
regi&aments,
I-IDAMOWNP,RS SIGNATURE c5: �t,cn��, n r7
APPROVAL OF BUJLDING OFFICIA-L
Revised 7.2009
Form Homeowners Exdmption
'130AR.b OFAPPBALS 688-9541 I CONSERVATION 688-9530
HEALTH 688-9540 PLANNING 689-9555