HomeMy WebLinkAboutBuilding Permit #690-11 - 68 SURREY DRIVE 4/12/2011TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:
IWORTANT:QApplicant
�must complete all items on this age
LOCATION I iii �" \ �s�' 1 ��oAd
r "
Print
PROPERTY OWNER e v 1 us 1 rn SINS ec S G--
Print
MAP NO: 7 7U PARCEL: ZONING DISTRICT:_ Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
One family
❑ Addition
❑ wo or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg .
❑ Others:
❑ Demolition
❑ Other
O.,Septtc D.xWell
p Floodplaiui C7�W.,etlands
'�; WatersledtDistnct - <�
OtWater/Sewer
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Identification,Please Type or Print CIearly)
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ONER: Name ! '`-"' f d� t I - .l �t l 4 � 1 iq _T w� Phone -7 g J n S'- 7 W7 q
Address:
rlr r `�' 1� cwt
OR Name: V �� ®� Ph e•
Address:
Supervisor's Construction License:
Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone:
Address:
. No
FEE SCHEDULE: BULDING PERMIT: $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F.
Total Project Cost: $ 3 FEE: $��
Check No.: Receipt No.:
NOTE: Persons contract' ith unregistered contractors do not have access to the guaranty fund
ofco'—
Sianature.of Aaent/Own r:': : _
Plans Submitted ❑ - Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑
Well ❑
Private (septic tank, etc. ❑
Tanning/Massage/Body Art ❑ Swimming Pools x
Tobacco Sales ❑ Food Packaging/Sales ❑
Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION Reviewed
COMMENTS,
WEALTH -
COMMENTS
0
l
Reviewed on Signature
•0
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Comm
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
Located 384 Osgood 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
NOTES and DATA — (For department use)
�D b tm v fi` G D/ m to r/
a
U Notified for pickup - Date
Doc:.Building Permit Revised 2008
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. Lic3,1ses
❑ Copy Of Contract
❑_�r❑v,/crossecticn!Elevation. P!ar' Of Pro -nosed VVork With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (lf 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
DOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
iat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
lust be submitted with the building application
Doe: Doe.Building Permit Revised 2008mi
Location dr
No. l �� Date
TOWN OF NORTH ANDOVER
;o Certificate of Occupancy $
Building/Frame Permit Fee $ r
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # / U
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F OORT,4 TOWN OF NORTH ANDOVER
O��t4lO ;6 �41�
OOFFICE OF
6..aP_ •. a L
BUILDING DEPARTMENT
�o �* 1600 Osgood Street Building 20, Suite 2-36
:�s� �"' •p�<~5 North Andover, Massachusetts 01845
Gerald A. Brown Telephone (978) 688-9545
Inspector of Buildings Fax (978) 688-9542
HOMEOWNER LICENSE EXEMPTION
BUIDING PERMIT APPLICATION
Please print
DATE:
JOB LOCATION: �(�( ri (,� U� e 17 j
Number r S eet ddress G Map of
HOMEOWNER Ad " '� `��l 1 hs o >�&- �
Nam Home Phone Work Phone
PRESENT MAILING ADDRESS 63
City Tovni.
_. - (Q 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. 11
The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building Department
minimum inspection procedures and requirements d that he/she will comply with said procedures and
requirements.
HOMEOWNERS SIGNATUR� / _'Al ,
APPROVAL OF BUILDING OFFICIAL
Revised 7.2009
Form Homeowners Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535