HomeMy WebLinkAboutBuilding Permit #731 - 78 SUTTON STREET 5/22/2006Aleii
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TOWN OF NORTH AN DOS ER
APPLICATION FOR PLAN EX:'kNl ATION
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V Date Received: � Z�
—J—Permit NO:
Date Issued:
IMPORTANT: Applicant must complete all items on this page
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PROPERTY OWNER
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MAP NO.: PARCEL: ZONING DISTRICT:
TYPE AND USE OF BUILDING HISTORIC DISTRICT
TYPE OF IMPROVEMENT PROPOSED USE
Residential
New Building a One family
C Addition Two or more family
Alteration No. of units:
_ epair, replacement Assessory Bldg
t7emolition
Movin (relocation) _ Other
Foundation onI
DESCRIPTION OF WORK TO BE PREFORMED
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04
YES ❑
Non- Residential
Industrial
Commercial
Others:
A ,, [dentificat�on Please Type or Prmt Clearly)
OWNER: Name: v \ �'`C- U^ t Phone:
Address:
CONTRACTOR Name: _
Phone:
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License:
Exp. Date:
ARCHITECT.fENGINEE R Name: Phone:
:address:
Reg. No.
FEE SCHEDULE: BULDIAG PERMIT. S 0.00 PER S1000.00 OF THE TOT. IL ESTIAA TED COST B. S U� $115.00 PER S. f
Total Pro.lject Cost :$ x10.00=FEE:$
Check No.: Receipt No.:
11:qie 10'4
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TYPE OF SEWARGE DISPOSAL
-,
Tanning/ktassageBody Art i
Swimmin, Pools
Public Sewer
—
Well J
Tobacco Sales --
Food PackagingSales
' -
-
Permanent Dumpster on Site
Private (septic tank, etc. _
Electric Meter location to
project
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fiend
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 ❑ ❑
[]Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
COMMENTS
CONSERVATION
COMMENTS
DATE REJECTED
DATE APPROVED
a
DATE REJECTED DATE APPROVED
HEALTH ❑- . [ --1
COMMENTS
Zoning Board of Appeals: Variance, Petition No:
Zoning Decision/receipt submitted yes
Planning Board Decision: _____— Comments
Conservation Decision: ___ Comments
Water & Sc\er connection signature & date
Temp Dumpster on site yes__no_ Fire Department signature. date
Building Permit :approved and Issued by:
Building Setback(
Front Yard Side Yard Rear Yard
Required
Provided Required
Provides Required
Provided
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Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
Cn:nrd IM( Lm _r Ju
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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
J 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
❑ 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
t>oc: 115PEC1'IONAL, SERVICES DF,1' %R'rMEN r:01 FORN105
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Certificate of Occupancy $
�N�sE Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # !�(�
Building Inspector
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tAORTH TOWN OF NORTH ANDOVER
OFFICE OF
Alp+ BUILDING DEPARTMENT
400 Osgood Street
North Andover, Massachusetts 01845
Gerald A. Brown Telephone (978) 688-9545
Inspector of Buildings Fax (978) 688-9542
HOMEOWNER LICENSE EXEMPTION
Please print
DATE: Z,0 Z G
JOB LOCATION: 6y --7D 5, n, 54,
HOMEOWNER
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Name
PRESENT MAILING ADDRESS
Street Address
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Home Phone
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City Town
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State
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Work Phone
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 tIrt he/she understands the Town of North Andover Building Department
minimum inspection procedures and requ' �nents and that he/she will comply with said procedures and
requirements. /I
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Revised 10.2005
Form Honiwwneis Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-
9535