HomeMy WebLinkAboutBuilding Permit #Exception - 805 FOREST STREET 5/28/2013Permit NO:
Date Issued:
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
IMPORTANT: Applicant must complete all items on this page
LOCATION
Print
PROPERTY OWNER
Print 100 Year Old Structure yes no
MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
0 New Building
11 One family
El Addition
0 Two or more family
0 Industrial
El Alteration
No. of units:
11 Commercial
El Repair, replacement
0 Assessory Bldg
El Others:
El Demolition
11 Other
0 Septic, 0 Well
0 Floodplain 0 Wetlands
El Watershed District
11 Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address:
CONTRACTOR Name:
Address:
Phone:
Supervisor's Construction License: Exp. Date:
Home Improvement License:
ARCH ITECT/ENGI NEE
Date:
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: $ FEE: $
Check No.: — Receipt No.:
NOTE: Persons contracting with unregistered cont ctors do not have access to the guarantyfund
of Aqent/Owi,,--r Siqnature of contractor
Plans Submitted Plans Waived U Certified Plot Plan El Stampe d' Plan -s El
Location S�vs... ±YY4
No. Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee
TOTAL $
Check# I oq '--!>41
t Building Inspector
26442
4T
Plans Submitted [I
Plans Waived Certified Plot Plan
Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer
Tanning/Massage/Body Art El
Swimming Pools El
Well
Tobacco Sales
Food Packaging/Sales D
Private (septic tank, etc.
Permanent Dumpster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
( CONSERVATION Reviewed
COMMENTS
HEALTH
COMMENTS
Reviewed o
DATE REJECTED
11
�5
DATEAPPROVED
n
ature
Sianature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes - ..
Planning Board Decision:
Conservation Decision:
Com
Comments
Water & Sewer Connection/signature & Date Driveway Permit
DPW Towo Engineer: Signature:
Located 384
FIkEDtPA'RtM'EN-T' -'Temp Dumpsteron site yet no,
Located at 124 Mainstr(jet
Fire Departinefit-pignatute/date
COMMENfS
ood Street
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 21 A —F and G min.$100-$1000 fine
NOTES and DATA — (For department use)
0 Notified for pickup - Date
Doc.Building Pennit Revised 2010
Building Department
The folipwing is a list of the required forms to be filled out for the appropriate. permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
u Building Permit Application
Ei Workers Comp Affidavit
u Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o Copy of Contract
o 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/Crossection/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
Li Photo of H.I.C. And C.S.L. Licenses
Ei 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 app�,al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submAted with the building application
C,
Doe: Doc.Buildin" Permit Revised 2012
-r
TOWN OF NORTH ANDOVER
OFFICE OF
]BUILDING DEPARTMENT
'..1600 Osgood Street Building 20, -Suite 2-36
- North Amd"Or, Massachusett6 01845
Gerald A. Brown Telephone (97�) 688-9545
hsPcc.tor OfB@ldings:
F�x (978) 688-9542
110MMORNER-LICENSE MEMPTION
DMING -PERYHT APPLICATION
bease prjr,
DATF----5'—
.JQIB LOCATiON.—I-0 �_Qd f�
S,TreetAddress
Number
IIJOMEOWNER
Name
PRESENT MAMiNG ADDRESS 5
Phone
Map/Lot
'9
�, Olf 7-ql 1
Workphone
" //j
zip Coda -
The curTellt exemption fc)r,;homeo
)�mere'was extended to include owner-ocodpie.0 dw.611ings to two Units -or less and
_11or u 6 ir -Wh e no Osscss a JiMnse, provided that the, owner
_'ljow '9ui'b mpAv'ffiers to c-uga,'-"e all indiVid al -f r b e o do s tp
acts as SuPelVisor). State Building (Code Section 108.3.5. 1)
DEFINITION OF 110AMOWNER
PersOn(s) Who _9wns a parcel of land on which he/she resiaes or intends to residq� on Whi . ch there is, or - is intended to
be, a one or two farm-IY structures. A person who constructs more thatone home in a two-yearperi6d s'
considered a homeowner. hall not be
The undersigned "homedwnee, assumes responsibility fo
Applicable codes., by-laws, rules and regulations :r compliances with the State Building Code and other
k
The undersigned ".homeowner,, certifies that he/shet-nderstands the Town Of gorth Andover Building Department
m'n'Tnum inspection Procedures and requirem
requirements, ents and that he/she wiR comply With,said procedures and
110MEOWNP311S SIGNA
A�PPROVAL ORBUMDING OFFICML
PcYlsed 7.2009
Folm IiOmeOwmers Exemption
]30ARI) OF APPEAT-S* 688-9541 COX(SERYAMN 688-9530
BEALTH 698-9540 PL-4-NNNG688-9535
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MORTGAGE PLOT PLAN
E K SURVEY INC
0 HAVERHILL, MA 0
Phom 97&A69-1965 + Fax 07SA69-7046
MORTGAGOR �g&&j &MASJ �fMV I;WVWP DEED REF. my PG.
AODRESS OF PRINCIPLE BUILDING PLAN REF.
DATE OF INSPECTION ft4i/ /Q� rm 7
M, AfA SCALE: 1� = 501
/VMS,(
'�'t - . po", 3 -ma -r
. N .4.1
GERTIFICAT)ONTO: dR-jj&jA�jW=jW TI* locatlon of the pirincIple aructumts
This MmtMe Plot Plan was prepared speoffically for No.
m%Vap purpom only and R Is not Intnded or represerited with the Wal zoning bylaws In effed when congmted
to be a pDpedy The or land survey. Ttft plan is not to be umd ancif or is mompt from VmMw enforcement
to edabkh any of the property lines for any purpose. No 1 ILN%v act;on under Mass B -L We VII, Chap. 40A, Sec. T.
respomNtly Is mdended to the kW owner or moupant. Sub)ect buIWIng Is not in 9 Flood Hazard Arei
This oartibeation Is bask on the location of survey "rker 0 Su*ct builft Is h a Fbod Hamd Area,
of others. Flood Hazard determined from the FIRM rmp#_
Dated
JOB# jjjjq
RaAjns Aa WUL0:8 100;� 1�1 Rew
North Andover MIMAP May 14, 2013
105D-0071
790 FOREST ST
105.D-0044
105J)-0040 781 FORESTST
105.D-0173 105.D-0176
105.D-0045
804 FOREST ST
105.D-0017 1051)-0039
105.D-0175 793 FOREST ST
105.D-0018 805 FOREST ST
R1 105.D-0037
105.D-0172 830 FOREST ST
.. ..... 105.D-0162
T.
M�
105.D-0163
105.D-0158 ..' * .... ...
110 LACONIA CIR
105.D-0160 105.D-0161
105.D-0159 851 F�RESTST
\ 130LACONIACIR
— Rail Line Wetlands
Zoning
Interstates Exempt Lands
Busm:! s 1 District
Interstate
Major Roads
L, Busin ! s 2 District
a Bu:in.! . 3 District
Horiwntal Datum: MA Stateplane Coordinate System, Datum NAD83,
Roads
IS Bun !no! s 4 District
Meters Data Sources: The data for this map was produced by Merrimack
Valley Planning Commission
M Ge am Business District
J40RT#J
(MVPC) using data provided by the Town of
N rthAndover. Additional data by
C, Easements
C3 Planne� Comm ercial De
'%.
provided the Executive Office of
Eno ironmental Affairs/MassGIS, The information depicted
C3 MVPC Boundary
Comdo Develop entDist
on this map is
forv,lanning purposes only, It may not be adequate for legal
0 Municipal Boundary
Zoning Overlay
0 Comdo Deve pment Dist
to
13 Corrido Development Dist
Indust I District
Ind.al n6 :1' 2 District
0
13
4
boundary
de n
M finitio or regulatory interpretation. THE TOWN OF NORTH ANDOVER
AKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING
THE A CURAC
C Y, COMPLETENESS, RELIABILITY, OR SUITABILITY
Adult Entertainment
DID nlown Overlay District
=:ndus�,i:� 3 D
4
4
OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT
i—s
0 H toric District
r District
0 ndus i S strict
ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
THIS
M Water Protection
Reside ce 1 Di:�rict
ResideMl)i rict
INFORMATION
El Parcels
r � Hydrographic, Features
Strearns 96 ft
CJ P—ide ce 3 District
de ce 4 District
—�_'de ce 5 Dis :d t
de ce 6 Di. Nc.
as
.ge[.i.d.ntial District
C