HomeMy WebLinkAboutBuilding Permit #459 - 83 HUCKLEBERRY LANE 2/27/2009BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION I
Permit NO: S Date Received 2 Of
Date Issued:
IMP RTANT: Applicant must complete all items on this page
LOCATION 0 ko,�F \�N `P
Print
PROPERTY OWNER i L�`� 'F,--Fy-wJ `e-+� C)
Print
MAP NO:PARCEL:4/.'5- ZONING DISTRICT: Historic District yes
QP -
Machine Shop Villaqe ves
no
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 PREFORMED:
Ske� 7,x?
Identification Please Type or Print Clearly)
OWNER: Name: (k&JQs;eJ 74re� 6 Phone:
Address: � �uc��Ve,�
CONTRACTOR Name: Phone:
Address:
Supervisor's Construction License:
Home Improvement License:
Exp. Date:
. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No
FEE SCHEDULE: BULDING PERMIT: $Iyb PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ FEE: $ �6
Check No.: Receipt No.: "
NOTE: Persons contra ting withreistered contractors do not have access to the guaranty fund
Signature of Agent/Owner Signature of contractor
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. 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
❑ 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 2.2008
L
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
Doc.Building Permit Revised 2008
Plans Submitted Plans Waived 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
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COrMMENTS
Reviewed
Reviewed on Siqnature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Comm
Conservation Decision: Comments
Water & Sewer Con nection/Siqnature & 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 3134 Usgood Street
no
Location G ��
No.
Date ' %
TOWN OF NORTH ANDOVER
r 9 �
Certificate of Occupancy $
s�cMUsEt� Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # ��
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Growth Management Bylaw Exem pt1'
Town of North'Andover Building Department On Statement
This f0rM shallTown of North A dovedto r Growth Managt the ement Bylaw. The bui '
Building Department in their determination of exemptions under section 8.7.
as requested below. Iding applicant shall provide all of the necessary information
,Address of Property for Permit (below)
Mapand Parcel:
Phone Number of Applicanpose o lication (check below)
Single Family
I the undersigned applicant for the above grope Two Family
form is completed does comply with the EXEMPTION section the attached of the North
Management Bylaw. I also understand providing this form does .6 oftbuilding
from the requirements of obtaining other permits required prior to the issuance g permit for which this
Further I understand that obtaining
interpretation r the Andover Growth
t absolve me or any party to this permit
Department and is only officially accepted when the Building Permit is issued,a of the Building Permit.
EXEMPTION status is subject to review by the Building
Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the w
above lot, in the building permit application and associated attachments, complies with
following sections as indicated by a check mark. work as applied for on the
This is an application for a building one or more of the
existence as of the effective date of this by-law, provided that no additional residential unit i
Permit for the enlargement, restoration, or reconstruction of a dwelling in
The lots) were/was created prior to May s created.
Bylaw. y 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning
This application is for dwelling units for low and/or moderate income families or individuals, where
conditions of 8.7.6.care met and/or represents Dwelling units for senior residents, where occupancy
restricted to senior persons through a properly executed and recorded deed restriction running with the I
Purposes of this Section "senior, shall mean persons over the age of 55. all of the
of the units is
This application is a and. For
reduction in density part of a development project which voluntarily agreed to a minimum 40% permanent
environmental conditions ofbtheltract,bwith the surplus land equal to at least ten buildable
ldable lots)
designated as open space and/or farmland. The land to blow the density e preserved shall be Protected permitted under zoning and feasible given the
Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other veto
approved by the Planning Board that will ensure its protection. b e acres and permanently
d from development by is
This application represents a tract of land existing and not held b similar mechanism
adjacent parcel on the effective date of this Section 8.7 shalt receive sone -time exemption from the er
Rate and Development Scheduling Y a Developer in common ownership with an
Parcel. g provisions for the purpose of constructing one single family dwelling unit on the
Planned Growth
on
commissions ons hacveibeenpreceived and the lot which
project is infor
comlance with
does not accommodate issuing a building building Permithose ts all other permits from all other boards and
Development until such time as the Dev le opment�S hedulethat aaccommodates issuing building d the Development Schedule
supply approved form h with this EXEMPTION, ar, one building Permit will issued per Year per
Please provide any and all information that would assist the Building Department
Applicant must
that your application is allowed one or more of the above EXEMPTIONS.
t in making a determination'
BY signing below I attest to the accuracy of the information provided and that the attach
allowed an EXEMPTION as cited above. Further I understand that the submittal of Misleading
inaccurate information, or the checking off of an above item which does not comp) , whether
knowledge or not, is ed building permit is
unds f r fusal by the Buildin pe ding and or
9 partment to issue a%Buildin Perini done to my
ignat re o wrier or Authori a ent who si ned C
This form must be attache to he Building Per 1 �u onaahed Buildin Pe
P pplication for such to
Perm
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and been/ btitS from is uSea ICATrO`�FORM
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ants lth �Y a not elire nts the hav ng j u eSsa,
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CATION; Assess ���a hls sectlpn******
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Date ApProved
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