HomeMy WebLinkAboutBuilding Permit #684-13 - 86 JOHNSON STREET 4/17/2013TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: _ `� Date Received
Date Issued: f ��
IM ORTANT: Applicant must complete all items on this page
LOCATION
Johaso)?
Q
PROPERTY OWNER /) ciUP �I•F.Rl�
Print 100 Year Old Structure yesnno
MAP NO: PARCEL: ZONING DISTRICT: Historic District yes
Machine Shop Village yes
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ One family
0 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:
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el
Ident'i}cation Please Type or Print Clearly)
OWNER: Name: f ��c�_ Phone: 9Z U,gS�
Address: � Z 'Too"
CONTRACTOR Name: Phone:
Address:
Supervisor's Construction License:
Home Improvement License:
Exp: Date:
. Date:—
ARCH ITECT/ENGI NEER
ate:
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: $ .` 0&0 FEE: $ 3 v
Check No.: -31 O '/ Receipt No.: -!2 —T 10/
NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund
Signature of Agent/Owner �°� Signature of contractor
Plans Submitted 0 Plans Waived ❑ : Certified Plot Plan ❑ Stamped Plans ❑
I
z
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
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION
COMMENTS
HEALTH
t COMMENTS
. DATE REJECTED
DATE APPROVED
0
Reviewed on Signature
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Comm
Conservation Decision: Comments
Water & Seger Connection/Signature & Date Driveway Permit
DPW Tow; Engineer: Signature:
v FIRE DEPARTMENT - TemLocated 384 Osgood Street
p Dumpster on site yes no
Located at 124 Main Street
Fire Departinerit�signature/date
COMMENTS
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
MUTES and DATA — (For department use
® Notified for pickup - Date
Doc.Building Permit Revised 2010
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 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 subm;tted with the building application
Doc: Doc.Bui?ding Permit Revised 2012
Location
Date 6 17 '1
Check # ?6, (/
26301
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
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Building Inspector
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TO" OF NORTH ANDOVER
OFFICE OF
BUILDING DEPARTMENT
it
fy'�s A
.1600 Osgood Street Building 20, -Suite 2-36
ApuuS4os c�5
S�.
North Andover, Massachusetts 01845
Gerald A. Brown
Inspector ofBuildings
Telephone (97g) 688_9545
ROMEO
F�x (978) 688-9542
WNER LICENSE EXEMPTION
GUIDING PERMIT APPLICATION
Please mint
DATE:—� — z
JOB LOCATION:_
Number Street Address
IJOMEOWNER
Name . ome
one,
PRESENT MAILING ADDRESS JQ k,t7 _S
. MaapiLot
zf— 4-7U
Work Phone
' - state
Zip Code
The current exemption for "homeowners" was extended to include owner -occupied dwellings to two units or less and
to allow such horneot,Ters to engage an individual -for hire who does not possess a license, provided that the owner
acts as supervisor). Slate Building (Code Section 108.3.5.1)
DEFINITION OF HOMEOWNER
Persons) who Qyyns a parcel of land on which he/she resides or intends to reside, on which there is, oris intended
be, a one or two family structures. A person who constructs more that one home in a two-yeaer eis, O shall not e
considered a homeowner. to
The undersigned "homeowner" assumes responsibility for compliances with the State Building Code and other
.Applicable codes, by-laws, rules and regulations.
t
The undersigned `homeowner" certifies that he/she understands the Town of North Andover Building Department
minimum inspection procedures and requirements and that he/she will comply with,said procedures and
requirements, . , g P went
HOMEOWNERS SIGNAT
A.PP,ROVAL OF BUILDING OFFICIAL
Revised 7.2009
Form Homeowners Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530
HEALTH 688-9540 PLANNING 688-9535