HomeMy WebLinkAboutBuilding Permit #475 - 9 ELM STREET 11/20/2006Permit NO:
7�
Date Issued:
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
® toecjiv�e Y
IMPORTANT: Applicant must complete all items on this pale
LOCATION 4-LIA S�
Print
PROPERTY OWNER 5&Vi(YOk.E A- A&SSa A4A-- T POSSO
D.;. +
MAP NO.: 4;� PARCEL:
TYPE AND USE OF BUILDING
ZONING DISTRICT:
HISTORIC DISTRICT YES ❑
'0
v'tt``D/`••ryO�
t 9
0.").746
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ Addition
❑ Alteration
❑ One family
❑ Two or more family
No. of units:
❑ Industrial
❑ Repair, replacement
❑ Demolition
❑ Assessory Bldg
❑ Commercial
❑ Moving (relocation)
19Other 5j' EU
❑ Others:
❑ Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
Identification Please Type or Print Clearly)
OWNER: Name: 5h-t-VA-vk46- I� 1-/44i4 R-kS SD Phone:'?7k- 2-!?f4?-2!�-
Address: ! L -2 1X , 5 Tiu-7 T
CONTRACTOR Name: Phone:
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERM/T.• $12.00 PER $1000.00 OF THE TOTAL EST/MATED COST BASED ON $125.00 PER S.F.
Total Project Cost :$ 10 6�-, FEES -3e)
Check No.: Idi9
Page I of 4
Receipt No.: I! CN' q 9
j / 1
Location � } 4 r
No. Date
TOWN OF NORTH ANDOVER
9
Certificate of Occupancy $
,Ss4CIWStt Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee Cllr �� $ f9l
TOTAL $ 7j� r r/!/!)
Check # �a
Building Inspector G
:'-I -
TYPE OF SEWERAGE DISPOSAL
Art ❑
Swimming Pools ❑
Public Sewer El
❑
❑
Tobacco Sales
Tobacco
Food Packaging/Sales ❑
Well
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 guarantyfund
Signature of Agent/Owne6;�®� 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 ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
CONSERVATIOl'al
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH ❑ ❑
COMMENTS
FIRE DEPARTMENT - Temp Dumpster on site yes no
Fire Department signature/date
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer Connection/Sirpature & Date Driveway Permit
Building Setback (ft.)
Front Yard Side Yard Rear Yard
Required
Provided Required
Provides Required
Provided
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
NOTES and DATA — (For department use
Page 3 of 4
Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM05
Created 1MC. Jan.2006
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
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
Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM05
Page 4 of
Gerald A. Brown
Inspector of Buildings
Please print
DATE: J L-- Ow
TOWN OF NORTH ANDOVER
OFFICE OF
BUILDING DEPARTMENT
1600 Os
good Street Building 20, Suite 2-64
forth ,"lover, :Massachusetts 01345
Telephone (973) 688-9545
Fax 19 %.i j ri�s4-9;.}?
HO�IEOV�'NER L[CE'VSE EXPOPTIOiv
JOB LOCATION:_
Number Street :Address -"
Map/Lot
HO,tiiEO�'4'NE111 si L/N/��4�iSS6
Name Home
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PRESENT MAILENG ADDRESS_ 6I—
City Town
State
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.
w2'.��
The undersigned "homeowner" assumes responsibility for compliances with the State Building Code and other
Applicable codes, by-laws, rules and regulations.
The undersigned "homemi ner" 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.
HOMEOWNERS 'iIGNAI'LRE
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MORTGAGOR:
LOCATION:
CITY,5TATE:
DATE:
PAMELA L ORLANDELLA
9 ELM 5TREET
N. ANDOVER, MA
8/ 19/OG
DEED REF:
PLAN REF:
5CALE :
JOB #:
E
,8418/248
3819
1 "= 20'
20G.0395G
R=663.76' .,.�
� ELn1! ST[ZEET
CERTIFIED TO: . WA5HINGTON MUTUAL BAN
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