HomeMy WebLinkAboutBuilding Permit #535 - Exception 3/15/2010BUILDING PERMIT o* rvn �ry
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TOWN OF NORTH ANDOVER 0
APPLICATION FOR PLAN EXAMINATION
Permit NO: �� Date Received 4
Date Issued: %> �� SSAc►+us�
IMPORTANT: Applicant must complete all items on this page
LOCATION 1'� Z S co 4, ar si
Print
PROPERTY OWNER_ 90 �Z
Print
MAP 210 PARCEL: ZONING DISTRICT: Historic District es no
Machine Shoo Village ves no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
One family
Addition
Two or more family
Industrial
Alteration
No. of units:
Commercial
Repai _replacements
Assessory Bldg
Others:
Demolition
Other
Septic Well
Floodplain Wetlands
Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
124PLI�'CC C&II-' Al 1- 700 04J 1721 dim
Please Type or Print Clearly)
OWNER: Name:
Address: /7-f- Cc2,,,zX- ST
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ne:2 -'632o -- 6aS"/
CONTRACTOR Name:. it A, r „�A. :. , ^-rw Phone: Z 7-2 79-
Address: /Z r�rc�rL GZJ 41�V4mlut-
Supervisor's Construction License: 0/,9 Z 3 & Exp. Date:
Improvement License:
ARCHITECT/ENGINEER Phone:
Address: Reg. No
FEE SCHEDULE. BOLDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ #%civ FEE: $
01
Check No.:
/,-/o Receipt No.: -.2 2 F!!r�
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Own x Signature of contractor'x
Location
No.Date
HORT"
TOWN OF NORTH ANDOVER
� OL
Certificate of Occupancy
$
NUE��'
SACS
Building/Frame Permit Fee
$ —
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
$
Check # /,L/0
2254 14
/Building Inspector
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
COMMENTS
lY
DATE REJECTED DATE APPROVED
Reviewed on Signature
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department 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
NOTES 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
o 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
L3 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: Building Permit Revised 2008
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Gerald A. Brown
Inspector of Buildings
Please print
DATE:
TOWN OF NORTH ANDOVER
OFFICE OF
BUILDING DEPARTMENT
1600 Osgood Street Building 20, Suite 2-36
North Andover, Massachusetts 01845
HOMEOWNER LICENSE EXEMPTION
BUIDING PERMIT APPLICATION
Telephone (978) 688-9545
Fax (978)688-9542
JOB LOCATION: /Z5- CO y IZT ST= /L ZAIA9aw ,
Number Street Address Map/Lot
HOMEOWNER 10&n7' ,r9z�c��r� 7N/-c�Zo -6cz57
Name Home Phone Work Phone
PRESENT MAILING ADDRESS /Z-5- (-<�2!%, 7 ss%, 14
ti ,Olrinoy�y�. �� o /cam
City Town State 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 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 SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Revised 7.2009
Form Homeowners Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535