HomeMy WebLinkAboutMiscellaneous - 22 COLUMBIA ROAD 4/30/2018 (2)Location
No. Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
CHUS
Foundation Permit Fee $
Other Permit Fee
TOTAL
Check #
15356
Building Inspectpl—
TOWN OF NORTH ANDOVER
„�3IJILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH 'A ONE OR TWO FAMILY DWELLING
' BUILDING PERMIT NUMBER: DATE ISSUED:
SIGNATURE: C
Buildinj dommissioner/I for of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address: 1:2 Assessors Map and Parcel Number:
(2ez e--- '5 �_
Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area Fronts ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
- Required Provide RaVired Provided Required Provided
1.7 Wacr supplyM.G X.40. 34) 1.3:Flood zone Ihfoimation: IX Sewcnp Disposal System:
Public ❑ Private ❑ Zone outside Flood Zone ❑Mwicipal . ❑ On Sita Disposal: System ❑
SECTION 2 -,PROPERTY OWNERSHIPIAUTHORIZED AGENT
2:1 Owner/off Record
!r f L
Name (Print) jt Address for Service: /
Signature Ul Telephone
2.2 Owner of Record: i
Name Print Address for Service:
Signature Telephone
-SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor. Not Applies Q
Licensed Construction Supervisor:
License Number
Address'
Expiration Date
Signature Telephone
3.2 Registered Home Improvement Contractor Not Applicable D
Company Name
Registration Dumber
Address
Expiration Date
SECTION 4 -WORKERS COMPENSATION XG.L. C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this of
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes .......0 No....,_0
SECTION 5 Description of Proposed Work check all applicable)
New Construction 0 Existing Building 0 Repair(s) 0 Aherations(s) 0 Addition 0
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specifyr
Brief Description of Proposed Work:
A ��—
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollar) to be
Completed bypernut-ap hcanC
I . Building (a) rLie
2 Electrical (b) t of
- Construction
3 Plumbing Building Permit,fee�(a) x (b) ;
4 Mechanical AC
5 Fire Protection
6 . Total. 1+2+3+4+5.... 0 0. Check Number .
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR,APPLIES FOR BUILDING PERMIT
n 'If°J _i _ /i
will result
I,y /�✓�J-D ►"r�f1+ 1�- f. tf as O mer/Authorized Ag, -rt of subject properly
Hereby authorize .�oU to act on
My behalf _n -all atters relat v o ork au ed by this building permit application. /'
g
Signature of Owner I Date
CT.[-TToN 7h OWNER/ADTHORIZED AV&ENT DECLARATION
I, ,as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge.
and belief
Print Name
Signature of Owner)Agent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TMERS I sr 2 ND 3 RD
SPAN
DB/IENSIONS OF SILLS
DIMENSIONS OF POSTS
DtEMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
I
A
HORTFf
Town of North Andover 1�
Building Department ►.
27 Charles Street t
North Andover, MA. 01845. '•- x
D. Robert Nicetta
.Building Commissioner
(978) 688-9545
688-9542 Fax
HOMEOWNER LICENSE EXEMPTION
Please print ry
DATE '/ 1 / %' 0 O -
JOB LOCATION 0�
Number
"HOMEOWNER J/s
Name
Street Address
PRESENT MAILING ADDRESS v, a Cd L- 61rk r
Phone
-6 7/
Map / lot
%/-,)-3 71
Work Phone
. _ �y � L✓� c�C�c'��{ ' �r"��'155 �% vim' � J > �
City Town State 7 J
Zip Code
The current exemption for "homeowners" was extended to include owner -occupied dwellings
of 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 HOMEWOWNER:
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 dwelling, attached or detached structures ac-
cessory to such use and/or farm structures. A person who constructs more than one home in a
two-year period shall not be considered a homeowner.
The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other
Applicable codes, by-iaws, rules and regulations,
The undersigned "homeowner" certifies that he/she understands the Town of No. Andover
Building Department minimum inspection procedures and requirements afid that he/she will
comply with said procedures and requirements.
HOMEOWNER'S SIGNA
APPROVAL OF BUILDING OFFICIAL
Y
e
North Andover Building Department
Tel: 978-688_9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be
disposed of in a properly licensed solid. waste disposal facility as defined by MGL
c11,S150A.
The debris will be disposed of in:
(Location of Facility)
Signature of Pern4t pplicant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
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