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HomeMy WebLinkAboutMiscellaneous - 22 INGLEWOOD STREET 4/30/2018Location No. Date /Y TOWN OF NORTH ANDOVER 0 Certificate of Occupancy $ Building/Frame Permit Fee $ 0 CHUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ /0 Check # 16671 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING s, C axa: BUILDING PERMIT NUMBER: DATE ISSUED: 7 d� / 7 SIGNATURE: C Building Comniissi er/I or of Buildings Date SECTION I- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number ZZ �l 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft . Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) Public ❑ Private ❑ Zone 1.5. Flood Zone Information: Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District; Yes NO 2.1 Owner of Record ii rr C oto c- i Name (Print) 22 f N &-L X30-06 c� f Address for Service Signa � 2.2� er of Record: Nhi me Print phone C 7" Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature s Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor a Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone 00 M c/l SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 2506) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building rmit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check au applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: (aC_ SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item. 1. Building Estimated Cos(Dollar)be Completed by== , QFF1C� (a) Building Permit Fee Multiplier S1''(iLY� 2 Electrical (b) Estimated Total Cost of Construction l b 30-0 3 Plumbin Building Permit fee t8> X (b) l �. ..�- 4 Mechanical HVAC 5 Fire Protection 6 Total. 1+2+3+4+5 '' `'"• ' ' ' " '" " ' Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FORIBUILDING PERMIT I I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject prop y Her y 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/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS 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 Tel: 978-688-9545 Town of North Andover Building Department 27 Charles Street North Andover MA 01845 HOMEOWNER LICENSE EXEMPTION Please print. DATE P -r JOB LOCATION Number Street Address Section of Town "HOMEOWNER PRESENT MAILING AD Number Home Phone Work Phone City Town State Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings of six 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 109.1.1) 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 to six family dwelling, attached or detached structures ac- cessory to such use and and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance 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 No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and 'requiLements. A HOMEOWNER'S SIGNA APPROVAL OF BUILDING OFFI Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0 Construction Control. 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 properly licensed solid waste disposal facility as defined by MGL Chapter 111, S. 150 A. 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J e To: _4f./t#t!MU--/c�ae rG r4a E -a¢, - ------ I hereby certify that the above Mortgage Inspection Plan was prepared for use in connection with a new Mortgage and is not intended or represented to be a property line or land survey. It cannot be used for establishing fence, hedge , walls or building lines. No responsibility is extended herein to the land owner or occupant. The location of the original building(s) as shown herein was in compliance with the local applicable zoning bylaws in effect when constructed, with respect to horizontal dimensional requirements, or is exempt from violation enforcement action under Mass G.L. Title VII, Chap. 40A, Sec. 1, unless otherwise shown herein. Subject building(s) lies in a flood zone designated Zone:_:_f✓,/A______and shown on FIRM map Community -Panel t_ _Dated:____:--'__________ --------------------------------------- ----- JCD, INCORPORATED, LAND USE k DEVELOPMENT CONSULTANTS 4 AUTUMN LANE, METHUEN, MA 01044 508-663-9932 L o 7 3�} SNEO Coi�C• BLOCK O, 0 0 0 t o 0 QJ hi O � � z srcfr r h1 Oj I E,✓c. �u vv o o v J 3' EA17_Ry $c AG. /00 J e To: _4f./t#t!MU--/c�ae rG r4a E -a¢, - ------ I hereby certify that the above Mortgage Inspection Plan was prepared for use in connection with a new Mortgage and is not intended or represented to be a property line or land survey. It cannot be used for establishing fence, hedge , walls or building lines. No responsibility is extended herein to the land owner or occupant. The location of the original building(s) as shown herein was in compliance with the local applicable zoning bylaws in effect when constructed, with respect to horizontal dimensional requirements, or is exempt from violation enforcement action under Mass G.L. Title VII, Chap. 40A, Sec. 1, unless otherwise shown herein. Subject building(s) lies in a flood zone designated Zone:_:_f✓,/A______and shown on FIRM map Community -Panel t_ _Dated:____:--'__________ --------------------------------------- ----- JCD, INCORPORATED, LAND USE k DEVELOPMENT CONSULTANTS 4 AUTUMN LANE, METHUEN, MA 01044 508-663-9932 . a Town of North Andover BUILDING DEPARTMENT Homeowner License Exemption (Please print) DATE J u^) / !9-Z JOB LOCATION o20� IA; �� Number Street A _S % ress Section of town "HOMEOWNER" T� S aGrsuDfl act ��-�.93z/ Z,g7-2s Name Home Phone Work Phone PRESENT MAILING ADDRESS as fu �_Le"z,3c-z9 T- �UIS/� Ti�i LAD ev ao2 City Town State Zip code The current exemption for "homeowners" was extended to include owner occupied dwellings of six 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 109.1.1) 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 to six family dwell- ing, attached or detached structures accessory 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. Such "homeowner" shall submit to the Building Official, on a form acceptable to the Bulding Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance 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. c HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING 0 FICIA j___—,;ee,,e0, Note: Three family dwellings 35,000 cubic feet, or larger,ill be required to comply with State Building Code Section 127.0, Vonstruction Control: z�Vi Lu �- LJ� LLJ cq hw 2 x �► cww� 3�a H�ciJ r,J 3 3 ,�—� tnLU k- w N '-�43 Z L I 10 CA via LL.% to k Q W 9 '4 wa- J Cli -5 � aQ�vi w z t N o ��� z m o m W O tL FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. /****************Applica t fills out this section***************** v APPLICANT:� P oh ne LOCATION: Assessor's Map Number Parcel Subdivision Lot (s) I y/ J treet ------St. Number( ************************Official Use Only************************ O DATIO79 OF TOWN AGENTS: Date Approved �o • /d • 9Z-. Conservation Administrator Date Rejected Comments Town Planner Comments Health Agent Comments Public Works - sewer/water connections - driveway permit Fire Department Date Approved Date Rejected Date Approved Date Rejected Received by Building Inspector Date C 3 0 F=4 AS J CEJ CQ O z i ca h s�', F -A LU am r () W J z :w O led O0 as a u w W O W CL W •y E C• 4 96ma z a ZU. Z W 96 aW O u V < VA Z W C Z Q Z u L u �. C. a. E c y. O m m L C L LU L V L in Y C O C C 0 C C N CCC U u. ¢ LL ¢ m U. ¢ ii m LU am r () W J z :w z •y E C• 4 a -o C C Q yr L u O C. a. 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