HomeMy WebLinkAboutMiscellaneous - 24 SUMMIT STREET 4/30/2018 (2)l
Location
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No. -3 Date /D P3 ^ U3
NORTH TOWN OF NORTH ANDOVER
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# Certificate of Occupancy $
y�s'•�E<�' Building/Frame Permit Fee $
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Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
10
i 6773
Building Inspector
3M
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
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BUILDING PERMIT NUMBER: L j DATE ISSUED:
SIGNATURE: �
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Building Commissioner/lng=tor of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
o�a'aLi 36mm���
1.2 Assessors Map and Parcel Number:
Map Number Parcel Number
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1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Area (sf) 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) 1.5. Flood Zone Information:
Public ❑ Private ❑ Zone Outside Flood Zone ❑
1.8 Sewerage Disposal System:
Municipal ❑ On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
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Dame (Pri ) Address for Service:
Signa G /,, TelephoneI ( A A 4
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,ier of Kee 5rd:
Va. e P int Address for Service:
Si nature 4 Telephone
SECTIO 3 - CONSTRUCTION SERVICES
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Licensed Construction Supervisor:
Address
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Signature Telephone
Not Applicable
License Number
Expiration Date
Not Applicable
CotApany Name
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Registration Number
Add
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Expiration Date
Si nature I Telephone
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SFCTION 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 permit.
Signed affidavit Attached Yes .......❑ No....
SECTION 5 Description of Proposed Work check all a licable
New Construction ❑
Existing Building W
Repair(s)
Alterations(s) ❑
Addition ❑
Accessory Bldg. ❑
Demolition ❑
Other ❑ Specify
Brief Description of Proposed Work:
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollar) to be
Completed by permit applicant
., OFkICIAL�USE ONLY
1�/� B ildin -��
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(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 (9 d 0 r
3 Plumbing
Building Permit fee (a) X (b)
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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 FOR BUILDING PERMIT
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
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
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NO. OF STORIES SIZE
71
BASEMENT OR SLAB
SIZE OF FLOOR TIIv1BERS 1 ST 2 ND 3 RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
(MIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
FMATERIAL OF CH My NEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
Tel: 978-688=9545
Please print. 2 (,9-3 DATE 1' I
JOB LOCATIO
NORrk
OF,iea ,6'9
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Town of North Andover
Building Department �• ,
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27 Charles Street RSSacHUS
North Andover MA 01845
HOMEOWNER LICENSE EXEMPTION
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Number Street Address �,� Section
"HOMEOWNER ZZ" ZL( ���la �� O O �G07— ��_
Number Home Phone Work
PRESENT MAILING ADDRESS % `M r +
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City Town State Zip C1
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 procedi
HOMEOWNER'S SIGNA
APPROVAL OF BUILDING OFFICIA
Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with
State Building Code Section 127.0 Construction Control.
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