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BUILDING PERMIT °f<t`eO 'eAtio
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received �, °q,T.° �5
Permit NO: �SSACHt1s��
Date Issued:
IMPORTANT Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Resi ntial Non- Residential
❑ New Building One family
❑Addition ❑Two or more family . ❑ Industrial
AI ration No. of units: Q Commercial
epair, replacement ❑Assessory Bldg ❑ Others:
Other
iemolition ❑ ?/� v
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D� Sc�IPTION OF WORK TO BE PREFORMED:
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Identification hease Type or Print Clearly) 97&--
OWNER: Name: \ .� �� W� 0 Phone:
Address: �j � �f�S. � etw/t'
COM1ITRAGTOR Name Phone F >t F
f.
y Y Y -� g
Addrens r a <
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k
Supervis l's ConstrdGtion �cep'se
Exp Date
d{ r r yr
1 w' r -,• e `is.2 x �: Y a 44 Y� . t "( i.i P 3
P
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: $ 20 6)00 FEE: $ yv' o
v •
Check No.: 1� y3 Receipt No.: � 7
NOTE: Persons contracting w'h unregist red contractors do not have access to the guaranty fund
Signature pf Agent/Owner Signature a#contractor
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
❑ 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
❑ 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2007
COMMENTS . .
_ - s
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 2007
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/1V4assageBody Art ❑ Seng 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
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
CONSERVATION ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH ❑ ❑
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
0
Conservation Decision: Comments
Water& Sewer Connection/Signature& Date Driveway Permit
Located at 384 Osgood Street
fIR DEPARTMENT Temp Durnpster on slte yes' no
Located at 124 Mam'Street j
Fire Deparfiment signature/date
i
Location 30j //�11-r11�f /�6
No.—7 1'7 — 2 Date 112 /,f
• - TOWN OF NORTH ANDOVER
L Certificate of Occupancy $
Building/Frame Permit Fee $ •d
Foundation Permit Fee $
'� Other Permit Fee $
TOTAL $
Check#
25217 Building Inspector
NOR'i'F♦ .
..
TO'" Of
0
No. -_
gip( �,'� To LAKE dover, Mass.,Ap
COC H ICHEWICK V
�oRATE D P' '`C
v V BOARD OF HEALTH
Food/Kitchen
RMIT T D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT...P.5�.Al........ 5�.� . '/ & ................ .........
.... ........... .......... ........... .................... Foundation
has permission to erect................�.p.. . ....... buildings on r- ... . .
Chimney
im
to be occupied as . c .... ..�Y ....�Gl/.� (X.. 4� �................... Rey
..... ...... ...�..
provided that the person accepting this permit shalWneve respect conform to the terms of the application on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations 'Voids this Permit. Rough
Final
PERMIT E)TMS IN 6 MONTHS
ELECTRICAL INSPECTOR
V 1 v LESS CONSTRUCTIONS TS Rough
Service
.......................................C........... ..............
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry. Wall To Be Done FIRE DEPARTMENT.
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.
NORTH 9
o" o _ Andover ..0
No
o , �` dover, Mass.,
7` O - LAKE
e� COCHICHEWICK
.44
7�S RATED
U BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
BUILDING INSPECTOR
THISCERTIFIES THAT.... . . c1...................:........ ........... .......... ............ .................... Foundation
has permission to erect........................... .. buildings on .............................................................................................. Rough
to be occupied as. n d� . .... ...�t . .....�iGl/ru ... ....{.�.. e ................... •*,�ney
provided that the person accepting , : shalNn eve �yrespect conform to the terms of the application on file in sinal-
this office, and to the provisions the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Mover. PLUMBING INSPECTOR
VIOLATION of the Zoning or'Builo,,1 Regulations 'Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION V S S Rough
Service
...................................................... ..............
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Rough
Display in;a Conspicaous Place on the Premises — Do Not Remove Final
No Lathing or Dry. Wall To Be Done FIRE-DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.
GENERAL BUILDING NOTES/CHECKLIST-NOT LIMITED TO ITEMS BELOW
POST ALL LOT NUMBERS,ADDRESS, AND PERMIT(COPY 0K)..or no inspections
INSPECTIONS: (Minimum) Excavation, Footing, Foundation, Frame, Insulation, Final.
FOOTINGS: Continuous Full 2x4 Keyway
Continuous strip footings for interior columns
FOUNDATION: Rebar as required
Anchor bolts or straps
Damproofing
Foundation drain-„ r ' brie filter/cover and outlet connection.
FRAME:Fireblock-over girts/plates bei for joist
Penetrations for pluml. -at, elec,etc.
Walls at stair stringers.
Windbrace corners and center bearing partitions.
Size ridge to provide full bearing at rafter cuts.
Hip and Valley rafters-watch bearing at walls.
Ridge&Hip-Provide proper connections.
Cathedral roof rafters provide proper connections and use"Hurricane Clips"tie to plate.
Stair stringers-watch cuts and heal support.
Joist hangers-fully nailed w/hanger nails.
Sill plates 2-2X6(1 PT)w/sill seal.
Girts-solid brick or steel plate bearing at foundations
%"air space at sides in foundation pockets.
Lateral bracing at ends.
Certified calculations. required for Beams/LVL's Trusses.
Solid bearing support for Headers/Beams etc.
Check headroom clearances-stairways, under beams
Attic Access. (min.22x30 w/3'headroom above).
Crawl space access. (min. 18x24).
Bath exhaust fans to have metal duct to exterior(not in soffit).
Firecode S/R wood frame of 0"clearance fireplaces&stoves
Window Schedule or Every Habitable Room Must Have:
Natural light equal to 8%of floor area.
'/Z of required glazing shall be openable.
Bedrooms required min.20x24 egress window or door.
Vent attic spaces-"proper vent", soffit and required ridge vents.
Firecode under stairs if used for storage
FIREPLACES: Separate permit required.
Inspections at Footing-Smoke Chamber-Finish
Smooth parging,clean joints, 8"solid @ combust.
DECKS: Lag to house, provide flashing.
Rails min. 36" high, Baluster max space 4"on center.
Over 8' above grade, use 6x6 pop'- .gyral bracing.
Lag all posts and rails.
Pier footings down 48", Conc. pad , mir base.
FINISH: Handrails returned to wall/newall post.
Guardrails required alongside open cellar stairs.
Exterior grading complete.
Certificate or occupancy required prior to occupying structure.
Temporary Stairs required for inspection.
Re-inspection fee- $30.00(Be Ready).
Certificate of occupancy required prior to occupNinq structure.
GENERAL BUILDING NOTES/CHECKLIST-NOT LIMITED TO ITEMS BELOW
POST ALL LOT NUMBERS,ADDRESS, AND PERMIT(COPY OK)..or no inspections
INSPECTIONS: (Minimum) Excavation , Footing, Foundation, Frame, Insulation, Final.
FOOTINGS: Continuous Full 2x4 Keyway
Continuous strip footings for interior columns
FOUNDATION: Rebar as required
Anchor bolts or straps
Damproofing
Foundation drain-pipe/stone/fabric filter/cover and outlet connection.
FRAME:Fireblock-over girts/plates between floor joist
Penetrations for plumbing, heat,elec,etc.
Walls at stair stringers.
Windbrace corners and center bearing partitions.
Size ridge to provide full bearing at rafter cuts.
Hip and Valley rafters-watch bearing at walls.
Ridge&Hip-Provide proper connections.
Cathedral roof rafters provide proper connections and use"Hurricane Clips"tie to plate.
Stair stringers-watch cuts and heal support.
Joist hangers-fully nailed w/hanger nails.
Sill plates 2-2X6(1 PT)w/sill seal.
Girts-solid brick or steel plate bearing at foundations
'/"air space at sides in foundation pockets.
Lateral bracing at ends.
Certified calculations. required for Beams/LVUs Trusses.
Solid bearing support for Headers/Beams etc.
Check headroom clearances-stairways, under beams
Attic Access. (min.22x30 w/3'headroom above).
Crawl space access.(min. 18x24).
Bath exhaust fans to have metal duct to exterior(not in soffit).
Firecode S/R wood frame of"0"clearance fireplaces&stoves
Window Schedule or Every Habitable Room Must Have:
Natural light equal to 8%of floor area.
'/of required glazing shall be openable.
Bedrooms required min.20x24 egress window or door.
Vent attic spaces-"proper vent", soffit and required ridge vents.
Firecode under stairs if used for storage
FIREPLACES: Separate permit required.
Inspections at Footing-Smoke Chamber-Finish
Smooth parging, clean joints, 8"solid @ combust.
DECKS: Lag to house, provide flashing.
Rails min. 36" high, Baluster max space 4"on center.
Over 8'above grade, use 6x6 posts w/lateral bracing.
.Lag all posts and rails.
Pier footings down 48", Conc. pad at stair base.
FINISH: Handrails returned to wall/newall post.
Guardrails required alongside open cellar stairs.
Exterior grading complete.
Certificate or occupancy required prior to occupying structure.
Temporary Stairs required for inspection.
Re-inspection fee- $30.00(Be Ready).
Certificate of occupancy required prior to occupying structure
jaoRTH TOWN OF NORTH ANDOVER
OFFICE OF
0 BUILDING DEPARTMENT
1600 Osgood Street Building 20, Suite 2-36
North Andover Massachusetts 01845
�SSgcHus'�•c
Gerald A.Brown Telephone(978)688-9545
Inspector of Buildings Fax (978)688-9542
HOMEOWNER LICENSE EXEMPTION
BUIDING PERMIT APPLICATION
Pleaseprint
DATE:_ 0 Li Z3 Z_
JOB LOCATION: 3 a
Number Street Address Map/Lot
HOMEOWNER �tr-` �� E-�'" q �j 6 3 -3 7(4 3
Name Home Phone Work Phone
PRESENT MAILING ADDRESS._ �'� � (�,�, ,I� o�.,_� S
s r-
01(A
City Town m c+Y+w. 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 Qwns 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 7;z
s 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
NORTH 9
wn To
oAndover .
0
No.
0 o , �` dover, Mass.,
O - LAKE
I� COCHICHEWICK V
7�ADRATED ➢P�,`"`�
S V BOARD OF HEALTH
Food/Kitchen
PERMIT T -D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT.... . .. .AP......... o............................ ........... .......... Foundation
�
r
has permission to erect........................................ buildings on ......................... ................................................................... Rough
to be Occupied as.....V1.4 '�ll .. .�,(... (.. !rye"r-,t. ....v. .. 1��. ........... �^./tom.. X.. 4 /I. ................... Chimney
provided that the person accepting this permit shall eve respect conform to the terms of the application on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
UNLESS CONSTRUCTIONS TS Rough
Service
..................................................... ...............
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry wall To Be Done FIR_E_DEPARTMEN'T
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.
NORTH
O of
o1 '
No.
C" o' , �` dover, Mass.,
O -- LAKE
COC.'C..""CK V
7�ADRATED
S V BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
BUILDING INSPECTOR
THISCERTIFIES THAT.... . .l- !! ........ .1••4'•. I� / ............................ ........... .......... .......... .................... Foundation
has permission to erect...... ---� ( ` ���� ' D G Rou h
r
.................................. buildings on.................................................................... g
,� ,
to be occupied as.....xeiwm�lVk. e�,C. ......... ...�!. ... ................� (.?�.. �1. ........ .......... Chimney
��
provided that the person accepting this permit shall eve respect conform to the dta s of the application on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
UNLESS CONSTRUCTIONS TS Rough
Service
. ..................................................... ............... ..............................
BUILDING INSPECTOR Final
Occupancy Permit Required to Ocmpy Building GAS INSPECTOR
Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry. Wall To Be Done FIRE-DEPARTMENT-
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.