HomeMy WebLinkAboutMiscellaneous - 38 TURTLE LANE 4/30/2018R
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Location
No. - "���-� Date
TOWN OF NORTH ANDOVER
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Certificate of Occupancy $
Building/Frame Permit Fee $
Check #
18770
Foundation Permit Fee $
Other Permit Fee
TOTAL
/%
Building IV*Ilor
1.1 Property Address
�
1.2 Assessors Map and Parcel
Map Number
Number:
Parcel Number
Signature Telephone
1.3 Zoning Information:
Zoning District Proposed Use
Address for Service:
1.4 Property Dimensions:
Lot Area
Fronto ft
1.6 BUILDING SETBACKS it
3.1 Licensed Construction Supervisor:
Licensed Construction Supervisor:
a
Address
40
Signature Telephone
Front Yard
Side Yard
License Number
Rear Yard
Required Provide
Required Provided
Required
Provided
Registration Number
Address
1.7 Water Supply M.GL.C.40. 34)
Public ❑ Private ❑
1.5. Flood Zone Information:
zone Outside Flood Zone ❑
1.8
Municipal
Sewerage Disposal System:
❑ on site Disposal System ❑
MM; IJLVA Z - PRUPERI Y UWINERStHMAUTHURILZED AGENT
Historic District: Yes _ No _
2.1 Owner of Record
Name (Print)
/
C / 01,
Address for Service
02 5P412
Signature Telephone
2.1 Owner of Record:
ame Print
Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Licensed Construction Supervisor:
a
Address
40
Signature Telephone
Not Applicable
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
Not Applicable 0
Company Name
Registration Number
Address
Expiration Date
Signature Telephone
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SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6)
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 ....... 0
SECTION 5 Descri tion of Proposed Work check au applicable)
New Construction 0 Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑
Accessory Bldg. ❑ Demolition 0 Other ❑ Specify
Brief Description of Proposed Work:
r—n C( r'e- ro o !moo v s
I SECTION 6 - ESTIMATED CONSTRUCTION COSTS 1
Item Estimated Cost (Dollar) to be
s
Completed by permit applicant
1. Building
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) x (b)
6
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> r i 2 S Ck w a_r4Z as Owner/Authorized Agent of subject property
Hereby authorize to act on
My bem all matters relative to work authorized by this building permit application.
6"s—
Signature acture oof Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
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/1
Date
NO. OF STORIES SIZE
BASEMENT OR SLAB \.
RD
SIZE OF FLOOR TIMBERS 1 \ 2 3
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
1
awry TOWN OF NORTH ANDOVER
OFFICE OF
BUILDING DEPARTMENT
Osgood 400 Os
g Street
{A North Andover, Massachusetts 01845
Gerald A. Brown
Inspector of Buildings
HOMEOWNER LICENSE EXEMPTION
Please print
DATE:
JOB LOCATION: 2P z
Number Street Address
Telephone (978) 688-9545
Fax (978)688-9542
Map/Lot
HOMEOWNER �J14/InQJ bqt, 9��-6P_3 —5� L3
Name Home Phone Work Phone
PRESENT MAILING ADDRESS-#
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 10.2005
Forth Homeowners Exemption
PROPOSAL
PROPOSAL SUBMITTED TO:
NAME.
ADDRESS,
PHONE NO.
WORK TO BE PERFORMED AT:
ADDRESS
DAT OF4ANS
ARCHITECT
PROPOSAL N0.
SHEET N0:
DATE
Respectfully submitted
Any alteration or deviation from above specifications involving extra costs
will be executed only upon written order, and will become an extra charge Per
over and above the estimate. All agreements contingent upon strikes, ac-
cidents, or delays beyond our control.
Note - This proposal may be withdrawn
by us if not accepted within days.
ACCEPTANCE OF PROPOSAL
The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work
as specified. Payments will be made as outlined above.
Signature a4f��_
Date
Signature
MADE I PROPOSAL
ad—MADE N USA
Iry
40
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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
at: is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by NIGL
. i1,S 150 A.
Also, note Permits are required under Fire Prevention laws Chapter 148 Section
I OA.
The debris will be disposed of in:
(Location of Facility)
Signature of Pe it Applicant
Fire Department Sign off:1 44411—.1/�
Dumpster Permit
- c95
Date
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