HomeMy WebLinkAboutMiscellaneous - 79 JOHNNY CAKE STREET 4/30/2018Location 22 % OAVA %(--",1,/,
No. o2 d f9 Date fS- /3
40RTN TOWN OF NORTH ANDOVER
• O -
9
Certificate of Occupancy $ _
•'Ss�cMusE` Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $ _
TOTAL $ �S
Check # (A -
Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
_ ... ... ...... .r. zx.x. .__. ,. a ...... ,.
BUILDING PERMIT NUMBER: ^ .� DATE ISSUED: / `� a a
LX�2 6 �
C
SIGNATURE:
Building Co ssionef/IR&=tor of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address-
1.2 Assessors Map and Parcel Number:
Map Number (� Parcel Number
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
ReqWred Provided
Rapired. Provided
1.7 Water Supply M.G.L.C.40. 54)
Public 0 Private ❑ Zone
1.5. Flood Zone Information:
Outside Flood Zone 0
1.8 Sewerage Disposal System:
Municipal ❑ On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
Name (Print)
Address for Service
ale- Jl
Signature
Telephone 100,
i a
2.2 O of Record:
Name.Print
Address for Service:
Signature
Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
I
Licensed Construction Supervisor:
Address
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
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 re3ult
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes .......❑ No ....... ❑
SECTION 5 Descrition of Proposed Work check all
applicable)
New Construction 0
Existing Building ❑
Repair(s)
❑
4 terations(s)
Addition 0
Accessory Bldg. ❑
Demolition 0
Other
❑ Specify
Brief Description of Proposed Work:
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed by permit_applicantr
u O1+FICLAL, IIS QNLy
I . Building�h
q.(�
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) x (b)
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
as Owner/Authorized Agent of subject property
Here 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 0e/A ent
NO. OF STORIES
Date
SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TPVMERS 1
2 ND 3 RD
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
•u
Town of North Andover
Building Department
27 Charles Street
North Andover, Massachusetts 01845
(978) 688-9545 Fax. (978) 688-9542
DEBRIS DISPOSAL FORM
NORTH
O ,�i4mo ,6'9
COCCwIwKA
�.9S tA4TED
In accordance with the provisions of MGL c 40 s 54, anda condition of
Building permit. # the debris resulting from the work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL cl 1, sl 56a.
The debris will be disposed of in /at:
1
Facility location
�gnatu�reof Applicant
Date
NOTE: A demolition permit from the Town of North Andover must be obtained for this
project through the Office of the Building Inspector.
.D. Robert Nicetta
Building Commissioner
(978) 688-9545
. •: (978) 688-9542 Fax
Town of North Andover
Building Department
27 Charles Street
North Andover, MA. 01845
HOMEOWNER LICENSE EXEMPTION
Please print
DATE --—
JOB LOCA
"HOMEOWNER
Number / Street Address
Map / lot
Name Home P one Work Phone
PRESENT MAILING ADDRESS
City Town
State
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-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 helshe will
comply with said procedures and requirements.
HOMEOWNER'S SIGNATU
APPROVAL OF BUILDING OFFICIAL
f
FORM - U - LOT RELEASE FORM $-ya �� C
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i P( c� chi
INSTRUCTIONS: This form is used to verify that all -necessary approval/ permits from E-03-101
Boards and Departments having jurisdiction have been obtained. ?his. does not relieve the
applicant and or landowner from compliance with any applicable requirements.
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APPLICANT---�_PHONE
ASSESSORS MAP NUMBER LOT NUMBER 3
SUBDIVISION LOT NUMBER
STREET
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RECOMMENDATIONS OF TOWN AGENTS
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DATE APPROVED
CON VATION AD TRATOR
DATE REJECTED
DATE APPROVED
TOWN PLANNER
DATE REJECTED
COMB ENTS
DATE APPROVED
FOOD INSPECTOR -'HEALTH 1 DATE REJECTED
DATE APPROVED
SEPTIC INSPECTOR - HEALTH
DATE REJECTED
COIvAZENTS
PUBLIC WORKS - SEWER / WATER CONNECTIONS
DRIVEWAY PERMIT
DATE APPROVED
FIRE DEPARTMENT
DATE REJECTED
CONQ4ENTS
RECEIVED BY BUILDING INSPECTOR DATE
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