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Home My WebLink AboutApplication - 223 FOREST STREET 4/27/2005 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT EPA. RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLINGso s ioo 0* rn BUILDING PERMIT NUMBER: 6 5— DATE ISSUED: f SIGNATURE: Building Commission6r/Inspector of Buildings Date z SECTION 1-SITE INFORMATION o 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 1J (,-, A 17 q Map Number Parcel Number (� 1.3 Zoning Information: 1.4 Property Dimensions: Zonin District Pr osed Use Lot Areas Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Reqaired Provided 0 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: 1.7 Water Supply M�G.L.C.4%p 54) Public ❑ Private Zone Outside Flood Zone I Municipal ❑ On Sita Disposal System (� SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT !(3 'I`ti l Ct: 2.1 Owner of Record Name(Print) Address for Service &A, z Signature Telephone 2.2 Owner of Record: (+J iI-) CU F,- v-t-ter Name Print Address for Service: 6�1 Signature Telephone 1 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable Licensed Construction Supervisor: �✓ License Number Address Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ ® Company Name M Registration Number r r Address z 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 result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......0 No.......0 SECTION 5 Description of Proposed Work check aII applicable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. 0 Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: X a76) ' r�C-c r 0 t1i F3 OC K O F 00-'s 6 SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by pem-dt applicant 1. Building (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 1, 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 1, 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 NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINIBERS 1' 2' 3 SPAN D& ENSIONS OF SILLS DIMENSIONS OF POSTS DRv1ENSIONS OF GHtDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND _ IS BUU-DING CONNECTED TO NATURAL GAS LINE 0 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 or requirements. *************"***"*********APPLICANT FILLS OUT THIS SECTION-***"*"****** APPLICANT o v�Dc_H-6- LlRr�Axj PHONE_2L)k-�//V LOCATION: Assessor's Map Number----/00 A PARCE k_2_7 SUBDIVISION LOT (8) STREETJa(�L,-7— ST. NUMBER d,*)3 ............. OFFICIAL USE REGO IIA NPATIO NS,-QF,T0W"9EW%12E CONSERVATION ADMIVIS?MATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR EALTH DATE APPROVED DATE REJECTED SEPT INSPECT® -HEA H DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS -SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT- RECEIVED BY BUILDING INSPECTOR DATE RevlmW 9197 Jm „onTh TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 400 Osgood Street North Andover, Massachusetts 01845 ,SSAGH�S`� D. Robert Nicetta, Telephone(978)688-95454 Building Commissioner Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE: Ari ri i do , c200L JOB LOCATION: a a:� F70 R 6 5 t S�r . l Mo A 177 Number Street Address Map/Lot HOMEOWNER 143, x r �eRN, NQ TF �.0�r� u %) .�7s (/I`� 77S -lo�� %S3/ Name Home Phone Work Phone PRESENT MAILING ADDRESS a33 Fo RcsJ` SV- N, 1)c)oErz 1141+ 0ag 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� I' APPROVAL OF BUILDING OFFICIAL Il().\RD OF.\ITEALS I)R8-95-11 CONSI•:RVATION 688-9530 1IYALT1i G8R!9540 ITANNIN<i 1)81,'`9S35 =.z_ �k � PTPorTs clur 16) A , c tic,r) Vee 2,X I eCk 6 /' 11.E •� • 1� r NORTH Town of gAndover 'Aft 31D - LA q, C�over, Mass., y a d S COCMICMEWICK X1,9 A°RATED PP�`� .(`� `S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT.... „ �� 'C CVPrAPJ........................... ............... BUILDING INSPECTOR ............................................................................ Foundation has permission to erect....... . OZ ... buildings on 3 g '�•�� ................... Rough .. .................... ...... D FN c Qn �e • D w* 1ht t0 be OCCup18d as.. Chimney .............. ................................... ........................................................................................................ . provided that the person accepting this permit shall in every 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 PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS. CONSTRUST TS C Rough ..... ..... ................................ . ....................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough n. No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det.