HomeMy WebLinkAboutBuilding Permit #775-11 - Exception 5/17/2011TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO:_? r— � Date Received --5//7///
Date Issued: 6-117111
IMPORTANT: Applicant must complete all items on this
LOCATION -7 (4 6k f W 410- J free+
PROPERTY OWNER U_,ayl r1 4,4,Ss Q(� ()
Print
MAP NO: PARCEL: 43 ZONING DISTRICT:
TYPE OF IMPROVEMENT
❑ New Building
❑ Addition
❑ Alteration
❑ Repair, replacement
❑ Demolition
(]►Septic ;®`Welk
Water/Sewer•
PROPOSED USE
Residential
One family
❑ Two or more family
No. of units:
❑ Assessory Bldg
❑ Other
Historic District yes no
Machine Shop Village yes no
DESCRIPTION OF WORD TO 3E P EIS-ORMED:
1�W6it
OWNER: Name: S V 3 (t
Address:_ _ % q C4,S T LU -
Type or Print Clearly)
Non- Residential
❑ Industrial
❑ Commercial
❑ Others:
CONTRACTOR Name: Phone: _
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE. BULDING PERMIT. $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Ceisi: $ c`iSQO FEE: $ �7c>—
Check No.: 70 6: Receipt No.: '7 9/ 6 a
NOTE: Persons contracti g ith unre istered contractors do not have access to the guaranty fund
-- ur— --- -- ---- —
Signate'of Agent/Ow _'r ;. _. _gin►,+� s;f„���_._.r , n.
Location
2L/
No. 2 % Date
NOATM
TOWN OF NORTH ANDOVER
O
Certificate
of Occupancy $
�'� s''•°' t,�
+cNus
Building/Frame Permit Fee $ ria
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
76, 1� 2-
Check #
Building Inspector
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑
Tanning/Massage/Body Art ❑
Swimming 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
PLANNING & DEVELOPMENT ❑
COMMENT
DATE APPROVED
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board"Decision: Comments
. Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes
Located at 124 Main Street
Fire Department signature/date
COMMENTS.
no
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
NU 1 t5 and UA I A — 11 -or Clevartment use
Notified for pickup - Date
Doc:.Building Permit Revised 2008mi
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
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
❑ Building Permit Application
a Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
❑ Flo or/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
OTE: 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
ITE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Permit
i all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
at the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
ust be submitted with the building application
Doc: Doc.Building Permit Revised 2008mi
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oio pTH �ti TOWN OF NORTH ANDOVER
bE` , °L OFFICE OF
° BUILDING DEPARTMENT
1600 Osgood Street Building 20, Suite 2-36
North Andover Massachusetts 01845
Gerald A. Brown Telephone (978) 688-9545
Inspector of Buildings Fax (978) 688-9542
HOMEOWNER LICENSE EXEMPTION
BUIDING PERMIT APPLICATION
Please Print
DATE: IG rI hi
JOB LOCATION: -7q
Number
HOMEOWNER
wa)ol s -h e-0-
Street Address
Name Home Phone
PRESENT MAILING ADDRESS `%L4 G AS
Y`ll '41"Vd lei P,4
City Town
State
Map/Lot
663 33yJ-0�3
Work Phone
/pus
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 9wns 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. 11
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 SIGNATU�/W l ,
APPROVAL OF BUILDING OFFICIAL
Revised 7.2009
Form Homeowners Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535