HomeMy WebLinkAboutBuilding Permit #775 - Exception 6/8/2006.NORTN0.4
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w TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
,SSACNUSE� ,
Permit NO: Date'Received: 4.
Date Issued: 44,1-4,6
IMPORTANT: Applicant must complete all items on this vaLe
LOCATION C) ^ � > 'E,
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PROPERTY OWNER 3l0�Y1Yl2 \�i�ck�evt
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NIAP NO.: PARCEL: ZONING DISTRICT:
TYPE AND USE OF BUILDING
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TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
J New Building
'i Addition
Alteration
C One family
_ Two or more family
No. of units:
` Industrial
!--'Commercial
,,Repair, replacement
r_ Demolition
C Assessory Bldg
Moving (relocation)
' Other
F' Others:
Foundation only
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Identification Please Type or Print Clearly)--
OWNER:
learl OVbNER: Name: /4/7 I Phone:
Address:. 0E��Si ature��� t\J t VfB
CONTRACTOR Name: Phone:
.Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License:
xp. Date:
ARCIJITECT,FNGINF.E:R Name: Phone:
Address:
b. No.
FEE SCHEDULE: BULDLVG PERMIT: .5'10.00 PER S1000.00 OF THE TOTAL ESTLVA TED COST BASED ON
S 125.00 PER S. F. /
Total Project Cost S 2-S i xIO.00 FEE:$
Check No.: j X15 a Receipt No.:�
Location ( L) s
No. 7 Date
Check � -; g�
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Building Inspector
TYPE OF SEWARGE DISPOSAL
1
-
Tanning/Massage, Body Art
Swimming* Pools
� Public Sewer --
--
I
_
Well
Tobacco Sales -
Food Packagings Sales _.
-
I Private (septic tank, etc.
i
i
i
-
Permanent Dempster on Site
I
NOTE: Persons cunlractinl; w' li un ci,tstered co tractors do nut /rave access to the l;uarrnr{vjimrt
h � i
Signature. of ,,kgent/Owner Signature of Contractor
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
DATE REJECTED
❑ ❑
❑Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
DATE APPROVED
DATE REJECTED DATE APPROVED
CONSERVATION ❑ ❑
C=OMMENTS
DATE REJECTED DATE APPROVED
HEALTH
COMMENTS
Zoning Board of Appeals: Variance, Petition No:
Zoning Decision:'reccipt submitted yes
Planninu Board Decision:
Conservation Decision:
Comments
Comments
�1 ater & Sewer connection si(ynature & date
Temp Dempster on site yes__no Fire Department signature'date
Building Permit ,approved and Issued by:
Building Setback (ft.)
�--Front Yard Side Yard Rear Yard
Required I Provided Required
Provides Required
Provided
DIMENSION
N Umber of Stories:
Total land area, sq. ft.:
Total square feet of floor area, based on Fxterior dimensions.
r, 1( on
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
❑ Debris Removal Form
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
❑ Floor Plan Or Proposed Interior Work
Addition Or Decks
❑ Building Permit Application
❑ Form U
o Surveyed Plot Plan
❑ Debris Removal Fonn
❑ 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)
New Construction (Single and Two Family)
❑ Building Pen -nit Application
❑ Form U
o 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 .
o Mass check Energy Compliance Report
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Hoard 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: 1\SPECI OVAL. SERV ICES DEP.IRT\-IE\'r:BPFOR.NlU5
%y°RTH 1 TOWN OF NORTH ANDOVER
OFFICE OF
p BUILDING DEPARTMENT
400 Osgood Street
North Andover, Massachusetts 01845
Gerald A. Brown Telephone (978) 688-9545
Inspector of Buildings Fax (978) 688-9542
HOMEOWNER LICENSE EXEMPTION
Please print
DATE: 6 — <,3 —0
JOB LOCATION: IP-17-
Number
D1ZNumber
street Auaress
HOMEOWNER D � ,,,i, h7 rGkle
Name Home Phot
PRESENT MAILING ADDRESS /D
6,9127-7
Map/Lot
Work Phone
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
Form Hoinamneis Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-
9535
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