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Home My WebLink AboutMiscellaneous - 125 Philips Brook Road 125 Pw11,ps �I� ��Q . -- BuILDING FILE � Location No. Date NORTpl TOWN OF NORTH ANDOVER _ O 0 .. 9 Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ cMust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #13735 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMO".LISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. � DATE ISSUED: SIGNATURE: Building Commi "r/Inspector of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property lAddress: 1.2 Assessors Map and Parcel Number: O Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning DisVid Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R red Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record /2 Name(Print) Address for Service: � G ^ 9I�P ignature Telephone , 2.2 Owner of Record: Name Print Address for Service: Si nature Telephone c,CTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone rM 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number ras Address rM as Expiration Date ^ Si nature Telephone Y/ 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.......❑ SECTION 5 Description of Proposed Work check au applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS rr Item Estimated Cost(Dollar)to be � g OFFICIAL USE401!iLY Completed by 2ennit 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 UO Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 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 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 Si ature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST2ND 3 SPAN DM ENSIONS OF SILLS DfMENSIONS 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 BUILDING DEPARTIMEVT DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a properiy licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed of in: Location of Facility Com i SipafTm of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector i - y . . y ,1 "ORT �l Town of North Andover �? d�,•_ •• Building Department A 4 Y 27 Charles Street *�� North Andover, MA. 01845 '•'n^�•''ay 1SS��SEt D. Robert Nicetta Building Commissioner (978) 688-9545 r X978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print DATE. JOB LOCATION 2S Ilk S lvolw Number Street Address Map/lot Name Home Phone Work Phone PRESENT MAILING ADDRESS 4.r 4 I d 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 he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE < APPROVAL OF BUILDING OFFICIAL NORTH Town of Andover No. O tLA o dover, Mass., COC MICMEWICK OF AERATED S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......., .....,...... / IAO .... .I . . ............. " Foundation ... has permission to erect... h.. ......... build' gs .0on .. ..� .....� � , '.. � Rough to be occupied as "� Sd!.�.1...�...... .......... .................. 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, Altera ' and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR M VIOLATION of the Zoning or Building Regulations Voids this Permit. ' Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STAR ELECTRICAL INSPECTOR Rough ............ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove F Rough No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det.