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Home My WebLink AboutUPDATE TWO FAMILY HOME #35 UPDATE BATHROOM, KITCHEN AND ADD A BATHROOM #37 UPDATE BATHROOM AND KITCHEN BUILDING PERMIT N,osary OF Leo ,6��0 TOWN OF NORTH ANDOVER ®� 1'6 APPLICATION FOR PLAN EXAMINATION 4- Permit No#: 11 Date Received SRA �RArev PPay�GJ CHUS Date Issued: Z IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER A P 'nt 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED JJSE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Meration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other r❑ Septic r❑Well ❑ Floodplain ❑"Wetlands ❑ Watershed Distract UUater�Sewer DESCRI TION OF YVORK TO BE PERFORMED: noty )y Vc b a c0c r,- oct a \O GA 4,O®w• Identification- Please Type or Print Clearly OWNER: Name: V G� S Phone: 01 X9-Z06- -_�S 13 Address: - ,n S Contractor Name: Phone: Email: 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 Cost: $ 000 FEE: $ 600, Check No.: Receipt No.: C 4/ NOTE: Persons contractingit unregistered contractors do not have access to the guaranty fund � NORTI-r � 'Town ofAndover C% 4 ver, 1�1[ass, 2 �i ry�ps RATED COCHICHEWICK PPS 1 U BOARD OF HEALTH Food/Kitchen rvERMIT T Septic System .r- BUILDING INSPECTOR THIS CERTIFIES THAT M ......•••.. J� .• Foundation has permission to erect ..... buildings on :S��.•3-��•••• ' �`•:�s;,, ... .•.............. .............. p ........ � Rough. to be occupied as_� ....................... �............... ..................... ..... ..G......... Chimney provided that the person accepting this permit shall in every respect4nform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. - Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION TS Rough Service .ay�i:l� '. .1�7�....�...•••.................•..• Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired to Occupy Building Rough Islay in a Conspicuous Place on the Premises — Do Not Remove Fim,ai No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT V 1.600 Osgood Street, Building 20, Suite 2035 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: Z (.o JOB LOCATION: 3"S-- Number Street Address T4,iplf,ot 110MEOWNER �� ( �, e-V,) 7 0 3 91 C,0, 2- Name J Home Pione Work Phone PRESENT MAILING ADDRESS C n e s dnn l cz)rn City Town State Zip Code The current exemption for"homeowners"was extended to include owner occupied dwellings of one or two family dwellings and to allow such homeowners to engage an individual for hire who does not possess a license,provide that the owner acts as supervisor. 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 dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shalt not be considered a homeowner. (780 CMR Section I I O.R5.1.2) The undersigned"homeowner"assumes responsibility for compliance with State Building Code and other applicable codes,by-laws,rules and regulations. The undersigned"homeowner"certifies that he he understands the Town of North Andover Building Department ininimum inspection procedures and requi in n s and that lie/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL' Revised 8.2015 Form Homeowners Exemption BOARD OF APPEALS 689-9541 CONSERVATION 688-9530 HEALT1 1688-9540 PLANNING 688-9535 8 COMMORWeatM ofl�`as�c�chuselts 1)e at t 2er2 of_TU,&strIaA e®eats x I Congress,S' ee,Suite M ,> Sosto e,j"021-14 2017 t Wwznass'.gov1dia l icians/PXumbexs. TV lC txactoxsm eetrr "' 9 ensatzon urance A- davit:/W&,fTJNC,onA'UTROk2TTY- ©rkexs Cornu To BE,FJ7:MED VITfITHE 7'E Please Print L,e ibl U-1pacantwormati'.on f;Ut, in � Name($,asiness/Oxganizatioz�/Sndividaal): 13 -A.d&ess: J�� m A ®1 BSS MOM CitylStat�/Zap: V1 hype of project(xegui7ced): rany an employer?Clzeckf&appxopxiatebox: 7, �New construction employees(full and/or pail tune).: exvaith_--- 8. rwraodomg aemfor me inor artzrership andhavenemploye9. Demolition a sole prop o t" s'comp.j,,mance requited.] apacity IN IO❑BLlilding addition allworkmysel£�gowozkers'comp.ii�surancexequired.]t ao,f am.ahomeowner doing. xo exty Iwill conftacfozstocouductallwoxkonmyp p ��,,[lElectxiea�.xepav:soxaddztzons S am a homeowner andwill be hiring oadditio7?s — .. . — 4. — 12: Plum6xg xepa7rs- ensure that all contractors either have workers'compensation insurance or ares°e `psopreorswihnpemplpye .- 5L— Z arl contractor andx hav l ' sfnnheached sheet. �ROot�0ef1Cx epairs gewa # 14. ,these sub-contractorslive empyoooOxS pau t of exemptionpernA G. V6 workers'comp.insurance required.] 6, vey'e are a corporation and ifs of�rr�ers have exercised their zi 1 4 and .,I . . S.SIT ensation otic information ()� t,. outthe sectionbelowshowingtheirworkers'comp p Y Any app licantthat checks lion#1 must alsogeYe doing allworkandthenbue oufside contracfoxs must submit anev,'affidavitca�g Bch' i ny pwners who snbriiif tlua d axttEa hed an additional sheet showing the name of the sub-contsactoxs and sfafewhether ornotthose entities have ' 10 ees,tYiey must pro vide their workers'comp-policy number. sConftabtoxs that checkthis bpx p/j site employees. 7fthe sub-contractorsllave emu Y 2nsatlon insurance for"my employees. BeloNz is t/iepolicy and lob am an erliployer�that is pr'6vidfilg wor'ker's'eomp information. Lnsusance Company Name: ExpirationDate: Policy#or Self~ins,Eric.#: City/State/Zip: fob Site A ddxess: o 8-howing tie p olxcy� aTo er an d e�pix at%op date). ensation.pokey dedaxation tag ( unishableby a f]ne up to$1,500.00 Attach a copy of thewoxl�exs comp . 25A is a criminal vlolationp e as xequixedunder MGE c.1.52,§ ORDEL�.and a fine ofup to$250.00 a Failure to secure covexag enalties in tha form of a STOP WORK and/or on.e yea7r imprisonment,as well as civil p ba forwarded to the Office of Lnvestigations of the DLA for insurance day against�e violator.A,copy of this statement may coverage veriRCation* or�alti�s o �e�J''r"�treat tine information prrovzileci above rsI true and co3'r ecr. fdo/serei5yeerti stn r�t/aepaansanclp Date: ?iq S1 nature: 01 g GJ Phone#: cz or'toren of.1 ficial., of czal ztse only. Jho not wrdte in this area,to be completed ley 't3' Pexxnit"Cense City or TONM: Xns ector txthor! (circle one): Lss-ui�g.�- De axtment 3.Cityl7Cown Clex�. 4.JEXectxzcalBaspectox 5.Plum xng p 1.Board of F(ealth 2.Building p 6.atluex vaone 0: Contaet.Verson: