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Home My WebLink AboutBuilding Permit # 3/11/2016 BUILDING PERMIT TOWN OF NORTH,ANDOVER APPLICATION FOR PLAN EXAMINATION o a s - � o .... Permit No#• Date Received � i f RSSACNusk� Date Issued: Ii>PO12T iNT:Applicant must camplete all items on this age ` LOCATION 7Ste, r Print PROPERTY OWNER t Print 100 Year Structure yes MAP U'k' ) PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential =" Non-Residential New Building ❑One family Addition D Two or more family ❑Industrial Alteration No.of units: D Commercial ❑Repair,replacement ❑Assessory Bldg El Others: ❑Demolition ❑Other \ Floodpla n C Wetlands` P Wa e�s`hed DDistrtG \ ,, DESCRIPTION OF WORK TO BE PERFORMED: I Identification- Please Type or Print Clearly OWNER: Name: ' ems €�`7ffi ir— Phone: C1- Z ii Address: _ t Contractor Name: Phone: I Email: I 1 Address: t Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCH ITECTlENGINEER Phone: Address: Reg.No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost:$ FEE:$ Check No.: I , Recel t t"lo.:-; l l NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund � ®y�RT@y Town of "� ca...y E. ' c6 L ndover No. 2 1&. ver, Mass,_ �9 O"ATeDPER W�P°y E� l) BOARD OF HEALTH Food/Kitchen mm'ml�l ILD Septic System THIS CERTIFIES THAT............... ...... BUILDING INSPECTOR G0 Foundation has permission to ..........................b 'Idings on......'..6.... .............. ........ .............. �j Rough to be occupied as.... .......... .......................d............... ......'.....V4cl.N 0........ .... Chimney provided that the person accepting this permit shall in every respect conform to the terms pplication Final on file in 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION STARTS Rough Service ...... ........ .................... ....... Final BUILDING.... INSPECTOR. GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises—Do Not Remove Final 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 UILDING DEPARTMENT 1600 Osgood Street,Building20,Suite 2035 North Andover,Massachsetts 01845 Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION RAIDING PERMIT APPLICATION Please tint DATE: JOB LOCATION: Number Street Address Map/Lot 140MEMVINER G-q, 6,1?-�97-7A5,6f5 X 29 Name Home Phone Work Phone PRESENT MAILING ADDRESS 10 ��ALC � t✓a�Z 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 Erre who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Persons)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 shall not he considered a homeowner.(780 CMR Section II0.R5.L2) The undersigned"homeowner'assumes responsibility for compliance with State Building Code and other applicable codes,by-laws.rules and regulations. The undersigned"homeowner"certifies final:he/she understands the Town ofNorth Andover Building Department minimum inspection procedures and requirments and that he/she will comply with said procedures and requirements. f' HOMEOWNERS SIGNATURE '. APPROVAL OF BUILDING OFFI AL Reaised 8.2015 Fe n Homeol Hers Esz taion BOARD OF APPEALS 688 9-41 CONSERVATION 688-9530 HEALT€-r 688-9540 PLANK NG 683-4535 The Commonwealth of fassachusetts _ Department of 111dustrialAceidents =' T Congress Street,Suite 100 Boston,MA02114-2017 www.massgovtdia Workers'Compensation Insurance Affidavit:Builders/ContractorstPlectricianstPlumbers. TOBEFIL}3DFi'tTHTBEPERMCTTSRGATITgORITX'' pleasePrint Le'hl A 'licanthformatlna Name(Business/diganizationllndividual): „ I Address: l() J,}e" do � City/State/Zip: T� 1!� ✓CVL Phone 4: _ Type of project(required): ,Areyou an employer?(,4ec cfhe appropriafo box: 'm to ees Hall aodtorpad-time).' 7. ❑NeVdiinstr{iotlon LEI aamplayarwdth . e P Y •2.❑Imnasole proprietor orpartnarstilp and have no employees vrorking£ormain 8.[]Remodeling any capacity.[Noworkem'comp.insurance required.] 9• Demolition 3.❑Ism a homeownerdoing all workmyselFPlo workers'comp.insurancarequired.]' 10 E]Building addition 4. Tamahomeowner andwill be hiring contractors to conductall work onmy property.ZWril 11.❑Eleeirbal Tepairs or additions ansurathat all ontmc�o seitherhava workers'compensation insurance or are sole 12 U[Phaabingrepairs or additions proprietors wrthno employees. 5.❑Z am a general con(rgcto asndShava huedthe sub-conftaetom listed mrthe attachedsheet. 13..E]Xo6f r0air3 These sub-conh'aetrim have emgloyeas andhaveworkers'comp.insuranczt z4•>-1 athgr 6.QWeareacorporaliori andiis.officershave exeraisedtfieirright ofhxemptionperlvZGL o. t--7 152,§S(4)andwehagenoemployees:[No workers'comg.insuranceregamd.] "Any appllcantthat ahecksboxx#1 must also flu outthe section below shovtingffieirworkam'nompensatfongo&cy informarion: t Aomcownus who submit,thls affidavit indicating they am doing all warkaodthenhue outside contracfors must submitanaw affidavit indicating such. tContractors that checktluss Uoxinustaftaefied'sn edditional sheet showingthename of the sub-contractom and statpwhether ornotfhose entities,have employees.Iftha sub-contractors have employees,they mustproside their workers'—P.Policy n-1-- I am an employer that is providingtvarkers'compensation insurance for my employees•helow is tliepoTicy andjab site information. '.. Insurance Company Name: Expiration Dote_ Policy#or Self-ins.Lie.#: City/Statolzip: Job Site Address: Attach a copy of the Workers,compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required underMOL a.152,§25A is a criminal violation punishable by a f�e up to$1,500.00 andlor one impxLsonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a may be forwarded to the Offico of Investigations of the DIA for insurance day against the violator.A copy of ib s statement coverage verification. Zdo hereby c fy"ths andIonalties ofpeijuty that the inform ationpro videdahave is true andcorrect . Date' s 1 j- ZU' idea Si afore' Phone#: Official nese only.Do not write in this area,to Be completed by city or totun official. PermlttLicen50# City or Town: Issuing Authority(circle one): 1.Board of ifealth 2.Building Department 3.CityiTown Clerk 4.Electrical Inspector 5.Plumb ngInspectm b.Other Phone#' Contact Person: ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 0 --------------- -- ------ --- o M K 0 ool L�I co ----------- ---- --J4 ............... T- ...... ............—— .............. 9 M c== c== E0 IIS0 inn -—-------------------------------------------------- j .......................... .......................... —--------------------------------- - > GROUND FLOOR North Andover Residence Greer+ Dame 0 DEMO PLAN Renovation O benjaminjgreer@gmail.com 710 Salem Street 617.827,8081 FEB.2G,2016 North And—r,MA 01845 ------------ w -n a. O - quavz O ---- 37 _ - - u q O z --- E M za. 0 O'o=- �i E d N O m Tfl5/A' o i oA o k ). SECOND FLOOR North Andover Residence Greer+Dame O DEMO PLAN: PHASE 1 Renovation benjaminjgreer@gmail.com b 1/8°=r 710 Salem svee` 817.827.8081 FEB.20,2016 N—h Aedo—,MA 01845