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Home My WebLink AboutBuilding Permit # 4/13/2016 0.1 %aoraro-r BUILDING PERMIT TOWN OF NORTH ANDOVER ® APPLICATION FOR PLAN EXAMINATION ' 1 .. m � Permit No#: '� � Date Received i � o"lAr.R. �Ss�c�+us�-c Date Issued: 411 IMPORTANT: Applicant must complete all items on this page LOCATION r ru S! Print PROPERTY OWNERP,) I Z Print 100 Year Structure yeCno MAP ® PARCEL4�� ZONING DISTRICT: Historic District yMachine Shop Village y TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ["Repair, replacement ❑Assessory Bldg ❑ Others: [ Demolition ❑ Other ❑ peptic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District x ❑Water/;Sew�� , DESCRIPTION OF WORK TO DE PERFORMED: Identification- Please'Type or Print Clearly OWNER: Name: ��ar�. � .� 6"n 1 _65- Phone: rR Address: (ee, lJp.-A X'P,1qVe,) f Contractor Name: Phone: !2 7 y-- Zc 76 Email: Address: �� Il t��L; IYA Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ , `7 SO FEE: $ Check No.: b I Receipt No.: 2-5-7 Persons contracting with unregistered contractors do not have access to the guaranty fund .--.-_..--_--_-............. tkORTH Andover Town of No. 4111 41 Did (3, ;6 ® •�' y' C, hL VAI'' SSS' o LAN! COC NIC HI WICK �,qg Rgr�o Pe�R�� U BOARD OF HEALTH PErxM1T LD Food/Kitchen Septic System =200 lk THIS CERTIFIES THAT BUILDING INSPECTOR ............. ..... ..... . . .T............ ................. .... .............. Foundation has permission to erect .... ............ ....... buildings on . ........flef.. . . ... .... ' . Rough to be occupied as .. .. ..... .. ...... . . . .. ..... ... . .. ... .. ..... A Chimney provided that the person accepting this permit shall... hall in very respec conform 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 Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR T TS Rough ............ Service .......... ..... .�� ..... ............. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing r Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. TOWN OF NORTH ANDOVER OFFICE OF BUILDING- DEPARTMENT 1600 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 BUILDING PERMIT APPLICATION Please print DATE: JOB LOCATION: Number / ,Street Address Map/Lot 9 2Y —.53% _. S,5� Name Home Phone Work Phone PRESENT MAILING ADDRESS 5lk 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,provided 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 shall not be considered a homeowner. (780 CMR Section I IO.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/she understands the Town of North Andover Building Department minimurn inspection procedures and reg7�irements and that he/she will comply with said procedures and requirements. // HOMEOWNERS SIGNATU APPROVAL OF BUILDING O FICIAL Revised 8.2015 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9.530 HEALTH 688-9540 PLANNING 688-9535 2bl 1 rRa del Zcl �/X71'✓6�G'� �� .c.�� r' , / The Commonwealth of Massqchusetts F Department oflndustrialAccidents -- _ a 1 Congress Street,Suite 100 ~+ ` tl Boston,MA.02114-2017 www mass.gov/dia Workers,Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WxTH THE PERMITTING AUTHORITY. Applicant Information Please Print Letsibly Name (Business/Organization/Iridividual): J�j N.9 c'/( • I V'!^ 7) GPL / Address: City/State/Zip:/_)6, n L-10 t)e.r Are you an employer?Cireck&e appropriate box: Type of project()required): 1.[I I am a employer with employees(full and/or part-time).* 7. Q New conkruotion 2.Q I am a sole proprietor or partnership and have no employees working for me in 8. Remo delirig any capacity.No workers'comp.insurance required.] 9. F1 Demolition 3.F1 I am a homeowner doing all work myself.[No workers'comp..insurance required.]t 10F]Building addition 4.�I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors hale employees and have workers'comp.insurance.t 13.[]Roof repairs 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),andwe have nq employees.[No workers'comp.insurance required.] r:. *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. submit i Homeowners who sit this affidavit indicating they are doing all work and then hire outside contractors hiust submit a new affidavit indicating such. TContractors that check this box must•attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-coritraciors have employees,1ey must provide their workers'comp.policy number. ]'am an employer that ispi•ovidingworlrers'compensation insurance for my employees.'Below is thepolley andjob site information. Insurance Company Name: Policy#or Self-ins,Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a Eno of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do hereby certif under thepains andpenalties ofpeiyuiy that the information provided above is trate and correct. Si afore: Date ,t / Phone#: Official use only. Do not write in this area,to be completed by city or town official.. City or Town: Permit/License# Issuing Authority(circle one): i 1..Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: North Andover MIMAP April 12, 2016 w y n ar' ku I f I I ern Pd 0 r r 0 MVPC Be Inlerslates Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, I Meters Data Sources:The data for this map was produced by Merrimack —SR F10RTp Valley Planning Commission(MVPC)using data provided by the Town of Roads Ot yt4iu r`"0,r North Andover.Additional data provided by the Executive Office of Easements }y4 p O Environmental Affairs/MassGIS,The Information depicted on this map is Parcels ' G for planning purposes only.It may not be adequate for legal boundary MO --- '' definition or regulatory Interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING it THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY }is + OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT M °o y ♦ ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION ACHUS� 1"=34ft North Andover MIMAP April 12, 2016 005.0-0007 - � � 009,0-0054 005.0^0008 91 BEVERLY ST ` 009.0-0077 97 BEVERLY ST 005.0-0009 4 r 005.0^0010 R4 - 005.0-0011 ,� 005.0-0012 61 �105 BEVERLY ST 005.0-0013 ro 009,0-0053 9 PERRY STti 5 PERRY ST `t I , 13 PERRY ST � 4 µ- - ,.,. N 005.0-0015 pe,rry,�tc�� 4V . 009.0-0050 A 005.0-0021 005.0-0022 2 PERRY ST 009.0-0052' 6 PERRY ST 005.0-0023 00510-0024 14 PERRY ST 005.0-0036 MVPC Bo Zoning Overlay Zoning 0 Municipal Boundary Adult Entertainment Dislric Busine s 1 District r,:,f Machine Shop Village Ove f.Busine s 2 District Horizontal Datum:MA Stateplana Coordinate System,Datum NAD63, Rail Line FJ Watershed Protection Dist Ed Busine s 3 DisMcl Meters Data Sources:The data for this map was produced by Merrimack Interstates Historic Mill Area EB Busine s 4 District WORTH Valley Planning Commission(MVPC)using data provided by the Town of ,,,.. U Medical Marijuana M Genera Business District ¢f �4tu r qH North Andover,Additional data provided by the Executive Office of —SR rj Downtown Overlay District 0'i Planne Commercial Dev {, mei •tb¢¢ Environmental Affairs/MassGIS,The information depicted on this map is Roads ®Historic District Corrido Development Dist ,} G for planning purposes only.It may not be adequate for legal boundary Osgood Smarl Growth(46 "Corrido Development Dist 4 *—• •"' th definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER i)Easements r Hydrographic Features I0 Corrido Development Dist F MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING ❑ParcelsIndusui 1 District * 4 THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY --Streams Industn 12 District IF �, n OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT Wetlands Induslri 13 District y. ria wS g ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF rtE Induslri S District 9.a THIS INFORMATION Exempt Lands Reside cel District „ °Mr,to Reside cel Dlstricl s'RC HUst' Raside ce 3 District y de ce4 Dlstricl 1"=41 ft (j-•de ce 6 District r d.E6 6 District ,.,22 asidemlial District