HomeMy WebLinkAboutBuilding Permit # 4/28/2016 IJIL I PE MIT taoRr�y
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TOWN OF NORTH ANDOVER o -
APPLICATION FOR PLAN EXAMINATION
Permit No#: f e Date Received pDRATED
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Date Issued: r111
IMPORTANT: Applicant must complete all items on this page
LOCATION 1
�. Print
PROPERTY OWNER Fall
Print 100 Year Structure yes no
MAP' PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Resi ential Non- Residential
❑ New Building VOne family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
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DESCRIPTI N OF WORK TO BE PERFORMED:
Identi ation- Please Type or Print Clearly
OWNER: Name: , Phone:
Address: ��' to csi�l `i7 6� 7 cCLVA
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 PERM T.$12.00 PER$1000.OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
ed $
Total Project Cost: $ � � k FEE: $
Check No.: 9//0 Receipt No.:
NOTE: Persons contracting with unreg' ered contractors do not have access to the guaranty fund
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Andover
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COCMIC.IWIC.' 1•
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ll BOARD OF HEALTH
Food/Kitchen
Septic System
THIS CERTIFIES THAT ..... ... ' : . ................... BUILDING INSPECTOR............................ ...... .... ............ ..........
has permission to erect.......................... buildings on Foundation
..
to be occupied as ►�',y''���f �� - 4< <`�/�ry �� &j/U-/L.�� Rough
...................Zall
e.......... . ............./.. ........................................ ugChimney
provided that the person accepting this permit in every respect conform to the terms of the application
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Final
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 ® T S I ELECTRICAL INSPECTOR
UNLESSCTI STARTS Rough
Service
..........�.... `: .......................................... Final
BUILDING INSPECTOR
GAS INSPECTOR
ccupancy Permit Required t® Occupy Buildiuz Rough
Display in a Conspicuous Place on the Premises — ®o Not Remove Final
Lathing or Dry Wall To Be Cone FIRE DEPARTMENT
Until Inspected and Approvedy the .Building Inspector. Burner
Street No.
Smoke Det.
o� ttORTtj TOWN OF NORTH ANDOVER
yt;;"O 16`6�0� OFFICE OF
04
p BiTII.DING DEPA.12'I'IVIENT
o ,z 1600 Osgood Street,Building 20, Suite 2035
"6R;T;o icy North Andover,Massachusetts 01845
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Gerald A. Brown Telephone(978)688-9545
Inspector of Buildings Fax (978)688-9542
HOMEOWNER LICENSE EXEMPTION
BUIDING PERMIT APPLICATION
Please print
DATE:
JOB LOCATION:
Number Street Address [r Map/Lot
HOMEOWNER M-64. `fWGLK 4 �huGG G`a
Name Home Phone Work Phone
PRESENT MAILING ADDRESS .2,13 0w!0L C
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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 110.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
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Revised 8.2015
Form Homeowners Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535