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Home My WebLink AboutBuilding Permit # 4/26/2016 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION / Date Received p Permit No#: � °BAYED p �� Date Issued:�1� 1 .POI[ FANT4 Applicant must complete all items on this page LOCATION - Print ...._ PROPERTY OWNEf �` LLQ " ,„ � Print 100 Year Structure yes Lnol, MAP PARCEL: :.�... ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential Q,.New Building ❑ One family ❑ Addition 0 Two or more family ❑ Industrial 0 Alteration No. of units: ❑ Commercial 0 Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other f ,r Gand lain ' Wflands 'r /, ❑ 'Wate'rshed District J/J❑/Sept1C / ❑Well ;u. / �% s;.. ❑/11 // m„ / r j//�/w•// D r/%r,i /% ri//r� /. / r,,,;i,. DESCRIPTION OF WORK TO BE PERFORMED. 0 > OWNER: Name: °� Identification- Please Type my- riot C)<eai-]l y Phone: ) ,) Address: CN � f> �.. Contractor Name: µ Phone: Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: _ Address: Reg. No. FEE SCHEDULE:BULDING ERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. r Total Project Cost: EE: $ Check No : Receipt No.: uceranty fund _dig ria .��.res�r�ntr rto _ 1 F Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swnming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL, SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on 14 ld-jo Si nature' COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connectionisignature & Date Driveway Permit DPW Town]Engineer: Signature: Located 384 Osgood Street FIRE ®EPAR-TMEN - Temp Durnpster on'site yes , no Located;at124 Main Street- Fire ®epartro4ent sh aituee/dale , COMMENTS NORTH 0%, w n 0 ® ® 2,6t z ]� Z �+ {] T ® LAKE..h ver, as S' COCNICNE WICK 1' RAreo rp ,�•e;5 S U BOARD OF HEALTH Food/Kitchen PERMIT L D Septic System THIS ............. CERTIFIES THAT ....... ... �.............................C' BUILDING INSPECTOR .. . ....... . . .............. ... has permission to erect .......................... buildings on t-b....Z&APillm.. ........ .. Foundation . Rough tobe occupied as .... ..... .......................................................................... chimney provided that the person accepting this permit shall in every respect 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 I S IN 6 MONTHS ELECTRICAL INSPECTOR LES S CIORT Rough Service .................. .... ............................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy BulZdln Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathingor Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. ' 1 r t pq�� L � 1 J i J i [1 ,116,e66y' CE�T/FY TO TyE T/TGE/,t/SUPO.P ANO G.. r; 14/V ' ,77Z:��:) TflE B 4 NK T//qT Tf/E O/f'ELG/u6 /S/E G4T qS Sf/O/Y,t/ANO THAT/TOGiES CO.(/FOPiyJ //V yY/Tf1 7f/EYow�i OF�vo q�oo�ce 20///NG eEa,ULAT,V,VS jz _'Fli,CTy�',e CErPT/FY Tf/.�T TH/..S O/YEGL/N6 /S LVOT LOLATEO /�/ THE FEOE.PAG FG000 H/IZA.PO A.PEi4, ®,PA�ii/ /�O.P tSHBvv�1! O/C/ F�iN.q:.G'pic.� vN�7"y PANEL '� '1-�° %+t 250098 0005 .B STEP/1E.�/• *-;:s' , � ;�. .C:S. DATE � , Bovvo,Py a �" �'.'f•`�,Ri''+''t�v OUNOA.FY �lE,P.FY�1.9 �";,'''� I ;;,.,.�,,. .�,�; /.tifo,P�!- GY ��t/Gic/EE•f'/.1/G SE,PI�/CES AT/D.(/ TA�E.S/�", ,Ja • i�IJ /(/G�PECoPOS. (� f'.Q�P� .STPEET ,,r rye,, A.t/ODYE.C, /l J�4SSAC//!/SETT,S o/8/O TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT g 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 BUIDING PERMIT APPLICATION Pleaserp int DATE: r a JOB LOCATION:-63 �_ ,pw Number Street Address Map/Lot HOMEOWNER _6 S-C V-3 Name lkme Phone ' Work Phone PRESENT MAILING ADDRESS tA"%, City Town State "-tip 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 hue 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 minimum inspection procedures a • quirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNA APPROVAL OF BUILDING OFFICIAL Revised 8.2015 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLAT\MIG 688-9535 The Commonwealth o Massachusetts Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2 017 www.mass-gov1d1a Workers'Compensation Insurance Affidavit:Builders/Contra actors/Electricians/Plumbers. TO BE F11LED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly NaMe (Business/Oiganization&dividtial): as !c Address: _ City/State/Zip: J'�,,)v Pholle#: -s I 2 Are yo a an employer?Check ffiIc app'ropriate box: TypeOf project(required), .I.[]Iam.aemployer with employees(full and/or part-time).* 7. []New construction 2.[Almn,a sole proprietor or partnership and have no employcesworkfirg for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. F1 Demolition 3.[J I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 ( 'wilding addition 4Q lam a homeowner and will be hiring contractors to conduct all work on my property. lwill ensure that all contractors either have workers'compensation insurance or are solo 11 Electrical repairs or additions proprietors with no employees. 12.FJ Plumbing repairs or additions 5.n lam a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.F1 Roof repairs 'fhes'esiib-contTactor's.'n'av:p employees and have workers'comp.insurance.1 . , 9- , 6.QWe are a coiporation and its office,rs have exercised their right ofexemption per MGL c. 14.0 Other 152,§1(4),and we have ijo.employeep.[No workers'comp.insurance required.] .1 . . . . I *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. Homeowners who subn1if this affidavit indicating they are doing all work and then hire outside contractors iflust submit anew 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 �., rs� .• tl 11. '.1 , 1 .1 1 . employees, If the sub-c6fi�acf6 avo employees,iliey must provide their workers'comp,policy number.' I arra an employer that is piavidlhg workers'eomp ensation insurance for'my emplbyees.'Below is th epolley and job site information. Insurance Company Name: Policy#or Self-ins,Lie. Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' cbmpepsation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MOL 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 afine of tip 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. filo lierebycei-tifyunder'tlzepaiiisandpena les oJF'peiYuiy that the inforinationpro-pidedabove is true andcorlect < Sign Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: PermitUeense# Issuing Authority(circle one): i 1.Board of Health 2.Building Department- 3.City/Town Clerk, 4.INlectrical Inspector 5.Plumbing Inspector 6,Other Contact Person: Phone#;