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Home My WebLink AboutBuilding Permit # 5/16/2016 %AORTH BUILDING PERMIT 0:D, 16 TOWN OF NORTH ANDOVER go 0 APPLICATION FOR PLAN EXAMINATIOR'' Perm!tNo#: Date Received parva Date Issued: IMPORTANT: Applicant must complete all items''onfl&page LOCATION Print PROPERTY OWNER V0106 elt 1/ Print 100 Year Structure yes no MAP -PARCEL: ZONING DISTRICT:-Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Re *dential Non- Residential 'a Li New Building One family 0 Addition 0 Two or more family 11 Industrial ,dAlteration No. of units: [I Commercial 0 Repair, replacement El Assessory Bldg 11 Others: El Demolition El Other vv /44 1 1 afi/9 ttio DESCRIPTION OF WORK TO BE PERFORMED: R C11)rN,6 OWNER: Name: Identification- Please Type Phone: e or Print Clearly X 7' , Address: VIV)cn Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp.- Date: Home Improvement License: Exp: DatA-_*-.,:-., ARCHITECT/ENGINEER Phone: Address: Reg.,:Np FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED C0ST`SASE%0X$125.00 PER S.F. Total Project Cost: $ FEE: Check No.: Receipt NOTE: Persons contracting with unregistered contractors do not havddccess_,to,*-the guaranty and Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan Stamped Plans D TYPE OF SE7XURAGE DISPOSAL P" Public Sewer El Tanning/Massage/Body Art ❑ vinuning Pools El Well n El Tobacco Sales El Food Packaging/Sales 1-1 Private(septic tank, etc. El Permanent Duropster on Site F-1 THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM LANNING & DEVELOPMENT Reviewed On SignatuJ�L)" 646, 7� �0 COMMENTS— N XoNSERVA.TION ignatureReviewed on S , nature COMMENTS L 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 Connectionis Permit DPW Town Engineer: Signature: Located 384 Osgood Street PREEMPARTMENT -,Temp Dumpster onsite yes no,. Located,at"1,2+Main Street, Firb,,I)epprtitehf,s"ig'nAture'/d' 4te COMMENTS ®RTI Town ofAndover ,.' �' I to �, ver, ass, ® LMK� 1. COCKIC P6Q WICK � U BOARD OF HEALTH PER T LD Food/Kitchen Septic System M THIS CERTIFIES THAT .. ........... ..... BUILDING INSPECTOR ......................................... ...... ........ ... .......... ............. Foundation has permission to erect.......................... buildings on ..... ... ......... ........ ......... ......:.... ............::: Rough tobe occupied as ....... ............................................... ............. Chimney provided that the person accepting this permit hall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Lawns relating to the Inspection,Alteration and Construction of Buildings in the Towyn of North Andover. PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT ELECTRICAL INSPECTOR CONSTRUCTIONUNLESS Rough Service <<��?........................ ..... ................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Bu Rough Display in s Conspicuous Place on the Premises — Do Not Remove Final Lathing r Dry Wall To Be one FIRE DEPARTMENT Until Inspected and Approveda uil in Inspector. Burner Street No. Smoke Det. (,7 'o\-n ok000� E X 012 C 13 c q7 lv\occ S -r 1�8 ove M ,� 55 30 � 37' eAve-C Wi[Kuji ---------------------- �� St 3 r 30 Flat j"Per ion+ i MOA 5 t �J ------------- --------- [,2fcCkg X) Aa coocoefe- , 5°'b25 i j � I � I I _ ns lo0 0 lnl `ft I � paq 65 MA Qo throvyh /3c,( f at '1 —IXIO X( ( ?1jotS 35 3 - � JC) X / � � xt � ' - a10 xlox Pt /' 3-eawv) �2ylcx Pt Oxy„fit �sT x10 1� TOI st J S e 2-0k IQC) 8/33 O r� S O(l,�4 T cJ��,s w i t� �✓(�S T �l �i C �e�'� y� ��-P �Xy Top cA p decL/c""i ivA w1� lvi4('zeIV(4rIS, 5 60 5� X' a+'h 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 BUIDING PERMIT APPLICATION Please print DATE: JOB LOCATION: 0A o oJ Number Street Address Map/Lot HOMEOWNER 6")- Name Home Phone Work Phone PRESENT MAILING ADDRE S S 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 shall not be considered a homeowner. (780 CMR Section I I OR5.1.2) 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 The Commonwealth of Massachusetts 5 Depar°tment of Industplal Accidents X Congress Street,Suite.100 :' ?k Boston,M.A.02-114-2017 sv�y�Wt www.rnass.gov/dia Workers'Compensation Insurance Affidavit:)Builders/Contractors/Ei*triciansffllumbe:rs. TO B,]MEED WITH TTI,P-L,RMTTTING AUTHORITY. Applicant Information Please Print Le0b Name(Business/Organization/Individiral): (w " ..vV.`A,. .Address: LA- O.A C. ' r° 0:.Jt ,:._ .° Phone#: City/State/Zip: tyre yon an employer?Check tlie appropriate box, 'Type of project(required): 1.❑1 am aemployerwith einployees(full and/orpart-time).° 7. F1 New construction 2,E]1 am a sole proprietor or partnership and have no employees working forme in $, El Remodeling ny capacity.[No workers'comp.insurance required.] Demolition am a homeowner doing all work myself,[No workers'comp-insurance zequu�ed,]t 9. L] lgEllara a homeowner and will be hiring contractors to conduct all work on my property. Twill 10 F]Building addition• ensure that all contractors either have workers'compensation insurance or are sole 11.C1 Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.E]T am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 13.r!Roof re ai's These strb-contractors have employees and have workers'comp.insurance. r 6.E]We are a corporation and its,officers have exercised their right of exemption per MGL c. 14.0 Other '" 1, ` 152,§1(4),and we have no,employees.[No workers'comp,insurance required.] , ,r:. . , `Any applicant that checks bo'x 4l must also fill out the section below showing their workers'compensation policy information. t Homeowners who sdbriiiti flus affidavit indicating they are doing all work and then hire outside contractors must 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 havo ('mployees, litho sub-rorilractors)rave em,2loyees,iliey must provide their workers'comp,polio,nu_nber. X am are employer drat is Pio Wing worker's'compensation insurance for-racy employees.' B'eloiv is the policy andlslob site information. Lisurance 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 coverago as required iuider MGL e. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisomnent,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office offivestigations of the DTA for insurance coverage verification. X do hereby certify under the pains andpenaltres ofper,jury Haat the information provided above is trice and correct. Signature: r r � �,� n. . _i Date' .. f ... Phone#: C i •.. 3 0 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Flectrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: