The URL can be used to link to this page

Home My WebLink AboutPermits Permit # 6/27/2016 ao ":w+ w.-'rvi, 6A w.„,,:.,.,.,•ai, :rrmm,iiw .. � 4 ';5"s�1 8^ry-r� UILDIN PER IT .,. , ^ m , TOWN OF NORTH ANDOVER 0 � ,w APPLICATION FOR PLAN EXAMINA IO ; Permit NQ: "" Date Received Date Issued: l° 17 "1 u IRTANTo Applicant must complete all items on this page / 7 ER F`RCF' Rl"Y OWN M,AI' NO ,� I�AREL. : �` `i ,�'t�C11�+1 ► II: T11 , , I�lrst+�rN :l � tr'rt// � s ah�� ah+ p SII yrs ��ry� TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family TAddition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: Demolition ❑ Other ❑ Sdpti ❑1/1/ ll Fl acadpl in ❑;W I ds ❑'W er h d Di tri t [ 1Naterfer ; ,,. T Identification Please Type or Print Clearly) OWNER: Name: " , �� - �' ' Phone: '' Address: ��I'' ��_ ;r' a t le dues ' / / r u + '��trtlr , l9tf o„ ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.,$1200 PER$'1000.00 of THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ Ji o'05`0 FEE: $ Check No.: iii Receipt NO.: NOTE: Persons contracting with unregistered contr ctors do not have access to the guaranty.fund ° AAl Signtureof Agent/Owner gnature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer 0 Tanning/Massage/Body Art ❑ Swinuning Pools Fj Well Tobacco Sales Food Packaging/Sales 0 Private(septic tank,etc. Permanent Dumpster on Site D THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVE LANNING & DEVELOPMENT COMENTS UA I L KLJLU I ED- VLU CONSERVATION 4 V COMMENTS DATE REJECTED DATE APPROVED V rEALTH TI' ❑ C COM OMMENA to/ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature&Date Driveway Permit Located at 384 Osgood Street ........... to 7777 ''777777 VON, t%ORTH Town of2 ndover 0 ® Opl �p Zh ver-, ass, O • LAKE 1 CHICHI-1c it A°RnTE® P ,�C2 � U BOARD OF HEALTH Food/Kitchen PER IT LD Septic System THIS CERTIFIES THAT BUILDING INSPECTOR ..... ........ ... . . Foundation has permission to erect .......................... buildings on ..... .. ..........L .. .. ........... to be occupied as ... ' ..... .. ........ Chimney Rough p ....... ... ..... .. ..... ®. ...&WWJ.."bft-nkt1 .... ney 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 e I pection,Alteration and Construction of Buildings in the Town of North Andover. feru& tck 4 PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final MONTHSPERMIT EXPIRES IN 6 ELECTRICAL INSPECTOR UNLESS CONS T Rough Service ~ ........... . .. ....... ........ ........................ Final I BUIL ING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® 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 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: 0/0—,Og, JOB LOCATION: � S L P,& . Number Street Address Map/Lot HOMEOWNER fA `j,6 q r) D Name Home Phone Work Phone PRESENT MAILING ADDRESS ,�j - �,000-(z- City Town State Zip Code The current exemption for"homeowners'.'was extended to include owner occupied dweiiings 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 C!YIR 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 and requirements and that he/she will comply with said procedures and requirements. /1 HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 8.2015 Form Homeowners Exemption BOARD OF APPEALS 688-9541 COrSERVATLON 688-9530 HEALTH 683-9540 PLANNINTG 688-9535 The Commonwealth o,f Massachusetts Depariment o,f IndlustrialAccidlents d .l Congress Street,Suite 100 - '< Boston,M4 02114-2017 www.mass.gov1d1a Wovkers'Compensation Insurance Affidavit:Builders/Conttactors/E lectricians/Plumbers. TO BE, FILED WITH THE PERMITTING AUTHOMY. Applicant InformationJJ please Print Legibly Name (Business/organizationll-idividual): ke 1 ST f .Address: L{; Sq , City/State/Zip: A,,i qac e!✓ , MA blgt1J Phone 01�-q Areyon an employer?Checktlie appropriate box: Type of project )Vequired): 1.❑I am a employerwith i employees(fulland/orpart time).' 7. Q New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. RRemo deliYig any capacity.[No workers'comp.insurance required.] I❑I am a homeowner doing all work myself,[No workers'comp-insurance required.]i 9. ❑Demolition 10 ❑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 ILE]Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ � 13.[]Roof repairs These snb-contractors have employees and have workers'comp.insurance. 6.[]We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§i(4),and we have no,employees.[No workers'comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers 'compensation policy information. homeowners who snbmititlris affidavit indicating they are doing alt work and then hire outside contractors must submit a new affidavit indicating such. tConiractozs that check this box must affached an additional sheet showing the name of the sub contractors and state whefher or not those entities have employees. If the sub-oo. actors fiave employees,:�tiey must provide their worlters'comp.policy numbEx. . I ain an employer that is providing workers`compensation insurance for my employees.'Below is the policy and'fob site information. Insurance Company Name: Policy#or S elf-ins,Lic.#: Expiration Date: fob Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration(late). Failure to secure coverage as required under MGL o. 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 WORD 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 of Investigations of the DIA,for insurance coverage verification. I do hereby certify un der the pa•ns andpenalties ofpeijuiy that the information provided above is true and correct. Sign o: �' / Date: Lilt,/ 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Or 140,00) 5 db Building Setback APPROXIMATE APPROXIMATE EDGE OF Line WETLAND AREA PER TOWN GIS MAPS. LOT AREA .04 0 44,603 S.F.± 0, 163.6' IP \FND Shed / Approx. Septic- APPro, 0*t ol (j) \'01 �� G\5 0' '- Tank Location Septic, 1`�O0A �,Esk /LeachlP U, Ex. Debk-,Io ngl 0� / Field N -1 �&E 1> be Remove Location CO 0-, k -,4, (� Prop. Deck Ex.-7DMk' to C"C I4 be Removed Prop. Screen Porch Ex. 1' DH 19. E-'( OverhangZONING INFORMATION: . 2 Stor34, FND N Wood Frorny ZONING DISTRICT : R1 7, 1 11 Structure e MIN. BLDG. SETBACKS: 1.23"' FRONT 30 FEET SIDE 30 FEET to Ex. 1' 41.2' REAR 30 FEET Overhang ASSESSOR INFORMATION: MAP 105D PARCEL 113 81.9, 7 DEED REFERENCE: 0 ..... IP BOOK: 9935 PAGE: 156 FND OWNER INFORMATION: MICHAEL & KRISTI HALE 15 155 (DEED� 37 ' 45 LACY STREET DHD N47'45'10"E NORTH ANDOVER, MA 01845 FN 0 LACY SMEET PLOT PLAN OF LAND 114OF #45 LACY STREET PM NORTH ANDOVER, MASS. "OF PREPARED BY: JOHN D. SULLIVAN 111, P.E. CODP.O. BOX 2004 .41 No. WOBURN, MA 01888 i 0 .-T (781 ) 854-8644 IONAL SCALE: 1 "=40' DATE: 6/16/16