HomeMy WebLinkAboutBuilding Permit # 7/27/2016 ft
BUILDING PERMIT ,raRr
TOWN OF NORTH ANDOVER a
APPLICATION FOR PLAN EXAMINATION _
Permit No#• e rG-�
Date Received ��sS CHUS���y
Date Issued: Z-iL Z40-1 11-P I
IMPORTANT: A Iicant must com fete-all items on this page
LOCATION. I . KIJA
°
rint
PROPERTY OWNER 'W11
tint 9 00 Year Structure yes no
MAP PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Re ' ential Non- Residential
❑ New Building One family
❑ ddition ❑ Two or more family ❑ Industrial
Alteration No, of units: C7 Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic. ❑Well ❑ Floodplaln ❑Wetlands ❑ Watershed Distriet .
Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
t`tcatio - ase Type or Print Clearly
OWNER: Name: Phone: .�
Address:
Contractor Name: A Phone:
Email:
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECTIENGINEER Phone:
Address: Reg. No.
FEB'SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125,00 PER 5.
Total Project Cost: $ FEE: $ --
Check No.
44r) Receipt No. ,-,;o
NOTE: Persons contracting wi unregistered contractors rho not have access to the guaranty fund
NORTpl
Town of 2Andover
No.
z
p h ver, Mass,
TL 2&2AI�
�!- coc"Ic"aw.c..
V BOARD OF HEALTH
Food/Kitchen
T LD
Septic System
THIS CERT11=1BS THAT .............. IQPERMIT
Q ...,��.,..Q Z.......... .. ........ ............ BUILDING INSPECTOR
has permission to erect .., ... .,. g „ „ ��,� �,,, ��� Foundation
..... ...... ..... ildin s on ... .,...... ,... ., .....,......
Rough
to be occupied as ........ ............. ..M+....,. . .�.. � .11A S.—U i ,Ije? al...IV. 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 t e Inspection,Alteration and
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 IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONS Rough
Service
fes- - _
... ....,. .. ........... 4iUILD61NNSPE�.�I OR Final
GAS INSPECTOR
Occupancy0ecypancy Permit Required to Occupy Buirdin 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.
Basement Finishing Plans for 67 Prescott St N. Andover MA 01846
Date: 07/27/2016
Rev: - r
Scope- nsulation, framing, drywall, drop ceilings fc U U �}
114" 72" 120"
.E
4
48'
Electrical Panel closet
Laundry Closet --
72"X38" "
c�
Bulkhead E
=
Door to
i0j Backyard
Room 1 ]
s ROOM 2 35X80" `
172" X 114" 142" X 120"
Drop ceiling height 83" Drop ceiling height 83"
lacy
_.
105r, columns 95'
72"
Storage
'_ Closet
Water clean-out closet �� �b' Door -
11 fl
c7� �7 30 X80
26" Storage Closet
42" M. 154" X 80"
Basement Stairs 80" window
From Kitchen2�„ Hot eater 31"X22°
111" X 42" - -_
aced wal)with.fi5 Prescott St
41;7 111 r, 154"
�2
TOWN DE NORTH ANDOVER
o R.m Zlu 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
BLIDING PERMIT APPLICATION
Please print
DATE: J 7
JOB LOCATION:
Number eet Address —7e Map/Lot
HOMEOWNER
Name Home Phone Work Phone
PRESENT MAILING ADDRESS CQ
. . ..........
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, i'ovided
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-ox two-family dwelling,attached or detached structures accessory to such use and/or Tann structures.A
person who constructs more than one home in a two-year period shall not be considered a homeowner.(780 CMR
Section l I0.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/he 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 688-9.539 HEALTH 688-9540 PLANNINIG 688-9535
n8 Commonwealth of Hassachusetts
z.. Department of fndustrialAccidenls
Z Congress Street,Suite 100
: Boston,MA 02114-2017
www mass.gov/dia
o Trexs'Co�npe safao usuranceA�dav�it:BZdiders/Contractors/Elect�rle�ians/P1uMbers.
TO BE MED VnTR THE PEPMTTING AM)IORM'
Apphcant irforrnation Please Print Le `bl
Name(jusiness/organrzation&dividual):
Address: (�
City/ tae/Zip: one
Ar'eyou an eniployer7 Checictlio aP1Iroprlaib hox: Type of project(.Tg' t'rtd):
1.❑I am a employervgth. empleyees(fall and/arpatt time).* 7, Q New co]istruction
2.E'I am a sole proprietor or partnership and have no employees working forme in &. KRem;odellft
any capaoity.[Na workers'comp.insurance required.] g, [ Demolition
3 I am ahomeowner doing all work myself~[ido workers'comp..iusumace required.]t 10 B��g addition
4. x am a homeowner and will be hiring contractors to conduct alI work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.[[Electrical repairs oradditions
proprietors withno employees. 12;0 Plumbing repairs or additions
5. I am•a general confsactor and I have hircd the sub-contractors listed on the attached sheet. 13.'[[Roof repairs
Thaw sub_coutractorsfia-0pinployees and have workers'comm.insurance.
14.E]Oilier
6.Q We are a corporation pd#q ofd,9ers have exercised their right of'exemption per MGL c.
152,§1(4),and we haverlgp oyees.[NP workers,eornp,insurance required.] .•
*Ally applicant that checks box 41 must alsaER out the section below showingtheirworkers'compensation policy information.
I Homeowners who submit j1vs affidavit indlcatingthey are doing all work and then hire outside contmetors must submit a new affidavit indicating such.
tContraetors that check thi box mu4EtttacJted an additional sheet showing the name ofthe sub-contractors and state whether ar not(hose entities have
employees, If the sub contracors`have empIayees,iliey moat prvgide flroir workers'comp.policy number.
parse an employer&at isproVidiizgtvoelseYs'compensation insue•ancefoP MY employees'Below is•thepolicy and job sate
inforlwation.
Insurance Company Name:
Policy#ox Self-ins.Lic.#: Expiration Date:
lob Sito Address: City/state/Zip:
Attach a copy of the Warlrers'coinpetisation policy declaration page(showing the policy ntambex and expiration.date).
Failure to secure coverage as xcquired tender MOL o. 152,§25A is a criminal,violation punishable by a fine up to$1,500.00
and/or one-year ianprisonment,as well as civil penalties in the foim of a STOP WORD ORDER and a fine of up to$250.00 a
day against the-violator•,A copy of dais statement may be forwarded to the Offfco of luvestigations of tho DIA for insurance
coverage verlftontion.
p do hereby certify un -tri ' ains and penalties ofpei juq that the information peovidecr abov is L7' e and correct.
Si afore:
Date: `
Phone#:
Official use onry. Do not ovate in this area,lobe completed by city of town offeciaZ,
City or Town: I'ermit/Lacense#
fssui ngAuthorit (circle once): i
1.3Board of Healt)4 2.Building Delaartment 3.CitylTown Clerk d.Electrical Inspector 5.Plmnbing Inspector
6.Other
Contact Person: Phone#: