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HomeMy WebLinkAboutBuilding Permit # 7/22/2016 VkORTH BUILDING PERMIT TOWN OF NORTHV PermitNO: APPLICATION FOR PLAN CAt11 aTICI ' . .. Received Bete Issued: ACHUS .P TANT:Ap2licant must complete all items on this page rint 'ROPE O`k ESI � ,,,„� C" .� . Print MAP NO: _ a C"" E.:�, C C IIVO 018TICT: Historic Oistrict yes no Machine Shop"pillage yes no TYPE:. OF IMPROVEMENT PROPOSED USE _ residential (ion-residential I l New Building _ ne family I:[addition ['I Two or more family [ I Industrial Alteration No. of units: [ I Commercial [:a repair, replacement I assessory Bldg FI Others: C-1 Demolition [:f Other Fu Septic i:_i Well 0 Floodplain F.1 Wetlands0 Watershed District i,JWater/Sewer i Cl( i � Identification Please Type or Print Clearly) OWNER: Name: Address: � t` ��'t.� �� ��'�.. ' CONTRACTOR Marne: Phone: Address: ' Supervisors Construction L icense: � p Gate: ;�� -1. i Home Improvement License.- Exp. Date. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project est: FEE.` W., Check No.: receipt No.: NOTE: Persons contrailing w, unregistere contractors coo not have access to the guarantyfund Signature of Agent/Owner '� __ _Signature of contractor 'Town of �DRTF$ 2 ndover ® - 0 ()IZ - 2617 h ver, Mass&- a6 Ito COCNICKS-ACK yry. SJ U BOARD OF HEALTH Food/Kitchen PER D Septic System THIS CERTIFIES THAT '�„ a BUILDING INSPECTOR .................................e.!!J...,.... ... ... .....,.. .,........, haspermission 1Foundation to erect,. ............... buildings on ..... .. ., .�.,...... ..... ... ............... . JAW JA ... . ..... .. ,. � Rough to be occupied as .... .. .................... chimney provided that the person accepting this permit shall in every respect co orm 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS p N Rough Service .. ...... .. ..... ....... Final UIL©ING INSP TOR GAS INSPECTOR Occupancy Permit Re aired to Occupy Buildine 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 .R OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 North Andover,Massachusetts 01845 Gerald A.Brown Telephone(978)688-9545 , Inspector of`Buildings Fax (978)688-9542 HOMEOWNER.LICENSE EXEMPTION. Please print Ff, DATE: JOB LOCATION:: 3 • . w , y f J Number Street Address Map/Lot HOMEOWNERA/ -k`fud -V(" ,�� ., Name Home Phone Work Phone PRESENT.MAILING ADDRESS— � S I1'7 'lla-s 1— %a�-1°1 /'�,nAwa allolc:��� ,v ,-i-LLua) _ City Town State Zip .ode The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less I and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor-} State Building (Code Section 108.3.5,1) DEFINITION 08 3.5.1)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 structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and othgr 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 an5l�Rat he/she will comply with said procedures and requirements. ff HOMEOWNERS SIGNATURE d APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homeowners Exemption 13('DAIdI)OF AI'"HALS 688.9,,541 C ONS@3RVA 1"1Q:YN 688-9530 III AI,"1`EI 688-9540 1'I,At` NId`96 689-9535 I s 9 ���lw if ���1�j aneawe,nwwrw�na« ��„ g V 4 � � 1 Z l "'"'"'•"�" '���� ....:PAS.. w,, E 4 n a Y r 41 911 The Commonwealth of)Wwaehusetts- Department of Industrio[Aeeidents a 1 Congress Street,Suite.100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TBB.I•U FILE,WVt TRTIIF PI;RM#1"TING AUTHORITY Annlicturt)` rfbrination --_- PfeagePr 4xL ily� Name (Business/Organizadon/Individual): A �to w A c. o Address: 3 S . , Ml] City/State/Zip: h �► /k e#: Are you an employer?Check the appropriate box: Typaof project(t egtsit:ed) I.❑I am a cmployer with employees(full and/or Part-time),* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. �Remodeling any capacity.[No workers'camp.insurance required.) 9. Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t IO❑Building addition I ante homeownef and will be hiring contractors to conduct alt..worleon my properly:.I wild 4,111%ensute thatall contmotors either have.workers'.compensation.insuranco or are sole 11.❑Electrical repairs or additions proprietowwittrno-employee 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 sub-contractors have employees and have workers'comp.insurance. 14.E]Other 6QWe are a corporation and its officers have exercised their right of'exemption per MGI,c. { 152,§1(4),and we have no employees.[No workers'comp,insurance required.] *Any applicant that checks box#t must also fill out the section below showing their workers'compensation policy infonnation. fiidameownemwho-submit-this-al idavit-indieating-they-are doing-all-work-and therrhirg vutsid centractorsmEist sus►nit newat davr iirnd€catirig sucG=- $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation hisurance fol'my employees. Beloyv is the polley and job site � information. Insuratrt;e Company Dame; Policy#or Self ins.Lic.A Expiration Date: Job Site Address: City/Statelzip: Attach a copy of the workers'compensation policy declaration}gage(showing the policy number and expiration date). Failure to secure coverage.as required under MGL 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 a fine of up to$250.00•x, day against the violator.A copy of this statement may be forwarded to the office of Investigations ofthe DLVfor insurance- coverage verification. Ido hereby certify under tl aims and penalties of peifusy that the information provided above is trite and correct t Signature: Date: 7` 'Z-'Z- Phone Z-Phone#: E5 72 w`I LCL_ Official use only. Do not ivr'ite in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): ; I, .Electrical Inspect r 5.Numbbig-J'EMISpecet(W— Other Contact Person: Phone M. C?�lec: iai�r�ia6�,rnerrlf�n �/1�r3 gr.�r{�eYYc 0fi zc ufCnnsunrer:.ffairs `Sr3sincss t2cguEaGoao 064E IMPROVEMENT CONTRAC.i OR 1 _ egistratic�r,: _^1'8259 Y �:"x�iratrc�rt .7I$,1Q17--.;� �nd��idual JASON�lA^1CHiNO 1 JASON BIANCFIENO - i,+ 209 LINCOLN ST#3 REVERE, MA 02151 - _ _- L�n[Jcrsecs'etarY