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HomeMy WebLinkAboutBuilding Permit # 8/2/2016 000Th BUILDING PERMIT" pF��Len TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 'JA - Permit No#: Date ReceivedppoR arEo� ,i � �1CHt15� Date Issued: - -� IMPORTANT: Applicant must complete,all ztems on this page LOCATION. Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes , no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition V'wo or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement- ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well . D Floodplain ❑Wetlands ❑ Watershed District Water/Sewer DESCRIPTION OF WORK TOE PERFORI>I D: Identification- Please Type or Print Clearly OWNER: Name: i � Wn•v A-vd� e � ,'V Phone: Address: ' '� � �� /V 0P_ Wove Contractor Name: Phone: � 1 Email �/ Address: Supervisor's Construction License: Exp. Date:_ fLa C�z Home Improvement License. 4z 17 Exp. Date: 0 ARCHITECTIENGINEER Phone.- Address: hone:Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER SF. Total Project Cost: $ c FEE: $W w Check iso.: Receipt No.: NOTE: Persons contracting with unregistered�ontructors do not have access to the guaranty fund N®RTH Town of t s ndover 0 No. �p - «K, h ver, Mass, 6z' �D CDCH1C"zwjCK y�' 4�RRTED )4'? S V BOARD OF HEALTH Food/Kitchen PERMIT L D Septic System 417 J11 THIS CERTIFIES THAT ., .�.. t ... ,,L►,r ,..�. /.. ............... ............THIS INSPECTOR has permission to ere .......................... buildings on ...... .... ... ....P. .................... Foundation ��® Rough to be occupied as . .. �. r.✓....... ........ ....,... L............................ Chimney 2411provided 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CON TI T Rough Service .. ...... ........... ................ ...... .,.,,.. BIJILDI INSP CTOR. Final GAS INSPECTOR Occupancy hermit Required to Occupy By 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. The Commonwealth of mass chnsetts Department of IndusirialAceldents 1 Congress Street,Suite 100 = ,d Boston,SIA 02114-207 , `h www.mass.govldia Wog;kers'Compensatio)i Insurance Affidavit:Builders/Contractors/El ectricians/pl-ambers. TO BE FILED WITH Tim PERMdTTING AUTHORITY. A :CantInfo3rmation Please Print Ie b7 Name, (Business/oxgauizatioWbdividual): a N !' Address• Z,�r c City/,State/Zip: &1)12 4 O t 16- Phono#: 33 �[ Are yatr am employer?Checktfie apr' . ' Type of project(rgquired): opriafe lrox: I.[]I am a employer with employees(full and/or parC Hine).* 7.- [I Now construction 2\0' I ant a sola proprietor or partnership and have no employees working for me in $. Remodolttig y capacity.[leo workers'comp.insurance required] g. ❑Demolition 3. lam a homeowner doing all Work myself-[No workers'comp..iusuranae required]T 10 ❑Building addition 4.E]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 X 1. Electrical repairs or additions prdpirietors withno employees. 12;n Plumbing repairs or additions 5.L]I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13_•D Roof x'epairs . These sub-cont[aotorsliaYe eitiployees andhave workers'comp.insivance.t 14. Other 6.❑We are a corporation and its of5ers have exercised their right of'exemption per MGIC o. 152,§I(A),and we have IP"mployees.[No workers'comp.insurance required.] 7- • • °s' - Any appiicanttbat checks b6x#1 miust also M out tha section below showing their workers'compensation policy informMiom T Ilcnteowners vbho s0iiiiiflUs a£,fzdavit indicatingthey are doing all workandthen hire outside contractors must s4braft anew affidavit indicating such. tContractors Pat check this box must•Attacan additional sheet showing the name of the sub-contractors and state whether or not those entities Dave employees.•Ifthe sub-coriiractars hate employees,itiey Muit provide thoir workers'comp.policy number. X am an employer that is piovrding'workers'comp ens adOH insurance for'MY employees.'Beloit/is the policy acid job site information. Insuranco Compaay Name; Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compepsation policy declaration page(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 dup to$250-00 a day against the,violator.A,copy of this statement may be forwarded to the Ofrce,of Investigatlons of the DIA.for insurance coverage verification. 1-do hereby certify under the pal s andpenalties ofpet jury that the information provided above is true ar<d correct. Si afore: e Date: © �/ Phone#: e/ze) Official use only. Do not-write in this area,to he completed by city or'town official. City or Town: I'erznitlLicense# Issuing Authority(circle one): i 1.Board of Health 2.Building Department 3.CitylTown Clerk 4 Dlectrical inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 1842HO 1542HO i - - r 1 tie� 55 Gross Sector 5 O x H m - O x ATTIC 3b'-01, x 181-a° I l 1642HO *42HO q and 00 g� �_ h Building new stairs to the third floor ---New kitchen o Renovating existing bathroom Babe q`-1 1511b iWHO OF - KITCHEN - 13'_5"X T-10" ENTRY $A 8, 1 E,X 3'-q,, -b"X b 11 UTI ITY BEDROOM 11`-b"X 10'-1" yg HALL Adding new bathroom 10'-5"X 4'-2" IIW� z ,Ease seas TH GLQ,SET "X 2.-3.. LIVING Adding new bedroom 15`-5"X 21'-q" ry BEDROOM BEDROOM 11'-b"X 11'-2" 151_2"X 11'8" na55F+o ross,o 3assHo LIVING AREA 1284 50 FT �1,1d o N -�1 11 5,� PoorL �eee ee3allo �r „ OF �ae«o aosa�«v 7TGHEN o , 11'-7 1116" ,! BATH ZZ;9 3'-b 71161, T-1 112" o _ m BEDROOM X 10'-3" zt SATH , imrF BEDROOM z IVING r 13-5"X 24'-6" BEDROOM KITCHEN 9'-1"X 13'-6" m LIVING 23'-11" 14'-b" s aiossNo za�a�+o naa 7assNo Saa,f+o LIVING AREA 1521 50 FT 1 I I in �I I UTILITY E BATH I m m N g m `? Js� m m m m m 16`-2 112" 4T-7 o o 31'_1„X 19'-3" PLAY ROOM i ,i- i 16-2"X 14'-3" A, � 355 f ,.. 9d1tH0 t 3'-3 112" 3'=3?116"i 24'-21116' 12'-1 518" T-4 3i8" LIVING AREA 1521 5Q FT