HomeMy WebLinkAboutBuilding Permit # 9/8/2016 BUILDING PERMIT �o►�rN
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TOWN OF NORTH ANDOVER 3
APPLICATION FOR PLAN EXAMINATION
Permit No#: Date Received `ls
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Date Issued:
I PORTANT: Applicant must complete all items on this page
LOCATION i- �J I
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Print,
PROPERTY OWNER JC d'1 L0Lz_)Sk(
Print 100 Year Structure yesLno
MAP PARCEL: / ZONING DISTRICT._ Historic District yes
Machine Shop Village yes
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ROne family
❑Addition ❑ Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
dkepair, replacement ❑ Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
D Se tzc11alell ✓ w ❑ FloodpJam ,u ®Wetlands ❑ 1111atersed DstncjL:s
F i ,,. s� ! c � 1'F ✓,✓'c' c r � -- r ',s: ,U c4 " � .-c�a' �--'�.-..-c.%.,Y�E:w .�rrz 'a�%s'-`-���'���,�,�✓�'`�.� ^�'�� '�,/ �:
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DESCRIPTION OF WORK TO BE PERFORMED:
ROL Lot'
Identification- Please Type or Print Clearly
OWNER: Name: Phone:
Address:
Contractor Name: Phone:
Email:
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
ARCH ITECTENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$15.00 PER S.F.
Total Project Cost: $ O FEE: $
Receipt No.: 1
Check No.: p
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
SORT"
Town o 5 ndover
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No. 9w.7017 * ��
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U BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
THIS CERTIFIES THAT .............. .but .. ,�! .... ..... ,. .. BUILDING INSPECTOR
..... .... ... ..... ..
•
has permission to erect .......... buildings on ..� ..... .. ,�, A&%4...... Foundation
.� 4W...��. .� . � ..�..010111 `.. ............. Rough
to be occupied as .......... ... .................................................. Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application Find
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 CONSTRUCTIO T T Rough
Service
... ....,. ..... .. ..... ............. Final
B IL G INSPECTOR
GAS INSPECTOR
Oeempancy permit Required to Oecupy„Building Rough
Display in a Conspicuous Place on the Premises a Do Not Remove Fina`
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke pet.
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:q(z h (,
JOB LOCATI.ON: I� ! (. )c f C�� nuC'
\ Nuzxrber Street Address Map/Lot
H{)1VIE{flWNER 1'kD`y`,i`i G 7 g
Name Hoare Phone WorIc Phone
PRESENT MAILINQ ADDRESS
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,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 CMR
Section 110.R5.1.2)
The undersigned"homeowner"assumes responsibility for compliance with State Building Code and other applicable
codes,by-lavas,rales aid regulations.
The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department
minhnurn 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 638-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
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Sob Site Addxess: CxtY/Staff e/Zip:
Attach a COPY of ev a &exs'coxupe sationpoIzcy cTce axalionpage(show
ingthepoRcyn.-a:mbex and e�p�a Da c�a�e}.
Fazlure to secure cov&aga as rcgUh0d und0rMGL c. 152, §25A is a cximinol violation prmishsble by a ire up to$1,500,00
az d/ox ore-yaax imprjonment,w well as ei�punafes i the i?onn of a STOP'WORK OTD R ar,c1 a na a up to$25(}_00 a
day agaiust the violator.A copy Oflhh statement may be forwarded to tha Office oflnvestigati6us OftheDfA foxinsaranae
coverage verztxoatloxz_
t1°/ierel�y eeYify ueN i]ie prciras and aperjx yliaze the iraforr�ztcti°rt p oVirlecZ ° is (p G e° f eco
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Offxczal ease only. Da notwvrze zn thzs area,to die corz�preted by city ar tawr�officza�
City or` OWDa. i2ez /�xcezzse
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