HomeMy WebLinkAboutBuilding Permit # 9/14/2016 BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received 44T
Permit05
No#:��.
e4 zely
Date lssued:02
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coml 49e
TANT A
-44, 21
LOCATION
Print
PROPERTY OWNER 16 i yes no
oo Year Structure
Print istoric District yes no
MAP PARCEL-,ZONING DISTRICT:--H
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Non- Residential
Residential
0 0 i?e family U Industrial
�
0 Addition wo or more family [i t Commercial
lrieration No. of units:Assessory
Others:
pp 0 Bldg
eair, replacement
D Demolition Li Other
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ae
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DESCRIPTION OF WORK TO BE PERFORMED'
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e ti.ficam Print ClearlY
t.Q) Prilease ype or
P Phone
OWNER: Na me 11'y'10
Address:
Co
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tra
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or
Name:---- -
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Phone:
Email:
Add
Supervisor's Construction License"
Exp. Date
Home Improvement License: Exp Date:
_—
-
ARCH ITECTIENGI NEER_ 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.
%, FEE- $
Total Project Cost- $ :>�, , - --e 4�
9 o oa—
_%�---Receipt No.:
Check No nty.fund
N'OTE: Persolis contractiO wit nregi,�er'�d con"Ctors do not h ve tiecess to the guara
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Town o _ 6
ndover
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BOARD OF HEALTH
PERMIT T D
Food/Kitchen
Septic System
THIS CERTIFIES THAT ...4� L.` ....11 ;�j�C.� ,/�/ ....................................... BUILDING INSPECTOR
has permission to erect.......................... buildings on .... �...,... Foundation��.
Rough
tobe occupied as .....� ,±...Qxwwo .......... ...� ,. ,,............,....................................... Chimney
provided that the person accepting this permit shall in eve 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 CONS T TI® Rough
Service
... ..... .. ... ... ..... .. ....... .............. Final
BUI G INSPECTOR
GAS INSPECTOR
Qccu2ancy Permit required to 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
:0 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 LIC13ME EXEM13TION
BUIDING PEWMIT APP11CATION
Please print
DATE:
-------------
Y,
c
JOB LOCATION: C �)u� h e�) j
Number Street Address map/Lot
Y"n
ER
140MEOWN
Name Rome Phone 'Work Phone
,
PRESENT MAILINU ADDRESS 0--)
City Town State Zip Code
The current exemption for"homeowners"was extended to include owner occupied dwelfitigs of one or two family
dwellings and to allow such homeowners to engage an individual for hire who does not possess a license,pEQyi&q I
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 CNa
Section 11 O.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.
C
HOMEOWNERS SlGNATUA&A, �1
APPROVAL OF BUILDING OFFICIAL
Revised 8.2015
Form Homeowners Exemption
BOARD OF APPEALS 638-9541 CONSERVNFION 689-9530 HEA.U171.1 688-9540 PLANNING 683-9535
AMC
Sales: 800.448.3636
Phone: 804.271.2363
NEx,r GENERM"110N Fax: 804.743.7779
S'l 0RMWA'1'.F'.R MANA.(I'l�,.Ml,"N'.I' SOI.A,,Jl.'IONS acfenvironmental.corn
LET'S GET IT DONE
Site Development and Retrofit ® Low Impact Development 9 Green Infrastructure
FOCALPOINT(high flow Wofiltration) RJANK(rrimiular subsurface storage) PAVE DRAIN(paving,drainage,storago.) IWCO(decentralized treatm ant)
............
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' The Conamanivealth ofmassgx kus'etts
D_,pa-rftUeajj off'' i �t zr l E(cctc�c t
.1 CoBmess'Street, SUte 100
MA 0,2114-2017
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APP
iieant.h-foxmation lease print Ge> b1
NaMO (F3-mzmess/Dxg at-ionffudivzc3na7.): 4 _.
dcres: _ .
City/State/zip:
Axe you an.employer? Check Type of proje(EL(rgcZuix'ird):
1.�I am a amployervitlz _..�employees(lull and/arpaz-time)' 7, Now coristructioR
2.Tarrcasole proprzctorarparinarsbipandhavenoeanployeesWald zzgformein 8. R.emodelffig
any capacity.(No workers'comp.insuranca racluirad,:j ernolition
3.LXIamahomeownezdoingallwozk;rnysel�JNovwazkers'comp,-imarancezecluircd.]! 10Builc� gaddition
4.F-1 I am a homcowner ar la will be hiring contractors to conduct all-work on my property. I will
11.E]�+,lactaxcal re airs or additions
ensuro that all corziractors eithor have workers'coznpansation
in an Gr orare sole F
pr6b'ietors withza.o einplayees. li,Q Plumbing xepaixs or additlon:s
S.E]IaMaganeralcoptractorand lhagehiredtbesub-cantaators listed ontbeattaehedsheet. Z3 '� oo 'epalrs
These suh-confracforsliade Pfxiployees andhaveworkers'comp.insurancc; 14.El Oth z
6.0 We are acorporatiom pact 4q pf ftcorshave exercised their right ofhxemption perMCrI,c.
152,§1(4),audwehaeer}c!. aploye?s.[t7owarkars'comp.insirraracerequized.l 4-Any applicantthat cheok:sb&41 ran a1,alsofdl outfha s5ationbalowshowiugtheizworkers'0ampensati0npolicyinfannatrosr.
T Homeovmers-,,ho suB6ifkbk affidavitindioatingthoy are doing all work andthcabire outside contractors must siiraitanew affidavit indicating Stroh.
TConfractors bat Check f fi boK must-4gechea an additional sbect showingtha name of The sub-oantractors and Attate whether orpoiithasa enti'des have
r. • p'policy
employees.Iftho sab-con�Za c cors}lave emplayees, icy mnsi provide their workers'aom clic Wombat. _
i acre crrz erriplayer t7xat as pi�ovidfi%gworkexsl eoln.peimation insu�ancefor rrzy ernploye�s.'Belottr zs tliepolic�andjoZ�s'zte
i-nforrrtation. .
Ins-trance
Policy#ox Self-ins.Ii a. �__ L+ pitation Gate: _
T(5b Site Address: ----
Attac-h a copy ofthew orlxers' co:aa eMationpoliey declaxafion;page(sbowh.tgtbepol cynrinzbex'and expi-ratzoit daze).
pailan:e to securc coverage%as jequixoda,mder MCGL c. 152, §25.x.is a criminal.'vxolatxon punish ibla by a fine up to$1,500.00
and/or Onc-•year.•imprionnaen:L,as'well.as civil penalties in,-the form of a STOP-WORK ORD193.and a.fim of-6-P to$250,00 a
day against&u-violator.A,copy offiis statcn33cat may be forwarded toffie Offico of rnves-tigations o1'the1):CA.liar instr:raracc
coverageverification. - -
X rXo Aereby y U21& _ pains cl pr�aities of��eJj�ry Haat the informatioxz lir o7rirler�ab ace is,trzi e�cl correct
Si a;t •e. �,
1 hone f t:
Official we only. _vo-j.ot-pvr'ite in this area,to be cONPZeted by city or toofftcial
y ax Town: �__ _._� ermsL/Ltcezr e#
Cit3 —
Issrzingkathorzty`(circle one): ' d. �Xectxzra:C tns ecfor 5. C'laxarabiza lags.c cica c
.C.TSoar(iofI e,,iRTA . rxiZdiszgJ�epaxtrxaenE 3.C%, I'['awn CZer p g p,
Ci.Otb.ex.'
Phone