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Home My WebLink AboutBuilding Permit # 9/1/2016 OORTH BUILDING PERMIT rt=LI° TOWN OF NORTH ANDOVER ° � APPLICATION FOR PLAN EXAMINATI N Permit O � Date Receive up ` � saca+us�c Date Issued IMPORTANT: Applicant must corn Tete all items on this page LOCATION van 1 4 l ` �f- Pr' PROPERTY''OWNER ,40-4, � Print MAP O:&Yff_PARCELZONING DI Tfi I TI L Hist,or District y (( no M chine Sho illa e yo TYPE OF IMPROVEMENT PROPOSED U,9E _ -Residential Non- Residential El New Building 2 One family —.._ I I Addition I I Two or more family I Industrial ]Alteration No. of units: I:] Commercial ] I Repair, replacement I Assessory Bldg I Others: !-] Demolition D Other D Septic 0 Well D Floodplain 0 Wetlland�p D Watershed:District I-iWater/Sewer Identification Please Type or Print Clearly) OWNER: Name: r ` Phone: '�O- 941V .,.�� Address: . � "._._ .,w CONTRACTOR Name: Phone! Address: Supervisors Construction License: Exp. Date:, Horne Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ ew000 FEE: Check No.• �� ,�� Receipt No.: yy .d'_ �4'N IM NOTE: Persons contracting with unregzsteretf contractors do not have access to the giv ranty fund Signature of A ent/C)wner - µ signature of contractor O®RTH '� Town of s _ �.. 6 ndover 0 ? �+ No. P q ^K! h ver, Mass, [oc"tc" wKK y1. �,gs°RArea ►4a,6�(5 U BOARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THAT ....PERR�. T ....I:....... .... 'r � ...... ,.. R BUILDING INSPECTOR has permission to erect .................... . ... buildings on . + ... r ,, , ,,,, .,,,, Foundation .. Rough to be occupied as ..............411:16510 ...... �........ !M. A. .a............................. 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 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 LESS CS TION Rough V�EC Service "' Final BUILDING R GAS INSPECTOR Occupancy 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. 'AORT14 TOWN OF NORTH ANDOVER 1,90 #6 OFFICE OF 0 BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 Arlo North Andover,Massachusetts 01845 COS Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE:8/31/2016 JOB LOCATION:62 Wintergreen Dr 210/104 B-0194-0000 Number Street Address Map/Lot HOMEOWNER.Daniel & Caroline Armet 585-530-9844 Name Home Phone Work Phone PRESENT MAILING ADDRESS 62 Wintergreen Dr N. Andover MA 01845 City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less 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 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 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. 7 HOMEOWNERS SIGNATURE X APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homeowners Exemption BOARD OP APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers Compensation Insurance Affidavit:BuilderslContractorslElectricionslPlumbers. TO BE FILED WITH M P)u1 Nff 1"ING AUTHO1tI1` , Applicant Information _ Please Print Legibly NaMe (Business/Organization/Individual): Daniel Armet Address: 62 Wintergreen Dr. City/State/Zip: North Andover, MA 01845 Phone#: 585-530-9844 Are you an employer?Check the appropriate box: Type of project(required): LE]I am a employer witlr employees(full and/or part-time).* 7. ❑New construction 2.Q 1 am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp,insurance required] 3.Q I am a homeowner doing all work myself.[No workers'comp,insurance required.]t 9. ❑Demolition 10 Building addition 4.Q I am a homeowner and will be hiring contractors to conduct al[work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 1L0 Electrical repairs or additions proprietors with no employees. 12.®plumbing repairs or additions 5.Q 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'camp.insurance.t 6.0 we are a corporation and its officers have exercised theirright of exemption per MGL c. 14. ]Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant thatchecks box#I must also fill out the section below showing their workers'compensation policy information. #Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors mustsubmit a now affidavit indicating such. i #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 cnrployees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance far my employees. Below is the polley and job site information. Insurance Company Name: Policy#or Self-ins.Tie.#: Expiration Date: Job Site Address. City/State/Zip: i Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). i 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 foEni of a STOP WORD ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance F coverage verification. I do hereby cerci tiler the pains and penalties of per;jury that the information provided above is true and correct. Signature: . Date: /3/ 1 6- Phone#: Official use only. Do not sprite in this area,to be completed by city or town official. City or Town: PermitAWcense# Issuing Authority(circle one): ; 1.Board of Health 2.Building Department 3.City/Pown Cleric 4.Electrical Inspector 5.Plumbing Inspector b.Other Contact Person: Phone#: