Loading...
HomeMy WebLinkAboutBuilding Permit # 8/30/2016 �l O R TH BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Prnifi Nn#• Date Received er �SSacwuS�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION /iDA S (6` 6 — Print PROPERTY OWNER LE-C ! Print goo Year Structure yes no MAP A '�6r PARCEL. 2– 3 ZONING DISTRICT: Historic District yes no Machine Shop Village yes n TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑ New Building ;?6ne family ❑Addition Li Two or more family El Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg [3 Others: ❑ ❑ Demolition ❑ Other Se tc , Well A Q Floodplain ❑Wetlands Watershed District f / - r' ✓f ` ,: ,r^ 6 U D .;.... ..,...fes,( ti;:.�'f. �..;.,.�.�� - 4 ��"'.- sw..... � r^`. . DESCRIPTION OF WORK TO BE PERFORMED; RcAIMIT- Identification- Please Type or Print Clearly OWNER: Name: LG- C G K�-+ Phone: Address: ] (� ()t,) I� 1 64 . �O L 4,10 Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date- ARCH ITECTIEN GIN EER ate:ARCHITECTIENGINEER k � Phone: Address: Reg. No. FEE SCHEDULE.,BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBASED ON$125.00 PER S.F. Total Project Cost: $ 660 FEE: $ Check No.: Receipt No.: � NOTE: Persons contracting with unregistered contractors do not have access to the guaranty,fund k NORTF� '4 Town of .� _ a,. 6 ndover o w• 0 ver, Mass, 4019 170 ZO COCMF[.It WIC tea,t�C� S U BOARD of HEALTH Food/Kitchen PF. RMIT T LD Septic System THIS CERTIFIES THAT ........4a....r. ......S..,t . ..� .................................. BUELDING INSPECTOR has permission to erect .......................... buildings on ....40..i......... Foundation ���.� Rough to be occupied as .� ..� !!'!�L�!! .� / . ......�.'Cleo**6.040..................... Chimney provided that the person accepting this permit shall in every respect onform 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS C® STRUC I®N ST Rough Service ... P . . .. .... Fina[ BUILDING INSPECT �] g g GAS INSPECTOR J Permit Limit Red]uiref.��p to Occupy Bu ldin Rough Display in a Conspicuous Place on the Premises — 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 Det. The Commonveazlth of.IV.Xassc CAUSeds . x Department OfIndustrialAccidents _ I Coyagress street, Suite 100 ooston,HA 02114-2017 W0? Beers?Comp6nsatioxoLinsurance Af:fidavit:Builders/Cozy.tractors/FIeetx'Iczaxts[Rlumbers. TO BE MED'WITR T-GE PERMTTJNC AUMORM' A lxcantarpaatioxE :pleasePxiut ,e l NaMB(Bn=esWDrganiaatiGR(IndMdnal.): Address: city/stat,/Zip:_)goy. A--4'-Jj)6 y L iZ F'+ Pone#: A•eyou an employer? CheeI tba ap iTopriate box: Type Of project(Xe(p it' d): 1.�1 am a employer itla employees(port and/or pari tiiue).* ].• Now GOAS.0 ction 2,E]lam a sole proprietozcrpmtnership andha4eno employees working£oznrein 8. Remo delidg any capacity.[To worirexs"camp.insuuance required I 9. D eMolition. 134 lam a homaownerdaing all workmysel L`7n workers' 10 Q BuilcytLg addition <1lam ahomeow oxmdwillbehidngcontractorstoconduatallworkonmyproperty. I^wi13 11. Electrzca xe airs ox additions ensure That all contractors eithor-have workers'compensation insurance or are cote t.Q p proprietors witb no employees. I',[ Plumbing repairs or addztions 5-E]I arq agenerat oaractoz and T have hired Elie sub caatraetozs listed on he attached sheet 13:I--t Rope ePajzs These sob-cantcactorsba—va employees and have workers'comp_insurance# 1.4.�Otho 6.0 We are a corpoxatiga and ids plffcprshave e gercisedthei�right of'exemption perMUL c. 152,§l(4),anclwehavena,e�nployaes. Noworkers'comp.insuzaneerecgaired] -.Any appRomttbat chea3�sb6rWI must also`fdt outibe section belowshawingiheirvTorkexs'compensation polieyhfozmatian. i Homeowners who suti6M phis afdavitindicCmgthey are doing allwoaaudfhenhire outside contractors must sillmitanevt affidavit indioating sac13 Confiacfozs at r�eclztltisbo mnst a ac)acaaa additional sheet shovTmg the name oftlta s[zb-corziractors and sista whether vz;notihvse entities have employees. Ifthe sub-,,�Zi6,a 6xs tial:employees,�ieymustpravidetlieiz worka s'romp.policy atumber. ja221 an eniployertliat'1j_ax0,zdingxpovker3'compensation insuranceforyny emplijyees.'Below is thepolicy andjob site infor�natior2. _ - Insuxance CompanyNamo: PORGY#or Self ins,IiG.#: Expiration.Date: -'ob Site Address: City/Statemp: RaCll.a copy mftheyvoirkers, eblapeusation policy declaration page(sbowingihepoRcynurr�bex and exai�ratioa elate). Failure to secure cov:rage as xaquired under MGL c. 152, §25A is a oximinal-violation punishable by a fine up to$1,500.00 audlor one year imprisonment,as well as civff penalties i -L-ho fozm of a STOP WORK ORDLR and a fine of up to$250.00 a day against ffie violator_A,copy of this statement may bo forwarded to&o Ofea offhvestigations of the DIA.1'orh=auce coverage vadfloatIM. �•do hereby cerfi UBd'et t epai -andpenaT res ofperjxW that the informaiionpro�iVaho"visfrr�ec�deoxrect'r1 Daae: Si ate• p y_ ' 1'bone#: 0 73- 7 Official rtse only. Do not in thi's avert,io be completer by city Or fawn official. City or Town: Perm lLCricerzse# SssuingA.uorIW(circle oRO-- i l..)Board of$ealth 2.JBuzlding'Departnaexit 3.City/Tom Clerk 4.Electrical Inspector 5.RJU blugl'xi.spect0r 6.Othex l'7aoe#: Contact Person: i I I 6 4 TOWN OF NORTH. ANDOVER OFFICE OF BUILDING DEPARTMENT - 1600 Osgood Street,Building 20, Shite 2035 North Andover,Massachusetts 01845 Gerald A. Brown Telephone(978)688-9545 Inspector of Buildings, Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION DUIDING PERMIT APPLICATION Please 12ri DATE: ' 3 dh .TOB LOCATION: Obaoi5, i-VC. Z 3 Number Street Address Map of HOMEOWNER Le—C 6- SlR ay SK.r 9T Z 73 1- Name Horne Phone Work Phone PRESENT MAILING-ADDRESS r r 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 I IO.R5.1.2) The undersigned"homeowner"assumes responsibility for compliance with State Building Code and other applicable codes,by-Iaws,rules and regulations. The undersigned"homeowner" certifies that he/she understands the Town.of North Andover Building Department m nimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNAT APPROVAL OF BUILDING OFFICIAL Revised 8.2015 Form Homeowners Exemption BOARD OF APPEALS 685-9541 CONSERVATION 688-9530 HEALTH 683-9540 PL.ANNMIG 688-9535 North Andover MIMAP August 30, 2016 445.G-4a2T � 74 F�IAR�T"�T+t� At�h/E �r l�' r r r 1- I 445.G-4421 >r9 ;� 445.G-4022 75 ADAMS AVE r �� 445.G=4423 i STS ADAMS AVE � ,y�, �3 ADAMS AVE � � 6^1 ADAMS AVE v s pven�e Adam h� R 445.G-443:1 � a45°�-4434 (]MVPC Be Inlarslales Horizontal Datum:MA Slateplane Coordinate System,Datum NAD83, Meters Data Sources:The data for IIr1s map was produced by Merrimack SR V%ORTFf Valley Planning Commission(MVPC)using data provided by the Town of RoadsO4 ° +1,y North Andover.Additional data provided by[tie Executive Off ra of r"i Easements } vet�� - 6.6 'dp Environmental Affalrs/MassGIS.The Information depicted on this map is " L for planning purposes only.It may not be adequate for legal boundary Parwks O definition or regulatory Interpretation.THE'fOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING THE ACCURACY,COMPLETENESS,.RELIABILITY,OR SUITABILITY OF THESE DATA.THE TOWN or NORTH ANDOVER DOES NOT +► co ��f ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF '+ THIS INFORMATION e++TSD�'Tpy.Ed3 LSSA VIUS�� 1"=31ft rv ° North Andover MiMAP August 30, 2016 045.13-0020 045.G-0027 70 MARTIN AVE 045.G-0025 4 045.13-0021 f 045.G-0022 "I 75 ADAMS AVE y R4h 045.13-0023 045.G-0024 87 ADAMS AVE 03 ADAMS AVE 045,13-0002tt`` Ill ADAMS AVE nls t, N i �111111 43 1 A��ms pNer`ue — ' 045.13-0031 045.G-0030 045.G-0028 El MVPC Be Zoning Overlay Zoning [�Municipal Boundary D Adult Entertainment Distdc Busmen s 1 District G�Machine Shop Village Ove tiF Buaine s 2 Dlstrlct Horizontal Datum:MA Staleplane Coordinate System,Dalian NAD83, Rail Line Watershed Protection Dist itBusino! s 3 District Meters Data Sources:The data for Into map was produced by Merrimack Interstates 0 Historic Mill Area Busin s 4 District N012Tty Valley Planning Commission(MVPC)using data prowled by the Town of ....I a Medical Marijuana Of Genera Business Davict O��t 90 r 'qM1, North Andover.Additional data provided by the Executive Office of _.,SR & Downtown Overlay District 1I9 Plana Commercial Dev ` ° d Environmental AffairslMassGIS.The information depicted on this map is Roads ( I°listo4c District Corridd Development Dist ,� • 4 �(, for planning purposes only, It may not be adequate for legal boundary Osgood Smart Growth(40 .% Coo do Development Dist p to collodion or regulatory interpretation.THE TOWN OP NORTH ANDOVER kmr Easements Hydrographic Features Yl/t Coulon Development Dist F' MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING ©Parcels Indus[it I 1 District * • THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY Streams Indusui 12 District ;� .. OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT Wetlands ="� Indusai 13 District rt. "a �.`0 ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF EI Industri I S District '0 e..' " „k Exempt lands o �p`� y THIS INFORMATION Reside ce 2 District ��5$ACHU§Bid Rexlde ce 3 Districl de ca a Diskdct 1"=31 ft de ce 6 District do ce 6 District �a a esidential District