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Home My WebLink AboutBuilding Permit # 9/19/2016 BUILDING PERMIT Ole 0 TOWN OF NORTH ANDOVER 10 APPLICATION FOR PLAN EXAMINAT N 4 e 4 Permit No#:,1�9' 0 Date Received raD "US Date Issued: IMPORTApp ca ANT_ _111 jlmust c—OTPIetc all it—ems YR-this PaRc-- 1k,! -W 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—1WPRb-VEMENT PROPOSED USE Residential I�lon--Re�Jdenfial 0 New Building F1 One family El Industrial Ll Addition [I Two or more family No. of units: 0 Commercial 11 Alteration W?<e I pair, replacement o Assessory Bldg [I Others: Ll Demolition D Other ❑ -,16bdpl Z bt an,8IflJ edstnct 7n. DESCRIPTION OF WORK TO BE PERFORMED: 3&4, t cati Phase e or Print Clearly lk" 2'2J--',SA a. OWNER: Name: 'k Phone: G" "s Address: - ----------- L �4- Contractor Name: Phone: Email: Address: Supervisor's Construction License:—.—.— Exp. Date: --.-- F-lome Improvement License: - _ _�.Exp. Date: .. _._-� __m_ ARCH ITECTIEN G1 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. Total Project Cost: Check No.:--.- Receipt No.; NO,r:E: Persons contracting with unregistered contractors do not have access to the guarantyfifnd ..................... -------- Ari,=nf/n\Ainpr F VI®RT11 -q Town of :, 6Andover 0 � 0 A a LAKM h ver, Mass, dw �r coc"1041WK S U BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT ........ 1. .... BUILDING INSPECTOR has permission to erect.......................... buildings on .....,.......' ...... .. ..... . .. ............/! '* =...�9. Foundation qo . .. . .......... .,.... .® to be occupied as .......... ...N. ...... L Rough .... .!�'.�...................... ...... .. . C►..�.... Chimney provided that the person accepting this permit shall in every respect conform to the terms f 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 16 MONTHS ELECTRICAL INSPECTOR- UNLESS CONSTRUCT START Rough Service ...... ............................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® ®ccuzy 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 NO,1ZTH ANDOVE R OFF ICE OF B UILDING 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:APPLICATtO N Please print DXt E: JOB LOCATION:_9",-)------- Number Street Address Map/Lot T1,0ME'0WNER_d,A/77 Name Home Phone Work:Phone PRESENT MAILING ADDRESS 167/) City Town State Zip Code The current exemption fox"homeowners"was extended to include owner ocieupied dwellings of one or two family dwellings and to allow such homeowners to engage an individual for hire who does not possess a license,provide that the owner acts as suppr)dis9K. 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 I 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 unde ands the Town of North Andover Building Department minimum inspection procedures and re h-ei ients and,�Ir�alhe/she will comply with said procedures and requirements. HOMEOWNERS SIGNA'FURE. APPROVAL OF BUILDING OFFICIAL Revised 8.2015 Forin Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HLAUM 688-95,10 PLANNING 688-9535 y7m Common vealth oj'Massoc huyet`ff r . .. Deprrft zen�ofbida trialAccident� I Congrass Sheet,Suite 100 -oroRogtow, xy . zrx .govldia .5�4 Tts ez°s'coxnp6xwatio)a G�m-an.ce;A—Rda`vit.BuRdey /Co a ac�oxs/T'k. ,zc aslL'Zcmabexs. TOMI, + W..CMTJW,T tMU'i`.tNG`.�.'CI`TB:O:BM' �,.�,nlicant�n�coxxa.ati.oxt :�lease:l�xSnt :Ge�bX� N... (I3 sines/CJrgaraizai%ox�CCvdiv%tdnal): �;/ / / _.... ry ,yam Phollo il: Are You an empSayer? C zecl iTie ap izaprzafe ax. Type of project(TQ C�xdxed)' 1-Ell am a amplaycz th. ` :,. = emplayees(Dill andlazpazttitne). /.- ED env coais�txctinn "etaxar artnorshi andhavenaemployeesworlciug forme in 8. ra.odelixig z.n lam a sole proper p p �ry any capacity.iNQ wcAcre comp_insurance xcquired] ! Lie:mo i"L o11 Camahom nWnt-_jd0ing4WD1k3oyself J To svark€zs'camp..insruartcezeciuired.f t 10 L_l Building addition 4 .__ asZahm-n(, rrte<ramdvillbehiringconfrnctarsiacouductaltyazkonmyprapezty. 1 i11 Z� � c, o ©pc�lT9w a[{[Htdoz]S en urro thai ail cozntra dors r ichor have v orkers'rorxapensatian insurance err ara sole p4rwors-96thnoe]�ployeys. 1.2;C[Plumbingxepaz'rs 0r-LdCREOM agenezalcortudorand IlraVahi-Led thesub-conkracforslisted oil theaitmberisheeT. 3. oil xepGli�S 'I'hesb sub-cmtzaemployers andhaveworkars'comp_iwmance� 14.L]O f[for . _- 6.E]We are acazporaf in r andif�ocershave e�ercisedtixeirriht nfb�empuauparl (1L c. 152,§1(4),audefi�aena,,e�iplayaes•[Noworkers'comp.i�surat�cerequired.� . ___ _ Anyapplicanf €xatcheokbrixlmus�aTsafillorattbcseafianbolavtsPawingtbeir�rarirers'compeusaizanpolicyzzafazmatian i tomea nerstyliasiltria#loisa[L'tdapi:Pirsdic ngtheyasedainga11vvarlcaudthenhireaucsidecorilractnrsmustsi7'buxitanentafidaviindicatingsrW, iffff0 racWRars chard ih3sb mns afiac erlauaitiauatshe fshovaingth nameafihes -conizaciorsand Ltowhut erarpotthoseentitiesh_uvs , employees.Utho sub-cozy radars vee plod ees, ieymu pzoyide tbeig warkEss'comp.policy number. _ _ _.. 2u esri rla�ret tli aC:ts t avxcz g��t)oxTre7^,s'copTensWon zrasuFurtcefox'my er lciyees.' /3eZa'ty zs tTie oliry rzradjoF�s°lte xafce company-_N%me: — policy#ox Se'L ins. ic.#k: xpiratiozzl7ate:_ _ -- dab iteAcldxess: city'/State/ ip: �faebacopyo t size s' coxape sataa pagcyde�e.G-zx'ad0.upage(s�bo gthepaUcyn nbe:°RudeN,pix'atiaxE FailTxxeto scctzre cov t g�as xegi*ecl7xnderMa.L o. 152, §2.5�.is a criminal vxolation,pan h6ble by a fine 71p f-0 r`1,i 00.00 anWon onc. e�' . px� eni;as well as civi[penahles in-tile:fozm.o--a tSTOP WOE ORT and.aErne of up to$2,50-00 a day againgtgh -violator-A,a oftfiis statement may be forwardedto'�he Office ofb�vestiga�oza�ofidre�lA Eoranscrrataco c;oyarage v --- a_.._ a Tie eli e t,y rail j / n v Gesso pe7 xy t/acr the i lfr� rraEcfia�L lrtovir ecz cz7�as�e is rrae c c eaf eco ,Sign�turo�-• � ` __ __ I1ato� C3�.,-l� __/�_ _�. Phone 4: [[j,ficW r.se only. _Do nol-write in this area,to ire coNpleted ray czty or t0lvlz a�ezczl_ eaaseYrimgA'crt6.oxztg J,.7gaax°cl of,`�i ea(t�2;.:� Zcf�x�g'Depaxtm.exxf 3.C:tt�IT.'a .C,Xext� �.E�ectc°zcaX�'ns°pec-taar �_7�ZrxxnbxrrgSnspcetc�r.