HomeMy WebLinkAboutBuilding Permit # 9/14/2016 ,AORTH
BUILDING PERMIT
TOWN OF NORTH ANDOVER 0
APPLICATION FOR PLAN EXAMINATION
7)
Permit No#: Date Received )J__�_J_&
Date Issued:
-
- OI EANT: Applicant must comp�all items on this page
P
LOCATION
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Pri,7t
PROPERTY Oa_NER_� _ALM r A, ---7e�/ no
' Print 100 Year Structure
MAP S ._PARCEL: ZONING DISTRICT:( Historic District yes (no
1
Machine Shop Village yes 0
fY`PE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
El One family
w�Bu Building d-i
D Addition NC Two or more family El Industrial
No. of units: L71 o Commercial
W- Alteration
_1 Bldg 1.1 Others:
r, replacernent
[.1 Demolition 0 Other
d
Flood0laih 0 W J et on s,,/
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E,]
211-
terlSe ef',
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SH
DES�CRIP,T, ON OF '6 ORK TO BE PERFORMED:F (49 C C
51"v d 4-
Identification- Please Type or Print Clearly Phone: 0,
OWNER: Name:_
Address:
Contractor Name: OcIpt-IA1, Lv- Phone:
Email:
Address:
L7 _71
Exp. Date:
Supervisor's Construction License
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: I Reg. No.
FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED OPO 25.00 PER S.F.
Total Project Cost: $ _FEE: $
t
Check No.: Receipt No.:
Persons contracting with nr is erect contractors do not have access to the guaxan�yfiund
-
----------
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7
4 gnat,ure.afAq
................. e-
..
k NORTH{ q
own of
2 6 ndover
IL 1,a h ver, Mass,
cocw�cMew�c� 'k-
OAT .
RATED ►Pa�,cGJ
U BOARD OF HEALTH
Food/Kitchen
PER T LD Septic Systern
THIS CERTIFIES THAT .......... U BUILDING INSPECTOR
has permission to erect ....... ., bu"ldin .S OrI .. 1� ,.. .., . ^........ .... . . . Foundation
. ............ g ... ..
' �. Rough
tobe occupied as ............ .... ...... ... �. ..................................................................... Chimney
provided that the person accepting t 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 C® S T04BUILD=1NSPE&CT0R Rough
Service
Final
GAS INSPECTOR
Occupancy Permit Required t® 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 AN DOVER.
3, OFFICE OF
B, UILD ING DEPARTMENT
1600 Osgood Street,Building 20, Suite 2035
North Andover, Massachusetts 0 1.845
Gerald A. Brown Telephone(978)688-9545
Inspector of Buildings, Fax (978) 688-9542
HOMEOWNER LICENSE EXEMPTION
BUIDING PERMITAPPLICATION
Please print
DAM (.2 16
JOB LO(;ATION:—
Number Street Address Map/Lot
HOMEOWNER µCXG Wr,y�X`J -----------------
Name
---------------
Name -ftome Phone Worl(Phonc
PRESENT MAILING
City Town State Zip Code
The current exemption for"homeowners"was extended to include owner oc-cupied dwellings of one or two family
dwellings and to allow such homeowners to engage an individual for hire who does not possess a license,p
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-fainily 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 sliall not be considered a homeowner. (780 CNM
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 understands the Town of North Andover Building Department
ininfinum inspection procedures and requir ments and th t he/she will comply with said procedures and
requirements.
HOMEOWNERS SIGNATURE-
vu 5
APPROVAL BUILDING UILDING OFFCf
Revised 8.2015
Form Homeowners Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 689-9530 HEALTH 683-9540 PLANNING 633-)535
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progaietnrs with raneplo-yees. 12:[]Plumbing repairs or additions
S.�Iamageneralcoz�4rararandSlzaYehiredesub-oanactors7zs:ad nntbeaitacTdsheet. fig: pore7a1S
s hese sab-cnnisaclars]iaYe efnplayees-dhave workers'comp_insr ce* 4.El Ot11 x
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�$omeawners Wbosriliririf daviti caagtbEYare doinga]Iworkandfhen7 -Me,coniraeiorsmusL.si7bn?ztane rat davhindzcatingsuch
?ConixacEazs that cdieclrr isbv� ehndan addzkianai sheet s3� ngtbe name of r esrrh conaacrors and ate-Au er ornol those entzdeshave
esnglayees. Iftlta sub-cart a.c az3 Aaia emplaywa,tFiey must pravidetTreir�rorkeia'camp.p° cS'number.'
l ara exxiployex Haat ouicirzgwo kefs'compensa arz i�srxYarzcefo �lzy emf'�Yees'Belov is°the policy ay dybb Bate
infa�r�atcox2. _
lh=ance Company
PORGY or Self-Ins.Na.#'—Li
- Lxpixa�ax�.Date:
Tob Site Address:
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GL LIO r-- City/State/Zip:
Attach,a copyofthevo)ckcrs' eoxupaWatzoApoTzey rlcelaxatbn)page(showing thepo)xcynumbsX axed sratZoa clate�.
Failure to socurel cov6age as zequircclmanderMOL c_ 152, §25Ais a criminal violationpunishable by aflue up to$1,500.00
a
and/or one-year sovmont;as-welt as GiVA pcnaltim inthe farm ofa.STOP-WORK ORDER anal a.zine ofup to$250.{)0
znentmayba forwarded O�ca ofTn�estigatlaus oftheDTA>axinsurance
day against the-do Mot-A,.ropy Of-&&state
coverage'SrextLGattO
X cla exeby err ify rler' e s ra r era rties afpetjW-Ty�Iaac the znfo.r� adon prnlid'e o��is&M--c
Si atore_
Phone _ (' 7 a 0 LI-9-13 6
Officaal itse oNry. -Do nOi- rite bz thl'arert,to he completed by ciY a-rto0zz afficial.
City or Town: Permit/Licause f
�ssrx�.g.Aoxzty-(caxcle orze): � -
1.7E3oard oMegltll Z. 3vRJing)7epariM0Rt S.City/Town Clerk. 4.Electrical IUSPecfOr 5 RIurnnbzugXuslaector
6,Other
Ca tact Person'
North Andover MIMAP September 13, 2016
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0 MVPC Bo Zoning Overlay Zoning
(' Municipal Boundary Adult.Errleda€mnent Dlslric Busina s I District
Machine Shop Village Ova A, Buslne s 2 DisirlcI Horizontal Datum:MA Slateplane Coordinate System,Datum NAD83,
-- Rail Line 0 Watershed Protection Dist N Busina s 3 District Meters Data Sources;The data for this map was produced by Merrimack
Interstates 0 Historic Mill Area M Busino s d District hyQR71y Valley Planning Commission(MVPC)using data provided by the Town of
Medical MadjuanaIIIGener Q art rta Business District t q� North Andover.Additional data provided by the Executive Office of
r`
(,,;.b Downtown Overlay District 'Tri Planne Commercial Dev 4< ,red Environmental Affairs/MassGiS.The Information depicted on this map is
0 Historic District Couido Development Dist $� is �,(, for planning purposes only.It may not be adequate for legal boundary
[Toads Osgood Smart Growth(40 -- Corrido Development Dist d M definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER
t..a Easements Hydrographic Feature, 09 Corride Development Dist t" MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING
Induslri 11 District 41
- * 'THE ACCURACY COMPLETENESS,RELIABILITY.OR SUITABILITY
Parcels Streams Induslri 12 District * y « ,� OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT
Wetlands <.t. Industd 13 District y po s"' * ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
Exempt Lands M Induslri I S District 4p ro<.�..,'., THIS INFORMATION
p Reside ce 1 District '1f„q °44,$
Reside ce 2 District rsACHUS�
Reside ce 3 District
de ce4 District
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North Andover MIMAP September 13, 2016
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Intarslstes Horimntel Delete;MA Stataplane Coordinate.System,Datum NAD83,
SR Meters Data Sources:The data for Urls snap was produced by Merrimack
NORTH Valley Planning Conrrnlesion(MVPC)using data provided by the Town of
Roads Of t4a o r q� NoW,Andover.Additional data provided by Uta Executive Offrca of
q�r Easements 1' at1 4yd by Environmental AffalrslM—GIS,The information depicted on this map is
Parcels ' G for planning purposes only.It may not be adequate for legal boundary
O —- definiWe or regulatory interpretation.THE TOWN OF NORTH ANDOVER
MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING
41 % THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY
OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT
Y okb "' ♦ ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
TT0S INFORMATION
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