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Home My WebLink AboutBuilding Permit # 9/16/2016 ee aoar►, Qa�,ry E.O f b f�•r4J BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit IVa s Date Received � sAGFIL{`M�"4, Date Issued: C � IMP RTANT Applicant must coin lete all items on this page ,,; „/ r,,: „rrr;/ %, / � ✓ � o /r ,,,/. �r %r ,r „i., ,r r, -,,,,G> i ,z ,era // / ,r ��,,� ilii r /,,: /// rrr, / „, r,�/fli////c,,,iii �,,,,, / i„ / / �o r„•„ r ,-rri i / /i„ ,�, G, //,/r //i ,!/,r/o/a a�/ iii/ / /�, � .,/i ,,, � i �////,,,• ,r „;� a�////%/i /� / rii /%/ /i r r%/ ///,.,r/ �r ,,:rrr ,r�, rr / r,✓/ / ii„ r, ,r /% ,'�,',."„ /i -r, %/ �I/%//e, //// / r / r// r / ri r ,,,,,,�• ,��, ri„ i.,,, iii; � r,,,,/,/ /i G r ✓//r / /ii. /i//„ 'i/ /rr rj//i/rte % ri// //r ;; / r.. r r•• ,..,, ,> yr ,/ rr<.,:,, ,/ / ,rrr/ /„ ..r ...o ...reel -... / /ri /, % „/,i„ i /,�,,,,/rte r / ,,/ ,rr // ✓ ,„ / //• ,,,,, /��/rr� / %%/ ri r„//�i% / ,,,,,, /,/'i / /,: /,,, ,,,,, rir ..,,,� r/�r,//� /�i�/i/ „ o/ri ri / ,r�,,,, I,,,,/C,,,,/r�� .r ,/, •:"ar/;,, / �/ii rr/ .✓//oo/i/i,i //r// :,/ / /,/�/:;r r /� r%i rr �ri %ra p r�,..,...�/i/��✓i /,,, /// r/ ri,�„G, ,ri ,,,,,,��%-„ ,,;%/ r r.. i///:; a;, ,;,� /� ,, ,�jii/�, %i r��/, / r,rrry ,,,,,,,,,”,/��/�! %/,';��/�' ,,, ,;. ,/�,,,r�,p ri,c„/�%/////r%i c,.;✓%////, ,, /i � /�i/ �/ f/�' /lir '��:. / r /i ,. •r„r/ �rrr� �.o//� r.///ii rte, r:.///iii /i i/fir/� l�l /ic,/r/ ,�/ r .��. rrrr, r r / /.• / r / / % z �/ %�� ,..,///,/�,,, / ,///,a,//r/,,, ,%;- r,;.ir o. /rr•//// r./ �/i iii �,. .� r„ / ,r„ri , r .� r, �// rr//.r, /� or %/ ,,,� /,�� r //r,r„ �/ r, ,/ //, ( ,,, .; /r��.r/ � ,,,; i ,., r,,,x. ,•,,,,, �/ �i//,,ter. ,,,,, ;•, ;, � �rr r/.�/,/iii,,,� ;� „r� ✓i� /r. �„r, !r ;, r ,. r/. r/�� //ii//t r• "�A. / ,./o// ,. / % /,,, ,;. �„ r �/, ,,, „,r,•c� „i,„ „;' rro �, � i„/./ ,ri rJ1� %'7� rr// r/ / iii,� rrr i // ,r;i / „�� //to////. / r/i/%r,: /r ,/�o.. ,�” of/i/r,/�/ /��//�/�. '/i -� :• /� TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential rl New Building [ ne family r7 Addition r:i Two or more family Industrial 11 Alt ation No. of units: I::1 Commercial epair, replacement 0 Assessory Bldgs Others: n Demolition El Other r r rr, /ire% /rr%fir/�/r/ %„ r-,�.�,✓ rir// srrj/ i ///„1/ii ///��///�r,! -i i r is rl / /r,,.`rir i`/;;” / � "r/"ii�// // /', � / %��//r/, .: ,:., ,G�„ ,,,r�.✓r „r r r r ,ilii////, ,/, / /i/, r�/ r /, / /„ <,,,, �a // % � i r , i, / / /r/✓, r//�//,/ //,l r r ��/ „///%rr�////r Identification Please Type or Print Clearly) OWNER: Name: �- � � ° _.r .,�i Phone: 7 � � Address: rr /� : r � r< / rr/�✓i ar //,,.,,,rrr >,, / ,/ , /, / //i / / / �/ �/ /r // ✓rir/ , �/ </ ,.�j�ii r/ ,., r �,,, / /rr ✓., / / /%iii/ ri /i /r /„ .,. /r/ rir / �/%%/,,, r.. ✓ ��//% //,..� r... r .,,,, � ,,,, G/ J // r ,o"./////a///r,, //%.// /, /// / /r / / r,;r r r /,/ /�� i//// /�, a,,,,, r„r lir ri / i ri o/. r, ,r a r ./.. / o /✓ /r/ ///////fir ,/ ,�iC// ,.r%/ �/%/�� / r : / //,roi,,,r, /,,,,r ,.,,, r�,,,.///�, r//cam rr ,ro:.; ��„/�rr/ / .:.,•rr ,r//a/// .//iii/ /iii%/ii r/i./iii/ ,/ /,, r/rr%�iiiirr.:;,,.///%/,/%r. „ .,r//�,,//, i� /�..,i r / �c ��/////�i//, rrrr ,r. r., r., / r ,<�r r, /i ...!ir G,,, 'r, /%l✓,oi� ri rr/// !/ //// .”/iiiiiiir / / /, �;; ,//�i ire/// rp, ✓// ,/,,,"/ /,,, �/„ rr � / rD / /ii/i ri / /ri/ r / /ii %/ii //r„%7 r/„��rii 5,,,rrij�s,; /ri,,,i�s%,r�',;,,ir„ ,v//�/„/,,,,%�//// ri ri r„r„ r/ •,,,.. %i „r; %/rr /� "� f�/fir / r,� //�// ,r/ iii/i//�:. ,ri i r,/„ •i of '„r ,,, , „ic r�rl//r iii,,,,, rile%///�//i i,1,,,;,r ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12A0 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ � FEE: $ c Check No.: Receipt No.: ' 'µ � NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of ent/ w er Signature of cont ctor Town of z b ndover 0 No. 3_ O LANA ver, Mass, LOCNIL HE WICK 1' area U BOARD OF HEALTH PERMIT. Food/Kitchen T LD Septic System THIS CERTIFIES THAT .......... r..,........ '� I�.. . .... . ...... ...................................... BUILDING INSPECTOR has permission to erect .......................... buildings on Foundation Rough tobe occupied as ..XCOR V............... ............. .Am.S.I............................................................. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Final Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR I VIOLATION of the Zoning or Building*Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION STARTS Rough Service ................................................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy .Fermat Required to Occupy Bulldlno, Rough r 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. 00R'rf4 TOWN OF NORTH ANDOVER I'ap I OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 A North Andover, Massachusetts 01845 ` " 1845 C10 Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE: 1. JOB LOCA'1'ION:-2j4 k Ave . ffIA. OttLkS Number Street Address Map/Lot HOMEOWNER Name Home Phone Work Phone PRESENT MAILING ADDRESS,._.. A 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 lie/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE'_ZkI APPROVAL OF BUILDING OFFICIAL, Revised 10.2005 Form Homeowners Exemption BOARD OF A111TALS 688-9541 CONSFRVAIION 688-9530 111-AL'I'l 1689-9540 PLANNING 688-9535 The Commonwealth of Massachusetts Department of.IndustrialAceidents b I Congress Street,Suite 100 Boston,MA 02114-2017 wwip.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILE,D WITH THE PERM TING AUTHOMTX. A licant Information rr Please Print Leidbl. Name (Business/Organization/Individual): Address: ?N ( �_� City/State/Zip:(. �r�- .. naz:,�.�e r- ligA 01MThone "(�2 OCf—q 04 Are you an employer?Check the appropriate box: Type of project(required) 1,❑I am a employer with employees(full and/or part-time).* 7. New construction 2.Q I am a sole proprietor or partnership and have no employees working for me in 8. []Remodeling any .apaeity.[Noworkers'comp.insurancerequired.] 3. . I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 4.E]I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 1 LEI Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13, f repairs These sub-contractors have employees and have workers'camp,insurance.# 6.F]We are a corporation and its officers have exercised theirright of'exemption perMGL c. 14.F1 Other 152,§1(4),and Nye have no employees.[No workers'comp-insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information, t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an add itional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I ani an eiitployer that is provieliiig iporlrers'compensation itisitratl ce foi'niy employees. Below is th a policy and job site hifartilation. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: i Job Site Address: City/State/Zip.- Attach ity/State/Zip:Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). j 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 form of a STOP WORK ORDER and a line 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 coverage verification. Ido hereby certify under th pains andpenalties ofpeJmy that the information provided above is trite and correct. Si nature: . eDate: Ce Phone#: —qO<41 Official use only. Do not write iu flits area,to be completed by city or toltin official City or Town: Permit/License# Issuing Authority(circle one): ; 1.Board of Health 2.Building Department 3,City/Town Cleric Q.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: