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Home My WebLink AboutBuilding Permit # 9/27/2016 �yOR7y BUILDING PERMIT oF�TL�o TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION � 1 y h -7" 40/ Permit No#: o� Date Received �'�ss,�eHUSEt�� Date Issued: PORTANT: Applicant must complete all items on this page LOCATION , F Pent PROPERTY 01111NER t ' Pant 10U Ysar�tructure yes MAP I?ARCEL ZONING DISTRICT � ` Historic Drstrlcte no ;Mac}��ne Shop 1/illage ,. des no ;. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential pi�New Building �9 One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement �4 Assessory Bldg [I Others: ❑ Demolition ❑ Other ❑ Septic a Well ❑Floodplain ❑1Netlands ❑ Watershed D�strEct ❑,Water.ISewer .......... ...... . .. . . .... . DESCRIPTION OF WORK TO BE PERFORMED: 15 Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Confractarone, Email Address ' arm - 5u „erv�sor's Construction L[cense Ex Date P ARCH ITECTIENGINEER 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: $ FEE: $ Check No.: -7 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund �� ignatureof AgenV wner . Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OE SEWERAGE DIS]Pennarent Public Sewer Tauning/Massage/Body Art ❑ Swimming pools ❑ Well Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic flank,etc. Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On �' Signature 4A" COMMENTS CONSERVATION Reviewed on a b Si nature ` l� COMMENTS HEALTH Reviewed on Signature COMMENTS (!Y� Zoning Board of Appeafs: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/s; nature& pate Driveway Permit DPW Town Engineer: Signature- 71711A ignature: Located 384 Osgood Street FIRES TMTemp ❑umpste yep r r`on side Locatetl at 124 Main Street ., '� M a� Erre Departmen# srgnatureldate ; COMM,ENTS. . v%®RT� '4 i Town :� 6ndover No. ! T 3 � C h ver, Mass COCNIC NZ WICK DRATED s � BOARD OF HEALTH Food/Kitchen PERMIT_ T LD Septic System THIS CERTIFIES THAT ..... 0-N! -. � � .. ................................................ BUILDING INSPECTOR has permission to erect .......................... buildings on ......as... Nc- rA�..... Foundation Rough t0 be Occupied as ....:...........!!..[� ... .. ..... . .....................,.,....,....,...,.,,.,.,.,.....,..................., 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES 16 MONTHS ELECTRICAL INSPECTOR UNLESS CONST TI®N Rough Service . . .......... ..... Final BUILDING INS P OR GASINSPECTOR OccupaneV Permit Required t® Occupy By 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. tkORTH TOWN OF NORTH ANDOVER OFFICE OF 0 BUILDING DEPARTMENT 1600 Osgood Street, Building 20, Suite 2035 North Andover, Massachusetts 01845 ncHus� Donald Belanger Telephone(978)688-9545 Inspector of Buildings Fax ()78)688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please 116rit DATE:— 9/g? 7 1Z 6 JOB LOCATION: L-3-3—-------------- - ---------- Number Street Address Map/Lot HOMEOWNER ' 1 17 (,o4 2, ,3 1_ 7� Name? Home Phone Work Phone PRESENT' MAILING ADDRESS— _/00 ecr 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 supeisor. i)d — 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 pet-son who constructs more than one home in a two-year period shall not be considered a homeowner. (780 CMR Section 110.85.1.2) 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 minimum 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"APPEAL„ 688-9541 CONSERvivriON 688-9530 HE'ALT11 688-9540 PLANNING 688-9535 '12e Commonwealth of Massachusetts Department of-mdustriaZAccidents - Sire Suite 100 A w r 1 Congress Sir , _ - 02114 2017 - .8astox2,MA ~ w www.rnass.gov/dia Workers'Compensation ILnsurance Affidavit:puilderrslCont acto rsl lectriciansl'iwmTaexs. TOBREMEWWTTHTIM'PEP2&TTTNG AT3THMS '. ,lease Print Le 'bi A ' licant Znfaxnrzation -Name(Businesslorgatization9ndividual): `r � 3C w SY Address:— � � C>( 1, S' Phone#: 4 7 to •3 6 U 1 `7 / City/State/zip: _ Type ofproject(�recluixed); • Are you an employer?CheclitSie appropriate box: etnployaes(fail and/or part thno).* ry, ❑Ne�r`constriictioxt in i am a craployer with _ aodhavp 2Q I fan a sole proprietor or partnership iusuraace requiredl]yees working for me in 9. ❑Deanolitio�g any capacity.[N or 3,Q I am a homeowner doing all work myself °workers'comp,insurance required.]' 10 El Building addition q.[�c and vri31 bo Lorin$—tractors to conduct all work ort my property. 1W 1I.❑Eler-tri Tepa1T5 of ildtiittO?1S I am ahomeowner have workers'compensation insurance az are sole ensure that all contra'Aors either12 [�Pliunbit>g repairs or additions proprietors with no eiuA OYces. L_t 5.D I am a general contractor and T krave hiredthe sub-cortfractozs listed an the attached sheet. l I[J Rbaf rep airs These sub-contractors have employees and LSave workers'comp.insurancet ¢11 Offer 6,0 We are a corpazatiozi and its.officers have exercised their Tight a£examption per MOL e. I—� 152,§1(4),andvte Have no employees.iNo vtorkers'camp.insuranco required.] pr y applicant thhat cheolcs licked dust also fill olttthe section below showirrgtheir workers'compensation policy information•. ' davit Tiorueowmers who submit•this affidt alt indicating to additional shee th air doinghousing the IIk name°the sub contractors and Stateeub'ra outside Contractors fustw ether qr w.not'hoseentit}es have te,,tractors thatcher b _ employees. 7fthe sub-contractors have employeos,they utast provide their Workers'comp.policy num or. X arra an employer that is pr�ovidingVorke?s'conxpensatiort insurance for my errtployees. Pelow is thepo�icy and�ob site information. jnsurrance COrapaR.y Name: ExpirationDate' Policy#or Sel€ins.Lia.#: City/State/Zip:_ 14— �/ S lob Site Address: r the clic nrtanl3ex and e piratio-a.date). ttach a copy of the�vorkers' co�npellsa'donpolicy declaration page(showing p Y o by aab up to$1,500-00 Failure to secure coverage as reciuired undo 1M enol iies�in the arm.of A is a a OI?WORK ORDER jinal violation iMd a line of p to $250.00 a and/or ane-yeaa imprlsox>ment,as well.as i p day against the violator.A copy oftbis statement may be forwarded to the Office of fuvestigations of the DIA f`ox insurance Coverage veaification. rdo Iter eliy cert�triepains an pen rhes ofpeijury that the infornzationprovided above is tare and correct. . Date: Si attire: Phone#: -write in this area,to be completed by city or town official. Official use only. Do not • P�ea-bo;itlLicense# City or Town: fssuiugAuthority(circle orae): 1..roared of health 2.Building pepartment 3.City/Town Clerk d•.Electrical fuspector 5.Plumbing]'stspectox 6.Otlrerr Phone#: Contact Person', Sales: 800.448.3636 Q A CY F Phone: 804.271.2363 NEXI' GENERATION Fax: 804.743.7779 ACM=Z2E'M37 acfenvironmental.com LET'S GET IT DONE SFORMWATER MANA.(..�ll-,'.MEN'I' SOI,U'�.r]'ONS Site Development and Retrofit o Low Impact Development ® Green Infrastructure VOCALPOIN'r(high flow biofiltration) R-I'ANI((iriodkilarsaibsu-fiice storal,,e) PAVE DRAIN(paving,drainage,storage) FABCO(d(!ceriti-alizedtreeitii,ieiit) 01% 77 C. fib PARK ST. 2ND FLOORNO DOVER M A, 01810TELL:(ASSOCIATES,8) 837N 335 FAX:(978) 837---3336 MASSACHUSETTS OWNER: TERRY HOLLAND DEED REF, . LOCATION: 933 GREENE STREET PLAN REF. #1780 CITY,STATE.- NORTH ANDOVER, MA SCALE, 1"=20' DATE: 7/06/16 JOB #: 63.00'. I SKS � LOT ,2 11,900± sf I I { 26.5'f t 4 4 � PROPOSED'�-- ,GARAGE i 9B Y 30 i 1 STY ADD. � � L 4t _ TO BE REMOVED o 1 � EXISTING DWE'LLTIVG # 133 00 p