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Home My WebLink AboutBuilding Permit # 10/12/2016 taORTH BUILDING PERMIT °��z��° ,b � o TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received �� sacwus4�y Date Issued: IMP®IZTNT: l stens on this page r r v „r r / r,r, r r r 1, i,/, ,�i /�/,✓ �/,,, �^+ <n //,ri/�i /ri ri � !/ i �r /r/r/ r r r// r/!//O/ r /r�r/r/�ifiGii %% r�///!ri%/%��////!//a of �� ,✓�� LC7CRTlOi� a f/r�ir / i;,,' o„ ✓ %ir r�� //� / //rr/% /// r/ri/i rr / 11/IAP "_P�+RCEL ZOC1�It C?ISTIIT '%/ H�storicr strict r Mach�ne'Shop Village ye rr --— -------- TYPE OF IMPROVEMENT PROPOSED USE _ Residential Non- Res identia Cl New Building Tli-6ne y- 11 Addition ❑ Two or more family ❑ Industrial XAeration No. of units: ❑ Commercial pair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic, Ll Well ❑ Floodplain ®Wetlands 0 Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification - Please r ype or Print Clearly OWNER: Name: .. �.. .. Phone: 221 gy Address; .. Contractor Dame: Phone: Email Stapervisor'siritructicirr License: „ Exp: Date; / Florrie lrhprQve�nent License. ', Exp: Date: „` r %<, ARCHITECT/ENGINEER -- Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $. .. FEE: $, Check No.: 51 3 .5 Receipt No.: , NOTE: Persons contracting with unregistered contractors do not have access to the gu arcanty fund Signature of Agent/Owner Signature of contractor ¢ ,RORT}� owe. of .F. 6 ndover No. —F Ait- - �O LICK! h " ver, Mass, LOCM[C nC wrcK A. Areo V BOARD OF HEALTH Food/Kitchen PERMIT. T LD Septic System THIS CERTIFIES THAT ..........*7011N....... rtP BUILDING INSPECTOR N ..................................... has permission to erect ......... buildings on Foundation Rough OT .. to be occupied as � .w. y 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR _ UNLESS C®NSTRUCTIO STARTS Rough .......,.. .... Service . .... ........ � Final BUILDING INSPECTOR- GAS INSPECTOR Occupancy Permit Required to Occupy BuRough 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. The Commonweaith of Massachusetts Department of lndustr iarAeeidents ; . r I Congress Sheet,,Suite 100 a. . Boston,MA 02114 201 www.mass.gov/dia Workers, Compensation Insurance Affidavit:Builders/Contractors/li lectriciansfPlumbers. TO I3j�,FILED WI`fH TING pLi RnITTiING AUTFIORITY. ..Please Print Ise wbl A ')licant Information Name(Business/Organization/Individual):— J P, � Address: W✓I Phone#: City/State/Zip: r /rr [9, ype of project(Vequired), Are you an employer?Check the appropriate box: tl �emP to ees hill andtar pant time). . New"donstrtzction 1.Q I am a employer with 2.�1 am a sole proprietor or partnership and have no employees working far me in . Remodeling 3,� capacity.[No workers'comp.insurance required.] F-1 Demolition n a homeowner doing all work myself;,[No workers'comp,insurance required.]t 10[]Building addition 4. I am a homeowner and will be hiring contractors to conduct all work on my property. I will I 1.❑Electrical repaixs or additions ensure that all contractors either have workers'compensation insurance or are solo �-t p um, repairs or additions proprietors with no ea rp'loyees. 1 w:.J g 5.❑I am a general contractor and l have hired the subcontractors listed on the attached sheet. 11 FI Ro6f rep airs These subcontractors have employees and have workers'comp.insurance.£ 14,�Other ir right of'exemption per MGL o. 5,�We area corporatigri and its,officers have exercised the 152,§1(4),and we have no employees.[No workers'comp.insurance required.] kAny applicant that cheeks bbx#1 sxiust slso fill out the section below showingtheirworkers'compensationpoliey information. t homeowners who submitthis affidavit indicating they are doing all work andthen hire outside contractors must submit a new affidavit indicating such. lContraotors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or pot thoso,entities,havo emliloyces. If the sub-contractors have employees,they must provide their workers'Damp.policy number. lam an employer that is providing-worlcers'campewsatlon insurance for my employees, l3elaw is the policy and)oh site information. Insurance Company Name:_ --- ExpirationDate: policy##or Self ins.Lic. City/State/Zip:_. Job Site Address:__ - Attach a copy of the woxlrexs'compensation policy declaration page(showing the policy number and expiration date). ired under MOL e. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 Failure to secure coverage as requ s well as civil penalties in the form of a STOP WORKOpp-DER,and aline of up to $250,00 a and/or one-year imprisonment,astatement may be forwarded to the Office of flivestigations of the DIA,for insurance day against the violator.A copy s Well eaverage verification. X dpenalties ofperjury that the information provided above is true a d eon-ect. .I do herebycert undEr the �azns aw / � � f ...�,._,......� Date: ,✓" f ' Sitxnature: official use only. Do not sprite in this area,to be completed by city or town official. City or Town: _.___-----. - --' Permit/'License 0 Issuing Authority(circle one): i 1.Board of Health 2.Building Department 3.City[rown Clerk 4.Electrical Inspector 5.Plunxbing Inspector 6.Other Phone-- ContactPersaxa:� I ttORT#j p TOWN OF NORTH ANDOVER of OFFICE OF 0 BUILDING DEPARTMENT 1600 Osgood Street, Building 20, Suite 2035 North Andover, Massachusetts 01845 Donald Belanger Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION I'lease print DATE: JOB LOCATION: 2- Number Street Address Ma /Lot HOMEOWNER 2 1-6' 9 3 - Name Home Phone Work Phone PRESENT MAILING ADDRESS 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,p ovid d that the owner acts as suMi[vi-s-or. 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 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 SIGNATURE........_4k APPROVAL OF BUILDING OFFICIA( —------ Revised 8.2015 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTI 1688-9540 PLANNING 688-9535