The URL can be used to link to this page

Home My WebLink AboutBuilding Permit # 10/31/2016 ttORTH BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION .pA permit No#: Date Received �� RArep f-C SSAC FH1 Date Issued: IMPORTANT: Applicant must complete aI1 items on this page wVo .LOCATION pr lit PROPERTY +OWNER- � Print ISO Year'S ructure MAP PARCEL ZONING D15TR1CT :l-]tstoic Dlstnct yes M ad ine Shop pillage TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family [IAddition No, wo or more family [I Industrial Alteration of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ septic ❑1Ne[1 ❑ Floodplain D Wetlands 17 Watershed Distric 1NaterlSewer DESCRIPTION OF WORK TO BE PERFORMED: f t e d � Identificati n- P e se Type or Print Clearly OWNER: Name: r Phone: Address: �$ Cor}tractor Name: Pho.re. Email. Address::. . SUperv�sor's Construction'License Exp Date Horne Improvement License: Exp Date ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.'$12.00 PER$1000,00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER SF. Total Project Goat: , _ _FEE: $ — Check No.: _Receipt No.: NOTE: Persons contracting witl registered contractors do not have access to the guaranty fund Signature of Agent/Own _ Signature of contractor tAORTH '4 Town o _ ndover ® �++ No. ver, Mass, -a` COCN1CMlwic I ` U BOARD OF HEALT14 Food/Kitchen PERMIT . LD Septic System THIS CERTIFIES THAT .W.t.�i ( � BUILDING INSPECTOR THAT .....Z..* ............. �T ...................... Foundation has permission to erect .......................... b ildings o .tr. . �..... . .. ir. ..... �iw� Rough to be occupied as .. �. .. ..... ..................................... Chimney provided that the person accepting this permit shall in every respect con or 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 CONST TION S Rough Service "' Final BUILDING IN CTO GAS INSPECTOR Occupancy Permit Required to 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. of �oRr� TOWN OF NORTH ANDOVER OFFICE OF 10 BUILDING DEPARTMENT 1600 Osgood Street,Building 20, Suite 2035 North Andover,Massachusetts 01845 sAcµuse Donald Belanger Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please print DATE: U 1 .TOB LOCATION: I Number Street Ad ess Map/Lot HOMEOWNER ` rho Name Horne Phone Work Phone PRESENT MAILING ADDRESS _-Wld - 1),)'i '4zilev Ak - - OJIM7 ...... ................... City Town State 2rp 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 sWervisor. 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 IO.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 wi said procedures and requirements. HOMEOWNERS SIGNATURE-"' APPROVAL OF BUILDING OFFICIAL Ravised 8.2015 Form Homeowners Exemption BOARD OF APPEALS 658-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 The Commonwealth of Hassachlaetts • Department of indiustrial Aceldents -'� 1 Congress Sheet,SWM 100 a021.144 20X7 - F Boston,MA �t www.mass.gov/dia jt►�kexs'Compensation Tnsurazr ce Affidavit:Builder/ContactoxslElectriciansllu�mbexs. TO SE-FILED WIT,,THE pRMgTTlNG AUTROMY. Please Print Le 'bl A licant xn-formation JI I Na7TJ.0 (BusinesslOigariization/lntiividual): - - Address: Gi I Y Phone tate Y /�i ie datebox: "Type of project Qequzred), keyou an employer,Checkt ie app p X,❑I am a employer with employees(full andlorpart-time). 7. ❑N6yv'donstruction �. I atm a sole proprietor or partnership and have no employees working forme in $• Remo any oapacity.[No workers'comp.insurance required.1 9. Demoliti94 3•Ej I am a houzeowne,doing all woxkmyself[No workers'comp.insurance required.]t i o❑Building addition 4 I am ahomeowner and will be hiring contra, to conduct:all work on my property. I will i i.❑Eiec-rical repairs or additiops ensure that all contractors either have workers'compensation insurance or are sole �,—� hitt xe alYs o7 addztions Proprietors withnoe�pioyees. um �>L~-F�� - g rep sU I am a general contractor and I have hired the sub-coatraetors listed on the attached sheet. i3•.[]Roofre&ir's 'These sub-contractors have.hn iayees andhave workers'cramp.insurance.# I4. ]Other' (,,❑We are a corporation and its.officers have exercised their right of exemption per MGIC c. 15e re a G end We have no employees.[No workers'comp.insurance required.] -w showing their workers'compensation poliry Any applicant that checks bolt#� davit ind3 fang theysare doing all-work andthenhire outside ccontrao ors must submi'a m affidavit inc eating such. Homeowners who submit•tbis affi. . Contractozs that check this lion rrrust attached an additional sheet showing the name of the Sufi-coutracors and state whether or not(hose entities ova employees. Ifthe sub-c; have employees,they mustprovide their workers'camp.policy number. file�oZicy and j oli site I am an employer'that is providing-wopkerls'compensation insurance for MY employees Below is information. insurance Company Name: Expiration Data: Policy 0 or Self-ins.Lie.#:. City/State/Zip: lob Site Address: ' compensation policy declaration page(showing the policy number and expiration date). Attach a copy of tine worl�exs Failure to secu re coverage as required and penalties antbe form of OP 25A is a criminal violation ORDER and a fine f p to $250.0 0 a and/or one-yeax imprisonment,as well as evil p day against the violator.A copy of this statemeat may be forwarded to the Office of xnvestigatioxrs of the DIA for iusrxr once coverage verification. I of perjury that the information provided above is true and'correct I do hereby certify u Pains an Date: Si atuxe: Phone 4: official use only. Do>zot-Write in this area,to,he completed by city or town official: Permit/License# City or Tovvrr- Issuing Authoa•ity(circle one): i 1.Board of gealth M3uildingDepartnaent 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#: Contact Person;