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HomeMy WebLinkAboutBuilding Permit # 11/18/2016 0 , BUILDING PERMIT TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit NO: '. Date Received N NAT.. .01 Date Issued- US IMPORTANT: Applicant must complete all items on this page .......... TYPE QF IMPROVEMENT PROPOSED USE Residential Non- Residential 1-1 New Building Cl One family El Addition 11 Two or more family Industrial El Alteration No. of units: [--I Commercial D(Repair, replacement 0 Assessory Bldg 11 Others: 11 Demolition EJ Other D, P a), ["I 6ti h Di tact„% "Alk Identification Please Type or Print Clearly) OWNER: Name: N Phone: Address: --- m 0/1 MORE' "m, W// /z m 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 S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ,5fgp "o 'ot re f A11";�.ff 040 igh6turet"o "T F gs®RTH own of 0 LAMR h ver, Mass, �� its Zvi& COCKICKRWICK FigS0 ATED 1.7¢�i,�� U BOARD OF HEALTH Food/Kitchen PERMIT - Tu " LD Septic System THIS CERTIFIES THAT ......5ToN.... ... BUILDING INSPECTOR has permission to erect .......................... buildings on ....... Foundation r r � Rough to be occupied as . 1�F ,/M .. . . jj �.. jWW­ Chimney provided that the person accepting this permit shall in every respect conform ro thterms of the application 4AP61 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 CONS ® Rough Service . . .. .... . Final BUILDING lNS ECTO GAS INSPECTOR Occupancy Permit Required to OccuiZE 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. art t%ORT#1 TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 120 Main Street Arso North Andover, Massachusetts 01845 CHU Donald Belanger Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Building Permit Application Please print DATE: JOB LOCATION: Number Street Address Map/Lot O �� HOMEOWNERb' Y\ Name Home Phone Work Phone PRESENT MAILING ADDRESS— ) '2— 4(_ 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 supervisor. DEFINITION OF HOMEOWNER PQrson(s)who owns a parcel of land on which fie/she resides or intends to reside,on which there is,or is intended to be, a oric-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 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 fie/she will comply with said procedures and requirements. HOMEOWNERSSIGNATURE RE APPROVAL OF BUILD11<6 OFFICIAL 0­1 Revised 9/16 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVA11ON 688-9530 HEALTH 688-9540 PLANNING 688-9535 I'he commonwealth ofMassachusetts z Department oflndustrial.Aceidents h'. 1 congress,S`reet,AS`uite 100 Boston,M9i.0.2114-2017 rvww.mass.go-vldia ,s ' Wavkers' Com�pensat-iox�X�rsu�ra�a.ceA:�fidaYit:33u�ders/Contxaetoxsl�IectricianslJ'Xnmbe�rs. TO BD MUD WITH TEE BERwi�`z M AT7THDIUJ S'. Please Print Le '�l A ' licant W,o-r-Mation Name(Busine1esslOrgariizationlindividuaJ): o� �S` Pholae,4: City/state/Zip: �ieL mplopexY Cheep the appropriate box: Type ofproject quired):and/orpart-time).* 7. pI�e`{d6nsd-don l,[ Iamaemployerwith p y { $. �Rexuodel'eiig 2.�I aan a sole proprietor or parttaership grid/ante no employees working forme ixi - any capacity.�Noworkers'comp.insurance required./ 9. ❑Demolition 3,D I am ahomeovnner doing aU workmy'"K-[No workers'comp.insuzancerequiredj t 10❑BuUding addition. ¢.moi'I am ahomeowner and wM be/airing contractors to conduct an work onmy property. Iwill 11.F]EleetTzcal�epa3Ss or pddltlo}�s assure that all contrartbis either have workers'compensation.insurance or are sole Te ajrs or addatioa s proprietors withno empioyees. ��0 Pry g � 5.�I am a genezal contractor and I hays lairedtlae sub contractors listed authe afixched sheet. 11[�Roof repairs These sub-contractors Uav employees andhaw workers'comp.insurane�t lA.Q Other �•❑ eareacorporadaianclits.ofi csrshave exezcisedtheir light of'exemption perMOL o. i52,§I(4},and We]nave no employees. No wozkers'comp.insurance roquited] licy inbrmatio1r. *Airy applicant#hat ohs oks bbx€1 day inscli atuag they are mgl�work amthen hue outside ccontracto s mow showing their work-S'COMPeosavon oult submitnew affidavit indicating such T Iiomeawners who submitthis aids. tCnntzactors the#checkfiFiis lion r cruse attaclied'an additional sbeetshowmg the name ofthe sub-contractors and state whether of nae those entities ays employees. Ifthe sub-contractors have employees,they must protide their workers'comp.policy number. I am an employer that is providingiporkers'compensation insurancefor my employees. BeioFv is tliepalicy arzdjob site information. InBurance CornpanyNaxne: Expiration Date' Policy 0 Or Self-ins.Lic. �f[� IPA � 18''i 1 `� City/Stag/Zip: -- Job Site Address: �• sho-wing the policy uuMber and eXpiratio-.date). Attach a copy oftb.e�voxirers' com�pensa�tompolaey declaxation.Page is a Criminal Failuxe to by a ffib up to$1,500,00 secrete coverage as required undez�M penalties ins§he form of a STOP-violation ORDER and a�of p to $250.00 a and/or one-year inaprisonment,as-Well as x P day against the violator.A.copy ofthis statement may'be forwarded to the O�ca of).vestigdtions of the DIA fbr I suranor; coverage verification. xdo liere/iy certify der the at ar�dper�alties ofpetjury t7aat tT2e information provided aha e is trrxe and car�ect . Date: �2o t �, Si ature: Phone : offcial use only. Do no,-write ire this area,to be completed by city or town official permit/License# City or Townz xssui ag.Authority(circle one): � ectoz L13LfpTealtb �.BrxildingDepartment 3.CittylTo-vm Clerk 4.IllectricalInspector 5.PlmmbzngTwp Phoneerson.'