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HomeMy WebLinkAboutDEMOLITION OF CHIMNEY �aoRry BUILDING PERMIT °��T`En ;6�+� TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION -. ` �� Date Recessed permit.No#: �ssac►�u��� ©ate issued: 3 — IMPORTANT:Applicant must complete all Mems on this page 7-777777777777777777 -� inOGATION51, r nt� . � PROPERTY OWNER 1a0yearSt�uctute yes no Pent„ q eS nO PARGEI_ : ZQNING'DISTRICT H�sfor�c Distr�cpt yno IVIaclsirie Sho Village yes _ TYPE OF IMPROVEMENT PROPOSED USE Non Residential Residential ❑ New Building ❑ One family ❑ Industrial ❑Addition awo or more family ❑ Commercial ❑Alteration No. of units; ❑ Repair, replacement ❑Assessory Bldg ❑ Others: allemolition ❑ Other ❑ Septic D W611 u Floodplain ❑Wetlarids ❑ Watershed District ❑VlfaterlSewer DESC IPTION.OF WORK TO BE PERFORMED: �E� c�� , Identific do - Plea T e or Print Crly, Phone: ®~ OWNER: Name: Address: Contr-aetor Name:; Phoine::: .Address: 5upervisor's'Corlstruction Lacense: X13: Date Home Irnprovemet License: Exp. ARCHITECTIENG[NEER Phoria: Reg. into. Address: FEE SCHEDULE:DULDfNG PERMIT:$12.00 PER$?000.00 OF THE TOTAL ESTIMATED COST BASED ON$ 25.00 PER S.F. notal Project Coit: FEE: ^� Cheep No.: Receipt No.: � � NOT : Person contracting witli unregistered contractors do not have-access to the guaranty fund F, 5�gnature o entlOw er Signaturef contractor own of ndover 0 No. Y' O LANE h ver, Mass, 'AA • tocH¢MEWICA .[w S U BOARD OF HEALTH Food/Kitchen PERM_ IT T D Septic System THIS CERTIFIES THAT . .... tk. ...... .1..F.Y.c4res BUILDING INSPECTOR has permission to erect ........................ buildings on .... . .`.3. ......... .. K► `...... ... Foundation . . A M A0:116R Rough tobe occupied as ....... ..,.. ... ...... . .................................................... Chimney provided that the person accepting this permit shall in every respect c form 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 ® �g Final PERMIT EXPIRES 16 MONTHS ELECTRICAL INSPECTOR UNLESS C®NSTRUCTI® T RT Rough Service ..........,. . ...... ........................... ...... Fina[ BUILDING INSPECTOR 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. nE t%ORTN TOWN OF NORTH ANDOVER y�,�Ya 46y tia OFFICE OF BUILDING DEPARTMENT x 120 Main Street r Aa' 4h1TIIF North Andover, Massachusetts 01845 �T * FYI h� � 4"ACHUS Donald Belanger, Telephone(978)688-9545 Inspector of Buildings Fax (978)6$8-9542 HOMEOWNER LICENSE:EXEMPTION Building Permit Application Please print DATE: JOB LOCATION: Number Street Address Map/Lot i HOMEOWNER - v"°'t �.. y�^� Mr ✓1 w ... . . Name Home Pho e Work Phone I 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,provided that the owner acts as suet-visor. 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 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 SICNATUItI�,_��� " y APPROVAL,OF BUILDING OFFICIAL Revised 9/1.6 l Form Ilomeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Ae commonwealth of.HassachWI'18 ,Department ofjndastrialAceldents h . r X cong-ress Street,SdIM 100 ' d Dostoxj,HA 02114--2017 www mass govldia •oi SSA, Sy*� 7 -W.Vkere CompensationInsaranceAfl"tdavit:B dexs/C � s� txiciansl'I hers. TO BEYMED WITH'M'R=TRT�N �l [o Pgease Prnzt Digib A licant Wor ation \ ` V,), J Name(Business/Oigatvzationadividual): .A.d&ass: C.c�v � ' - Cid/8tate,/Zip: r . ;; AxeyoxrauexcrpSoycz? the app Type of projer (ra�nY red); 7. Nd4C6n8l6t10I1 part-time).* efull and/or z7th emPIaye 1.F]xaoaemploye l emodelilig 2.E]I am asoleproprietor orPmin ship andbaveno employees workiog Ibrme in 8. Q any capacity.jNo workers'comp.insurance required.] D olitiOn 3.�amahomeownerdaingAworkmy�elf[Noworkers'comp.insurancerequired.]` 10❑Bi diugaddition ¢.�l am ahazaeav�s€er and will be hiring contractors to eanduet all work onrny Property- I will f—f 7ler,4ical pepa,� a or additigPs ensure that all contractors erfl€eYhavo workers'compensation insurance or are sole �''L,J:P �unl7xligei1a3x5 or additions pzoprietors with.no 6rAbloyees. 5, I an a general cont IN,anti I have hizedtlte siih confraetors listed onthe attached sheet. 13.[�Ye6fre�airs These sub-coniractors have employees andhave workers'comp.insuxamce. 14• der fi, o ars a corpasatini and its,oftzcershave exercised their right of exepaptian per MGL c. I52,§1(4),sad vlehave no esnployces_[I.�7o workers'comp.insurance sequined pnsadon *Any applicant that cheAks bbic'#1 davit indicating they olAthe are doing all work andthen hira outside ow showing cntrac ors maust sabmit a now affidavit indicating such. i I3oroeowriers who submit dais a£ ,- tContractars that c7reckthis link must attach o an-additional t she their workers'comp.pokey n A tber and sLata vvhetbet oX ootfhose ent[1?es hate omplayees. Ifthe sub-eo,,6rtars havo ompl y they X am an employex that Is pro compensation ingurancefor my employees Below is tFiepoZicy andja site information. Insurance CompanyNama ExpirationWe, Polioy ff or Self-ins.Mo.ff. City/State/Zip: ddress: �sttachacopyol'-�e�vorl�ers' campeztsatiarrpolicydeclaratiou.page(showiugthepolicy bea�.ee�ta$.,500.00,. Sob Site A UP pailuze to securo coverage as required ua_derMU'I.,G. 152,§25A is a criminal violation punishable y att d/ax one-yeas impxisozzmeut,as well.as civil p enalties in the fozm-of a e Ofd a STOP WORK luvesgations of the DIA for JWuraUG�a day against-the violator.A copy oftWs statement may be foxtvarded to th coverage verification. do liere7ay certify txntler tliepaln8 andpeKattieg afper,�ury that tTie infonnationprovided above is irrxe and coIrec Date: 12' 2�PIZ_- Si ature: � I'haxie#: Of z e oxzly. Do not-Write in this area,to be pleted by city or town official PermitrUcense# City orTo - Issuing.A.Yxthooty(circle 011e), ty1Tp ecto� x.Board ofP[eal& 2.13ading ftart ept 3-Ciapvz3 Ciexk d»EiectxicaT lxzs ectox �.Pluxr�haaglnsp 6-Other Phoue##. Contact Person: