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Home My WebLink AboutBuilding Permit # 10/12/2016 OF NORTH HN BUILDING PERMIT .o TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ` Permit No#: Sri o -gat 7 Date Received P� ,SsacHusE Date Issued: IMPORTANT:Applicant must complete all items on this page PER OWNER �# FD(3eartr�cture �e '.. ��r MachtneSt�ap /aflage Yes 3n TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential New Building ❑One family ❑Addition XTwo or more family E Industrial X Alteration No.of units: -3 N Commercial ❑Repair,replacement C Assessory Bldg IS Others: ❑Demolition 0 Other II Septrc Well 1�Floodp(atn D FNetlandsl UVaterst�ed"Olstnct w 1.tTlater7Sewe( r ` DESCRIPTION OF WORK TO BE PERFORMED: ,7 ±rbc S"�t�. .aT€.-moi. hE es�l Y.F-L�. �t Z �pax zc n-� t�i� vGN W ZtvDpWS 'I` k1�e'E� C� SS 5T Identification-Please Type or Print Clearly OWNER: Name: i:5�1A., -ez�gr2c�, Phone:ff 5s 1 _ Address: 15-1 4 ,91,C0L- =fid.,> Contractor Name Phone Etnall Address St��l;lut��Constnlction License E�cp Die ARCHITECT/ENGINEER Phone: Address: Reg.No. FEE SCHEDULE:BULDING PERMIT$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: ' •< ' FEE:$ Check No.: JL Receipt No.: 31630 NOTE: Persons contracting with an red contractors do not have access to the guaranty fund Signature of Agent/Own - A Signature of contractor Plans Submitted❑ Plans Waived❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Swimming Pools ❑ Tanning/Massage/Body Art ❑ 6 well ❑ Tabaeco Saies ❑ Food Packaging/Sales ❑ Private(septic tank;etc, Permanent Dmnpster on Site El THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM PLANNING&DEVELOPMENT Reviewed On Signature COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance,Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer Con nectiontsi nature&Date Driveway Permit DPW Town Engineer:Signature: Located 384 Osgood Street FSE[DEPARTMENT Temp Dumpster on site .yes _ no Locatedat 124 MaS reet F re Department signaf ied1da-te Town ofAndover No. C, h ver,Mass, 10 . C2 ya its e BOARD OF HEALTH Food/Kitchen PERMIT TO ILD septic System THIS CERTIFIES THAT............. ..1.4.1 A . BUILDING INSPECTOR .:.. has permission to erect..........................buildings on.... ......... .... Foundation Rough to be occupied as.............RCM,.4.e ........ Jrfoc.'a...................... 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Nrmit Required to Occupy Buildin 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 Bet. t I L _- r 1 I 17> willI I i � t 1 I € 1 i 1 1 , i NoarH TOWN OF NORTH ANDOVER '.. OFFICE OF o BUILDING DEPARTMENT + 1600 Osgood Street,Building 20,Suite 2035 t"s* North Andover,Massachusetts 01845 4SSACHu`'�'t Donald Belanger Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please print DATE: k t JOB LOCATION: K) Number Street Address Map;`Lot HOMEOWNER Name Home Phone Work Phone PRESENT MAILING ADDRESS9D 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 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 hyo-year period shall not be considered a homeowner.(780 CMR Section I 10,R5.12) The undersigned"home-owner"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 f HOMEOWNERS SIGNATURE -' APPROVAL OF BUILDING OFFICIAL Revised 8.2015 Form/-tam—e.E—ption HOARD OF APPEALS 688-9541 COtiSERVATION 648-9534 HEALTH 688-9540 PLANNING 688-9535 The Commonwealth ofHassachusetts Department of IndustrialAecidents 1 Congress Street,Suite 100 Boston,l'VIA 02119-2017 wwMinass govIdia Workers'Compensation Insurance Affidavit:Builders/Contractors/EIectricians/Plgmbers. TO BE FILED WITH THE FERNIITMC-ADTHOMTY• .P.Iease Print Le•blv A 'licautInformation Marne(Businesst6igadizafion7lndlvi.dual): Address: 151 tkjAver- City/State/Zip: Nc,-�n1vt2 M i5t�f5 Phone#: 718� By RR Rr� Type of project()required)! P_reyou an emp2 Y rR Gheck thea ro ate box: em Io.fvll andtor part-time).* 7. ❑Ne'sv COILStI't2Gtlon 1.❑Iau aemgloyer with P Y 2.❑lam asole proprieforor partnersWP andhaveno omp.oyees working forme In S. �Remahti.. anY capacity.[�l'oworkers'comp.insurance required.] 9. ❑Demolition 3.T&I am ahDmeowncr daLng all vmrkmysol£[N.w akers'comp.Lisa nce repiv d.]t 10❑Building addition ¢,❑I am ahomeownor andwiIlbo hiring contactors to couduat all work en my property.I will 11.[]Electrical repairs or additions ensnreihat all confrac#ors either havewarkers'compensation insurance or are sole P�111Tlbirtg repairs or additions proprietors with xur einploycea 5.❑I am a generzS contractor and Ihape hiredtfie sulrcor==tractor listed antha stfached sheet. i3:[�I2obfrepairs ThesesulrcontraeforsLaveemployees ndhavaworkers'comp.insnrurce.t 1¢,t—SOtheT . 6.❑We are acorporation and its.offtcarshaVe axe;cisedfheir tight of'exampfion perMGL n. 152,§i(4},and wn have no employees.[No wozkem'<omp.insurarca rn}uued.] *tYaPRlicarytthat checks box#i must also fill out thesal�lwork andthenhire oufside cm ntrac o�s mwtsubmf aanzw afEdavit indicating soak *Any.or'•ners who submibthis affidavit indicatingthey g entities,have tContractcfs that checkthis tion must attacfied au additional shoot showin the name ofdze gab-Contractors and statewhether ornotfha:,, employees.Tf tho sub-coniractor5 fiave amFloY�.�Y must provide their n�orlters'comp.policy numfier. .. ...... Zanz an employer that is providing workers'eonzpensati,.insurancefor my employees.Below is the policy andjob site information. Insurance Company Name: ExpirationDate: Policy#or Self-ins.Lic.#: City/Stata/Zip: Job Site Address: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). quired under MGL c.152,§25A is a criminal violation punishable by a fine up to$1,500.00 Failure to securo coverage as recivil andlor one-year imprisonment,as W flellys stat went may be forwarded to the f e O Ian ORD uonss oof th DIA for insurance a day against the violator•.A copy coverage verification. I do hereby certify under'the pains and penalties ofperyury that the information provided above is true and,correct. .�! Date: Phone Eother only.Do notwrite Era this area,to be completed by city or town official. permit/License# ------------ e' hority(circle one): Health 2.Building Department 3.GStyfl'own Clerk .EIectricaIlnspector 9.plumbing inspector Phone#• son: