The URL can be used to link to this page

Home My WebLink AboutBuilding Permit # 12/5/2016 Iso RTII BUILDING PERMIT QR�t4Eo TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION �R'L Date Received TED a.- permit Not#: " i � /7 �SSac►�us�� pate Issued: �MpORTANT:App�cant ra�ust co�ptete all items on this page x �QCATION Print PROPERTY OWNER D Y � � y 1� ear Sfructure , Yes n - MPARCEL ZONING DISTRICT H�stor�c ®%strict Yep n.: n o. TYPE OF IMPROVEMENT PROPOSED USE Non_ Residential Residential ❑ New Building e family [I Two or more family [i industrial [IAddition ❑ Commercial Q ration No. of units, ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition [IOther y D Watershed District Q Flood fart : ❑1Netlarids I� Septic Well p ❑Wai:erlSewer; `: _ __ _ . :: .. DESCRIPTION OF WORK TO DE PERFORMED' Identification- Please Type or Print Clearly PI10ne: ri`�Cs� ' OWNER: Name: a r�- 9 Address: Contractor Name: Phone Address. Supervisor's Coristructi6h LJcense: : - Exp Date Home.:Irnprovement License:_ : .. _ .-. _ ---- Exp Date ARCHITECT/ENGINEER Phone: Address: Reg. Io. FEE SCHEDULE-BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBASED ON 5125-00 PER S.F. notal Project Cost: $ FEE: $ Receipt No,: Check No.: DOTE: P o s o tra zth unregistered contractor do not hcxve access to the guarc�nty fund ------------ c - - _� i - — Si nature of cont ratQr SYgnature-of, Ower .. : _ .......... ............ VAORTH Town o n over. 0 J. C7611 af i h ver, Mass, Co 61(0 c0c.1C.E-1 K LU) BOARD OF HEALTH PERMIT T Food/Kitchen LD Septic System THIS CERTIFIES THAT ........ BUILDING INSPECTOR ............................. has permission to erect .......................... buildings on .... ........ Foundation Rough to be occupied as . ...... .............. ........................... 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 CONSTRUCTIO RT / Rough Service .... . . . .. ................ ........ IM......BUiL.D.I.N.G INSPECTOR.. Final GAS INSPECTOR ,Occupancy Permit Reguired to Occupy Buildinir 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. ............................................ .............................. .............................. ............................. jy <, Ef Al ......... J)IOC�s"O . ... .. ........ ........ ...... .......... ,(9Zx The commonwealth of Massaebu88t1 _ Department of Iftdus'trIaIA-riden's N X Congress,SW eety S�M! 100 M Y Boston,AIA 02114-2017 ;•^ � ASK w�vw.�nassgo�ldia .'*" ' derslConf�acto�rslExect7rzczaxa�sl;�'I�rmbexs. au e,moi - y�7Q�:kers' CoxnpensatitzLlnsat:r - TOBELIMEDWUJITff E`1�11d I' GAU ORI X• PeasePria e 'b]- � '•licant I�'oxr�atiox� `b� � ', �aX31�(k3usiness!{]xganizatxan/Suctividual): �L�f�� i"�"��!s�.� . Address: Ce9V Phono tyl tatetZi : Type oftproject(ret�aixad); .Axeyou ext employez?G�ecktIie apprapxiatebax: F El 1.E]Tam a employer vri--fh. employees(�u11 andlor paxC ane}•'` 1 constf iicfaon g. Rexs�o deliiig qQIamasolo proprietarorparfnershpandhavenoeraploys WO)idng oxmeia ❑fie � oSi any capacity.�7ov,orkers'comp.insurance required.] Iamahomeownerdoingallvaoxkmyseli Nova'orkecs'comp.insurancerequired] �` Id❑Building addition 4. I am ahomeovrnBr aad will be hiring contractors to conduct a31 vroom on my propezEy_ Iwill x1.❑EIectricalepais or additions r ensisetlra all contxapthTs eitherlrav,workers,compensadon insmanoe or arc sole 1_2, '-_'�'''�ibjti .re a#,9 ox addi-dons ;7g proprletoro wlthnP earl�ny :5.F]I am a general nontracto<and I;havehuede sub cnnfracfors listed onthe attached sheat 13•.r]Roof zepaft9 These sub-contractors leave employees and have workers'comp.ins4uance.� 14. Other S.[:]We areacoVaration.andifs,of�cershave e�cereisEathDirrightofbxomptionperlVlGL c. 152,§1(4),and°ave hate no employees_[No workers'comp.ins�srance requi- 41 a oantthatch a] ostalsai?1lout thaseotiortbelowshowe,Stheirworlters'campensafionpo3ioyibinitnaiion AnyHomeowners what idvlt indicating they are doing alt work andtltenhire outside contractors must submit a new aidavit indzcaiit sue P]?h -. �Cnntractnxs that checkthzs liox must attached an additional sh their weork-0 of the sub -co'ntraot and sfiatewhether n irotttxose entitles ave employees. Ti•tha sob-conixactoxs have empinyses,they -oro-vide; ern r0 ees ..F�sIOFv is t1"i EpOTrCy al1d j'ob,site ram a epnpZoyep that is_pro ding�voxkeNs'ca npensafiorx xnsztrartcefop arty p y information. Xnsmance CompanyN=e: • �xpixatianDate= Policy#or Soff ins-Lir.#: City/State/Zip: Job Site Address: AttneRacopy ofthe-Workexs' eom�pensat�oxxpolieydecIaxatimzracgimiraalvioationpounishableebyafbibUPtoff 50000 pailuze to acture roveraga as regi ed uadez MGL a.152,§25A xs and/or t e-yeax haprisage as r as-veli as civil penalties inthe forte of a S I OP WORK Op and a$ite of up to $250.00 a day against the violator.A COPY ofthis statement may lee fozvlarded to tha Office of Trvestigatioxts ofthe DIA forsutance coverage-veri-flcation- rda hereby ceptify ep tZ crir�s and nalties Ofperjury tlxat flee infarraaatio�z ppavider�above M tpue ar?d correct - Data: Si atiarm Official rase orzly. Do not-W ite in taxis area,to bee by city ap tO{ r2 afjccia City or To-ym- Issuing AufhoXiLY(circle one): ' �.Elactriector S.Plumbing Inspector I.Board of)aealth )1.BuRdzngl)epart�aent 3.CitylTo n Iexl cal�sp 6.other Pltorte#- Cowtact Person: M4RrW TOWN OF NORTH ANDOVER G OFFICE OF BUILDING DEPARTMENT 120 Main Street o„4?.,.•* North Andover,Massachusetts 01845 CHU Donald.Belanger Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION i Building Permit Ap lication ) Please_�t_izlt DATE: ✓VW / JOB LOCATION: � ,6 6/ 5 ---- __ Number Street Address Map/Lot HOMEOWNERiN me o Roane ?hare Work Phone PRESENT MAILING ADDRESS ,/�/�� >>e�r_Tbw 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 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 lie/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURES -..,. APPROVAL OF BUILDING OFFI IrI Revised 9/16 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONS17RVNI'I£)N 688-9530 HEALTH 688-9540 PLANNING 688-9535