HomeMy WebLinkAboutBuilding Permit # 12/16/2016 NORTy
BUILDING PERMIT of 1Ct"En
TOWN OF NORTH ANDOVER w -
APPLICATION FOR PLAN EXAMINATION
qp `9
Date e ReL�+/�1t.rlv
N 8 P/ :a•q edf TED
permit No#.42%
�Y r l4yp �Ssac"us��
- pate Issued: -
IMYORTANT: Applicant must complete all 'items on this page
C/
L.ocATIoN � -
�
PRQPERTY OWNER ' -
Pnnt ar Sructure es
'IOD Ye Y
MAP. PARCEL �._ZONING D1STFlCT Hrsto`r�c ®istrict yes i
Machine Shop Village :__Y
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
p New Building MOne family
[I Addition ❑Two or more family [I Industrial
Alteration No. of units: ❑ Commercial
❑ Repair, replacement 0 Assessory Bldg
❑ Others:
[I Demolition ❑ Other
11 Septic 1Nell . ❑ Floodplain Wetlands Watershed District
�11VafierlSewer., .
DESGRIPTION OF WORK TO BE PERFORMED:
1 if� V'� � 1^01�� �G 7777 c.C�°I^ �✓�, �� {i
Identification.-- Please Type oT:Vrint Clearly' c� t
OWNER: Name: �c ,( "-G- I �1a Phone:
Address: � �1d �4ecd
Contractor Nafne
I`'horie .
;Address:. . .
5i�pervisar's Gonstructiori License
Exp: Dade
Home Improvement License: . Exp_ Dade -
AR CHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT.$12_0o PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F
( �J I
Fatal Project Cost: $_ t ® FEE:FEE: $
Check Na.: Receipt Na.:_, l
:DOTE: persons contracting witli unr"egister�ed contractors do not have.access to the guar�ranty fund
5ignafiUr: AA '9entf,wrier
Si natures of contractor
- . __ - _. . .... _....
` ORTH
own o ndover
M_ la
No. et
-� 1
soh ver, 4
COCHfCHI WICK 4�.
°4Areo
U BOARD OF HEALTH
T D PERMIT .
Food/Kitchen
Septic System
.�.. .� . �.. ........15-r-OWIVBUILDING INSPECTOR
THIS GERT11=lES THAT ••• • ••••""""
�•...;.. . �� �� Foundation
has permission to erect.......................... buildings on . ........................
...... .....•. Rough
....
g
...... ....................... Chimney
to be occupied as ..................... ,.......,..... ..
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
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit.
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCT RT Rough
...... '.... .... ......................................... Service
Final
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.
t%ORTH TOWN OF NORTH ANDOVER
OFFICE OF
0
1 'A BUILDING DEPARTMENT
120 Main Street
0 1
01414y#.—
North Andover,Massachusetts 01845
Telephone(978)688-9545
Donald Belanger Fax (978)688-9542
Inspector of Buildings HOMEOWNER ,NLICF SE_.EXEMPTION
Building Permit Application
JOB LOCATION: o_d
-
Number Street Address Map/Lot
11 TR( Doc)
'Doc)
, 0 d
HOMEOWNER— 61 Pv\\( 6I
—
Name Horne Phone Work Phone
PRESENT MAILING ADDRESS )
CityTownState 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 sui)ervisor.
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 stnictures 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 I O.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 with said procedures and
requirements. /1117 1
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING OFFICIAL -------------------
Revised 9/16
Form Homeowners Exemptiozi
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 1 IEALTH 688-9540 PLANNING 688-9535
CA J
04,
cod
ZIA VA v
QuAl
:,MAKE A PLAN
Use this graph paper to be in fleshing out your vision.
i
.,7
f ,
:
_
4 '
7 ,
_
a
1, (f
4
f
i
:
i
4
, I v
I
1
,
1
I r i
E
� 1
i
V
:
_
,
i
i
s
q
FDR NSQIRATION .a
SEARCHc
Pull pictures from magazines of what you like aesthetically.
y.
Y910 �
. . ..... ..... .... . . .. . . .. . ........... . ... ..
,ne Common�veart�i of Massa�����s
_ Department of Ix�dr�straalA
S I Cng_r_,ss Street, S4 Me 100
Boston,MI 02114-2017
~ s ww mass.gov/dza
FqW
wa kerb, com.-pe:asatiox� once A a4zP J3 �AUs to�S Lriciansl l ers.
TO BF,WID'Pi'yMTff 'lease 'xint Le 'bl
1� ncant Woation y�
`t
ile(BnsiulsslOXgaroizatSo�lSrol di victual):
Address:
d City/Mate/zip,
Type a roect[ eed)
i p
7.
Axe-you an erapinperY C Jleelr the apprnprtate box: �{1�e 1'co77sirirotlo3l
employees(full andlor part time}. 8. I � e3pooliiig
l.�X arrr a employer vrlth- -..---
2.�xamasaleprnpziatoraxpaxinexshipandbavenaemplayeesWorkingiormein [] ]emolition
any capacity.jl,7awarkers'camp.ixisuxance required a � addition
10 Buil " g
3.[ mnahom-eowmrdoingallwar$myself�NAworkers'comallSvorkonmy7?rOperty I-WRI ectrJcalxe ,$irsoradditions
contractaxsta condo �.�El p-
4. T am a homeowner anrlwill be hiring l j' re oars or additions
encore that all contzactars eitherhave workers'compensat[or�insurance or
are sola 12_�:�r k9
proprietors withn.employees. 3: Roo xeliairs
S.�Y am a general.aanfracfor andh1 v�andliayewarker�s'f as�stedon�atfaahed cheek 14. Other
These sub-contractors hay .P y t of exem tion er MSL c.
{.�pre sre acorporstiori and.its.affcershave exercisedtheirrtgl3 P p
15e §1(4},and a7aaveno employees.PNav�ozkers"camp.iusuranaezequired
a Iicantthatnheak5bl#1mi�sEalsofiltt}utt3reser tionbelov�sktoWingair�vorkers'campensafronpolieyiafomnation '
A''� pP ' aftaciavAt indiaaiing they are doing allwozk andthen bix,o#W coniza t zs and sEate ether or;a moose e 6Aesi b ve h
Homeowners who snbmitttus,., shectsthananae of
thb teontraetors that claeckthis liox must aftaa ed an additi must xo�ide thtk wa€l as'comp.policy numbex.
employees. Ifthe sub contractOrs lrave erployees,they P
at is roridirzg7vazkers'carazpe cation insUranceforrny emPlbyees. BeZorl�fstriepolicy aradjo site
X a n an em t7i P
infarmadon.
hgarauce compan-yNairlo ��p�atxanDa#e
Policy 0 or Solf-i s.Lfc. :-
City/State/zip:
Tarn Site Address: a e sho-WbIgthepolicynumber and expiration date).
Job Site
a copy'a the oxkers' cOL)npe?Lsation.PORCy declaration P g ( to 1500.00
A-Uas xe ed under MGL c.152,§25A is a arimix�al vial ORY OR7DFR and a fine ouii 020.00 a
Failure to secure coverage en.aities in the foxes ai a S p0'W
and/or one-yeax'imprisonment,as
-well as civil P
day again8t
the violato:t.A aopY o�this statement rosy'be forwarded to fha O�.ca a£�tvastigati.ons oath-a D7A.�bx i�3arauce
coverage yerlfication_ treat trte infar�ncrtion ,ovidec�a a-ve is tfae end orreGt
do riererxy cern undep tree grins andper�alties ofperjury
pate:
Si atUTB:
Ilona 0.0. Gaal
pf cial use only- .Do not"vr�ite In trim area'to hg cornpkted by city or toOn offi
• ?2'�erxnitlLiceuse�
City or'Z'ov a-
circle one}: Clerk d•.WeetrzeaUnspector 5.)'Zuxrxbi ng inspector
�srzibtgA-u-�hozity'( art�.eut 3.CztY1'�'o-Wb.
1.Board ol'-ff6 h 2-B gDep
6,Other
Phone#-