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HomeMy WebLinkAboutBuilding Permit # 12/23/2016 �o i?TN BUILDING PERMIT oF�TLEo ,6�. TOWN OF NORTH ANDOVER '.- APPLICATION FOR PLAN EXAMINATION Permit No#: a i f9 7 Date Received (v ) �SSACi-ius�� Date Issued: MORTANT:Apply cant must complete all items on this page LOCATIDN � ` . 1 Pnnt PROPERTY ®INNER _ y - Pnnt [W- ear�St crucru tore' T yes no jVIAP PARCEL ZONING D1STift1CTkH�sfiorlc ®istnct yes r�ca M S IiopVllage yes n TYPE OF IMPROVEMENT PROPOSED USE Residential Non Residential ❑ New Building WOne family ❑Addition ❑Two or more family ❑ Industrial TIteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg El Others- ❑ Demolition ❑ Other _ Food` lain C7111fet€ rids:;:M D UVatershed )aistricf I� Septic OV1Iell _: p. . _ : DESCRIPTI®N ®1=11VDRK T® DE PERFORMED: Identification-- Please Type or Prim Clearly OWNER: Name: W r, r Phone: w � Address: �u 7 ' Contactor Name:-- -,_- _ 5tipervisoe's Cartstructi-din Lise -- Exp? Datex Name lmprovemeri Liceasea Exp Date ARCHITECT/ENGINEER Phone. Address: Reg. ilio. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125,00 PER S.F: _ Total Project O®St: $_ �....' ®CSC! _FEE: $ Check No.: Receipt No..: NOTE: Persofts e0.trq4' g ifiih unregistered contractors do not ave:aeeess to the guarantyfund nnai rra:Mr AriPn'ibnPr " Sianafiure of coiitracfior - -T NORTH own of No. LAXI ver, Mass, �o��,�M�W,�� �. A7, BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ........ .. MA. XxsBUILDING INSPECTOR has permission to erect ......................... buildings on ...4V..... .......!.. .,......f.,,.. Foundation 4OV 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 CONSTRUCT , STA Rough Aro AV Service ....... .y, ..... .......... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Kermit 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 Det. 4 &228 REAH_em«_mAa Kitchen 1 - Plan e& All measurement in inches ? 000 0-9581-9169 »e . .27 3116 . 40 5315,116 a 61718 a i 36 < LO \ ^ \ G a | � \ _ — 2 Cl) 41 - � | � � C'j LO _ —e . J. i — H2518 231-12 Sa ! m 34 1116 2: 2 ! Important IKEA cannot accept a2 a&ity for the accuracy J measurements or furniture layout. Prices in this program are for products you collect fromIKEA, take home and assemble yourself. All requested delivery, assembly and inst&mm services are charged separately and not included in the price. Although we 6 t to nee that theinformation ams program is correct, we apologise aR6#a�trat;«sbk may occur. http.1/kitchenplanner.ikea.com/US/Ul/PagesAIPUI.htm ,@ of p0R7 ij� TOWN OF NORTH ANDOVER OFFICE O BUILDING DEPARTMENT + 120 Main Street VAT..0� North Andover, Massachusetts 01845 Donald Belanger Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Building Permit ApEfication Please print DATE: 2 JOB LOCAFION: / wcx o Number Street Address -- Map/Lot t HOMEOWNER J/"' L �t� 7 ` ` Sl21�- ' Name Home Phone Work Phone I'RES:LN`I'MAILING ADDRESS `� 0_4,&7 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 sut�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 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) `I"he undersigned"homeowner"assumes responsibility for compliance with State Building Code and other applicable codes,by-laws,tales 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. f i HOMEOWNERS SIGNA"T"URE APPROVAL OF BUILDING OFFICIAL I Revised 9/16 Farm Homeowners Exwnption BOARD OF APPE.A1.,S 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 ,3We commonwealth ofHassochasetts _ De lent a findastrialAccidefats x Street, Suite.700 n _ r Congress,5` y Boston,MA.021142017 www.rnass.go•v1dia YI�M '• syt Sl w..j.exs' Com.pensatioxAftsura=e Affidavit:Bnilderg/CG.A[]a �7C�I �r�c�a�aslL'um errs. TO BE I+`xLED�W3:.1'H THE 7�ER'NIl�"L�1N .Rlease 7'rint Lc 'bl A •'Iicant ormation a%onlxndividual}: r r l7 Name(BusinesslOxgariiz T�, (507 s� -rt( tiGo���C Q �y Address: g2t (� Citylstatelzip: Type ofproject(�ec��xed-)r Axe you an erapIoyer?ClEeclz the appropriate box: - . I am a employer vzith employees(full and/or part f imo)-- 7. [1 Nevr'donstruction g, �emodeliiig 2.0 I am a sole proprietor or partnership and have zoo employees WoTld"g for me in 9 ❑D emalition any capacity.[Ne�varkers'comp.insurance required-] 3-DI amahomeovmer doing allworkmyself.[Nnwarkere camp.imirancereguiredA t 10 F]I33uilding addition �am a homeowner and pili be baring contractors to conduct all work an my property. I will i ❑Flectrical.pep*3 or'additlgPs 4. + ensurethat all contracfbzs either have workers'cawpensatiorr insurance or are sale I2��-PlumbiDg repaixs or additions prnprietozs�rrith no i;�p7.aYees. 5.�I am a general contractor and.x�avahizedthe suh-confraetozs listed onthe attached sheet. 13.[ Moafrepaht �rese sub-o'al c fozs jave employees and have workers'comp.insurance. 14.r]Othex s.❑ perMGLn. eareacorporoorianits,oficer,haveexer rdtheirnightofexemption d. I52,§I(4),and ern have no employees.[I�7o vynr3[ers'comp.insurance zegtnred-1 . *Anyapplzcautthatcheckstrb>#1 must also lIoutthesectionbelowshowingtheirworkers'compensationpolicyinformation' I Homeowners who submit this a d�t 1 n&e an ad t-eonal sheet shout g thenameath sub cimtcactors and ewhether or nPotthnse gnti*5)1 ye h *Contractors that rhecktins box mast a employees. Tfthe sub-con#ractoxs have employees,they raust prow.detheir workers'camp.policy numt�er_ x am an ern Zoyer treat is pr'oviding�var*rcers'compensation insuranceft"my employees Below is trze policy and)0b site information. lfnsuranG0 Company Name: Expiration.Date< policy#or S elf im.Lie.#:. City/stato/zip: Iola Site Address: f (showing xou page(srov zgtbe QoficYn'mber a-ad expiration date). Attachacopyotheworkers' conpepsedon policy declara to$1,500.00 h`atlur e to secux'e covexage as xegm-ed un derMGL o. 7.52,§25A.ria f a STOP O WORK ORDERla-id a fine of uli to $250.00 a and/or one-Yea impzisonm ent,as well as civil p enalties in tb e farm of a;a� an against•the violator,A copy ofthis statement m ay be forwarded to the©f6 ce o£I'nvestigations of the DIA fox insurance Y coverage verification. urx er'tree ar s crxidpenalties of perjury thaI the information provided above true and carred 1 da rzer'eby certify - � ,� �/"�'"� Date• Si at.-pro: Ono#: official use only. Do notwrite in trzis area,to he completed by city or tarvn officiar Per)mnt/Licenso# City or Town.' IssuingA.0 X.ity(circle one): ectox 5.Pluxaxhiugx pector 7.Board of P(ealtb 2-)Building Department 3.Citylxo Clexl .Li lectrical Insp G.Other Phone#- 3 Contact Person.