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HomeMy WebLinkAboutBuilding Permit # 1/20/2017 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION (Permit NO: 730 Date Received I 1 r Date Issued: _ IMPORTANT:Applicant must complete all items on this page LOCATION n PROPER TY OWNER LI P ; m rant,,, � % 1f10 r old Structure yes �, . ZONING DISTRICT Hist nc District` yes n MAP NO: PARCEL: ; ,. (Vlach r e�Shap Village yes_ no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building T&One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration_ No. of units: _ EI Commercial Repair, replacement ❑Assessory Bldg ❑ Others: EI Demolition ❑ Other © Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DE.. �.. , SCRIPTrcr N OF BORIC TO BE PERFORMED: ..... . . Identifica..on Please Type or Print Clearly) Phone: �✓" OWNER: Name: Address: �, ',� . r , CONTRACTOR Name: Phone:, Address: Supervisor's Constructio L cense: Exp, Date: Horne Imp _, menf License: Exp Date ".._ ARCHITECT/ENGINEER Phone: Address:_ -Reg. No. FEE SCHEDULE:BULDING PERMIT $12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$1 0 PER S.F. " a Total Project Cost: $ U/? �h� n��r� �� � FEE: Check No.: Receipt No.: NOTE: .persons contracting with unregistered contractors do not have access to the guaranty fund .. Signaturef Agerit/C►!rvner i a w Signature ofi contractor . Plans Submitted El Plans Waived ❑ Certified Plot Plan Stamped Plans NORTH '9 own of �� bAndover O No. � ra;&-Al_ ,h ver, Mass, # 0 COCNICNEWscm V 4aRRYED F`p¢,ct7 BOARD OF HEALTH Food/Kitchen PERMIT T, LD Septic System THIS CERTIFIES THAT ...1�.��rr==� ., ..8.0.6.....fp.1044.9.ov ako kBUILDING INSPECTOR!�........................... has permission to erect ............ ........,' buildings on ......J►..q. .......�..l..Q&.k.....AX................. Foundation Rough to be occupied as wos.11mw ...... rM^ ...... 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 MONTHSELECTRICAL INSPECTOR _ UNLESS C T CTIT Rough Service .......... ... ,. .,. ......................... Final BUILDING INSPECTOR GASINSPECTOR Occupancy Permit Rf uired 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. txawrH TOWN OF NORTH ANDOVER �.�"aro »••�a4 OFFICE OF BUILDING DEPARTMENT 120 Main Street North Andover,Massachusetts 01845 CHU j I Donald Belanger Telephone(978)688-9545 Inspector of Buildings Fax (97$)6$8-9542 HOMEOWNER LIQEaNSE EXEMPTION Building Permit Application Please print DATE: 14 .,, 1 TOIL Number Address Street s Map/I.,ot HOMEOWNER 1- 61__` C Name Home Phone Work rk Phone PRESENT MAILING ADDRESS e x"Ic �/1d .s 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 suerp visor. DEFINITION OF HOMEOWNF..,R 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. HOMFOWNF'RS SIGNATURE ; APPROVAL OF BUILDING OFFICIAL i Revised 9/16 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSEIi VA'r10N 688-9530 HEALTH 688-9540 PLANNING 688-9535 X110 Coinmonwealth,ofMassaehuseds vepartment ofXndasirlalAreldefits r xI congres'v street,SO100 'A 'goston,yA o2114-2017 wwvw.mav8.gov1Wa ers. WaVlters' Corm'ensaon-� Wux'2n XCce.��.dav�.�3�`aildexs/Coaatxae�o:rs/.�7ectr�cza�aslk'�.t�m� fi f CT`l F47STS ', TO BE JND`W T19 k'ES h�C1T7rJCN .,Blease b-lut Lep'lbl fi 1 IxcantroK at!on a;f114 b NaMc�(,BasinessfoigaimaizonffRdividual) Addiess 0i v6r- er`i CJreelttTie appropxiateb©x: Axepou an exnplap 7. Ie %cau<striictian mployor with employees(full and/or part time). I-E]T am a e - g, .�R:oxriadol3tig 2. lam.asoloPraprie�toz.orpaxtaerspXpa°abce reouizecL]yees�rorking�axzneSn 9 r 7Deaolttlo� ave n any capacity.[NO workers'rom .incur 4 d —! 3, x arn.ahorneo Fez doing all workmyselt:jl7o workcrm ers'ep,insnrancezequired.]"r 10 F]Building addition .E]T am ahomeawner andwill bB fairing contractors to conduct all work on-my property. 1-wilt 11.0 L-lcctri cal x�;paixs oradditie�us ensnzotlaat all centraetozs eithorhave workers'compensation.insuranoe or are sole N=::?� n{]iSig xelaa}t s ox addiRoxtss 12 pr 't• oprrctazs wk4 -with no employees. 13,,0 X06 r4airs r am a general contractax�aud ihayeluredthe sub-contractors listed onthc attached cheek Thesesah-contracfozshaveemploycesandlragewaskers'comp.iusrrrance. 14.��Ot�7.e4_Otb-04---- I eareaeorparatio and its,adc&,shavee eraisedtheirrightofexemptionperMGL e. 152,§1(�,anq e hava no emplaydes. x�o workers'comp.znsrrranco zegnired. ollc informatkon rrch ap ohga pbx#1 nau atso ill outthe seciionbelow shawtng their workers compensatianp y i Hemeowners wwhesuhmit•this a#fidavitindi�atingthey arc doinga11warkao tlrame k f0 su9b eanfra tori an tow er X thoso enti*se ha e` Tcontractors tbat creak tarts bo dust attaeherl.k a addifaonal sheetsliowiug olic uuraber. e ern la ces,they mustprovidetheir workers'comp 3' �_ emp(oyces. 7f`tho sub corriractorslaav—P Y Za er at is prov!dbigworAejv compewsation insarancefo empXoyees, 73eZatfa is thepolicy ara jab site f am an emp y t afar ration. — lusurance -- o B;xpirationDOC)'- I'olicy#or Lio.#:� -- City/StatelZip:______�--- - lob Site.Addross: --__-_ # otic 3;;xalaex and expi'auffl dale). Aftaclla.COP�•o:f"IlevO'` ers' campensation�ol%eydeclaxatian�cx�uninalvia���aripurdsliab:le,byaBrieupto$J>500.00 FaRuxo to secure covorago as required tasderMC7L a.152,§25A is one- oar ixnprisoiiniant,as cell as civil Pena.tics in the,iorna.of a STOP WOR7<CGRD1�R and a�o o£up to $250.0 a and/or ofthis statoilieni zr�ay be Ea�wa�dedtothe{)fca r,FSnvestigotas oEtheJDXAoa israxanro day against aha violator. cagy – j cavor go Verification. �=�� f cto riereby cep" zrrzr�er triepazns rrracipenalties o er"sty t7�at aIle znformatioi°z pr'otrider�a av Sinaaro: clal Clffxeict�xcse awry. 7aa r2vt'wj�ite in t1jiv area,,to fie c,mpTeted by city OF to-Wn afar L'e]r)nit/Licewe 9 i ector SwingA ntlioxity(circle ax€e): 1.lioaxcl Of c altla 2.Ciuilclix�gJ)epaxtment 3.GityPi'own Clerk 4,B+lectricaX xnspectax S.l'Inxxt mg ? 6.OtxeC_.� Phoueii._. �-