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Home My WebLink AboutBuilding Permit # 2/3/2017 ORTsl BUILDING PERMIT _ TOWN OF NORTH ANDOVER 0 .; APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received dA`ATOP Date Issued: CHU IMPORTANT:Applicant must complete all items on this page LOCATIONPrint PROPERTY'0 kNER Print MAP P No. _*'ZONING O IDISTRMC`l:_____1-li toric District yds Machine Slop Village yes en.4 TYPE OF IMPROVEMENT PROPOSED USE Residential Non_ Residential flew Building ne family Iteration F wo or more family�.�ddition d" y [Industrial No. of units: Ebommerciai epair, replacement ssessory Bldg Others: aemolition Wither e,t c ' 'ell �lgcdpl F etlands t Watershed l st ict 5 ter/sew r Identification please Type or Print Clearly) OWNER: Name: m i l6w. � �-A L v Phone: �' �' c �' �y-�. Address: S_ 6�� `! C C tT 0KT)_/ , -�'a�� v6lL CONTRACTOR Name: Phone: ine: Address.. Supervisor's,Construction Ucera : Exp. bate. Home Improvement License Exp. Date: ARCHITECT/ENGINEER Phone: Address- Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$926.00 PER S.F. FEE: Total Project Cast: $ ' �� ... Check No.: ELI ^y Receipt No.: NOTE: Persons contracting with unregistered contractors Gln not have access to the guarantyfund Signature of Agent/Owne , k ,-.'_Signature of contractor V%O R H '� Town ofz t . Andover ® � - -�J R 2 � h h ver, Mass, • cocMctuewacK 1' _.� 3 0 _. 7V S U BOARD OF HEALTH PERMIT T Food/Kitchen • L IIIIIIIIIIIF Septic System THIS CERTIFIES THAT ..... • ..y...........A.M.0v................................................. BUILDING INSPECTOR has permission to erect ............................ ............ . ........, buildings on ...... . ... r' ,�. .......r?.1C Foundation A ............13. /�Tlit�r. Rough .. . to be occupied as .....,.. .O. �.�. ............................................... 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 c PERMIT IN 6 MONTHS ELECTRICAL INSPECTOR. . UNLESS CONSTRUCTIO TRough Service ................ . ...... ........................................ Final BUILDING INSPECTOR GAS INSPECTOR OccupancyPermit Required t® Occupy Bu 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. r 1 i �l d 1 " Nd l ...... - i r j d r 1 i ,:�, W " .� ..... A I rr l ! l � m ,,,, ,,,,, r lilt 1 I_ . �aoetrmmna TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 North Andover Massachusetts 01845 Gerald A.Brown `telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please_�rir�t DATE: ;�- �l 01 JOB LOCATION: 2CJ ti� ` �'/ C, Number Street Address Map/Lot HOMEOWNER r i g-�Y GA L_ v 1 IV d 7 19f y� 6v Name home Phone Work Phone PRESENT MAILING A.DDIZESS � t�`�' �'�'`' ' C l G L.. 6` U a ill kl if/ 1 U 11 /•fir 01 �N City'Town. State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 1(78.3.5.1} 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 structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the 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. HOMEOWNERS SIGNA'I"URE.........._. APPROVAL OF BUILDING OFFICIAL Revised 1,0.2005 Phren Homeowners Exemption C,iC:kFk1t[)C76"laPHIM.S(99C 9546 (,4 NSEI tVATI(;1Ad 689-9530 11F?AL t`Il 688.9540 PLANNING 688-9535 The Connnonlvealth of Massachusetts Department of Industr'ial Accidents 1 Congress Street,Sidle 100 Boston,MA 02.114-2017 w minass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractor•s/IJlectricians/PIumbers. TO BE FILED WITH THE I'I,Rkfl rING AUTHORITY. App.lientit Information Please Print Le ib1 Narne (Business/Organization/Individual): L V �✓ Address: o2 t) S b aoLl-T t, 000 t 12 L C L' City/State/Zip: W .T 1-{ AQOOVe71L IJIAO/�gSPhone#: q7 T— 3 t y — OUO�] Are you an employer-?Check the approp rinte box: Type of project(required),- I.Q I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.Q i am a sole proprietor or partnership and have no employees working for me in $APemodeling any capacity,[No workers'comp.insurance required.] 9. ❑Detnolitiott 351 am a homeowner doing all Work myself.[No workers'comp.insurance required.]t 10 n Building addition C[J 1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insuramu or era sole 11.❑)electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.[—]I am a general contractor and I have hired tine sub-contractors listed on the attached sheet. 13, Roof repairs Whose sub-contractors have employees and have workers'comp.insurance$ 6,❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and we have no employees,[No workers'comp.insurance required.] *Any applicant that chacks box#I most also fill out ilia section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of ilia sub-contractors and state whether or not those entities have employees, If ilia sub-cornractors have employees,they must provide their workers'comp.policy number. I aitt art errrployer tltat is provldiitg tvorlrers'eorrapettsotiott itistulatece for'tory employees. Below is the policy and job site irrfar�uatl ort. lttsurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the Workers'cmnpensation policy declaration page(sltowing the policy number•and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do herebycertify r oder the pants alt penalties ofpetyftry that the inforntatlon pro Pitted above' title r nd correct. Si nature: Date' y Rhone#: "I " i� Official ase only. Do trot write iu this area,to be completed by city oil town official. City or Town: Perinit/License# Issuing Authority(circle one): i 1.Board of health 2.Building Department 3.City/Town Cleric 4.Blectrical Inspector S.Plumbing Inspector 6.Other Contact Pei-soil: Phone M i 4 HT Clot 2666 co Master Bedroom ccs ccs C ' 068 co 00 co lW co co � 6666 `t� �1 3044 LIVING AREA 597 q tit i i Closet 2868 00 M Master Bedroom 00 (0 0 ce) 3068 00 CY) 6268 co (0 co 0 c\I 6268 c) ............ ------ ----------—---- 6656 3044 Ws-r'ER BEDROOM 605 sq fl: Bedroorn Bedroom i-o 32'3 .......... Bedroom MasterBath UP UP L-J 27'11 Master Bedroom 205 BRENTWOOD CIRCLE k-19 w I 1751 sq ft