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Home My WebLink AboutBuilding Permit # 2/3/2017 sem . OF kO oT a 1�O BUILDING PERMIT 16 0� TOWN OF NORTH ANDOVER ° o APPLICATION FOR PLAN EXAMINATION Permit NO: a 7 Date Received Ap �SSacHUS��i`o Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION o'. Y F�nnt PROPERTY OWNEf : V. ,., ��►t IiAP NCI � IAREI , ZONINGITI2T1= storac District yep r10 Itac hone , htip Villar TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential i New Building One family Addition !' Two or more family Industrial I(Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Sep#fie 1111t�ell Cl Flere�cpllr� I 'Vetltds C7; Watersh1 �Istrlct [ ,'aa on, ewer. 8 /1 Identification Please Type or Print Clearly) OWNER: Name: A cam•- Phone: 7R-''7 654 Address: t�NTR4CTtR NartteQae ►�e#tlress '' ..S:Yper ISf r`s F['�ns Yrf �k./ :LlllE-nit �i i(l r Qty+ ! Herne fmpr�r omen "LImaae E cp Bate . . ARCH ITECTIENGINEER. Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. /6' Total Project Cost: $ i , 0 0 C FEE: $ i FO Check No.:............ _ Receipt No.: at .5-0 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature at Agentl0wner _ �. Signature of cvntractar Town of6Andover 0 . 0 N®. 1&3-261 _ h �O LANE ver, Mass, I ' � • AL 01 C0CN1C"z W1M f` �' pQ�,`�� BOARD OF HEALTH Tw PERMI �T LD Food/Kitchen Septic System THIS CERTIFIES THATVC BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ......LIJ......1 .v.®. .�!'�........ .�.............. Rough to be occupied as ........:&f.M 901r.(W..........�.1.�!k.*0v.................................................. 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR CONSTRUCT]UNLESS T Rough Service ......... . .�a.................................. BUILDING INSPECTOR Final GAS INSPECTOR OeeupanejE Permit Reguired t® 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 wilding Inspector. Burner Street No. Smoke Det. of 00"Tif E TOWN OF NORTH ANDOVR o� OFFICE OF BUILDING DEPARTMENT n 120 Main Street North Andover,Massachusetts 01845 i Donald Belanger Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION BuildingPermit Application L?lease print DATE: r- f, JOB LOCATION: / Number Street dress Map/Lot f , HOMEOWNER �Narne Home Phone Work Phone PRESENT MAILING ADDRESS / ,m .�L;. /> 6/ City Town Stat 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,pzovided that the owner acts as srrperyisor. 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. I 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. JJ' y HOMEOWNERS STC3NA`I"T.11� -" _.........._A--- APPROVAL OF BUILDING OFFICIAL__------- i i Revised 9/16 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 r� wivmmass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricions/Plumliers. TO BE TILED WITH THE FERNIITTING AUTHORITY. APPlicant Information Please Print Legibly Name (Business/OrganizatioruTndividual): /G /'c� e Address: 6 City/State/Zip: AZVe4' OA'hone#-. I?7f` 755 �6 S-7 Are you an employer?Check lite appropriate box: Type of project(required): 1Q I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $- Pq,&emodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition IF]I am a homeowner doing all work myself.[No workers'camp.insurance required.]t 10❑Building addition 4,❑I 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 insurance or are 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 the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have,employees and have workers'comp.insurance.t 6,E]We are a corporation and its officers have exercised their right ofexemption per MGI,c, 14, Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the 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, $Contractors that check this box mast attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees, If the sub-contractors have employees,they must provide their workers'comp.policy number. I arts att employerthat is providing ivorlcel.s'eonipettsatioti lnsuraitee for'illy employees BeimP is the policy anti job site information. u Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date; o r /State/Zi Job Site Address: Ci t1' p: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL e. 152,§25A is a criminal violation punishable by a fine up 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. Ido hereby certify r r epains andpenalties of pet jury Ilrat the inforination provided above is true and correct. Si nature to v z� is Phone#• is Official use only. Do not write in this area,to be completed by city or towtr official, City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: RD V V 1 206 IR -1� �4BUTT BPP BB36BUTT_W BPP B24BUTT RD1224NH,B- . izI 24308 1311 if A .63 -52-2L�; I i �1" 36' _ 21 ' 36"... 15" 31 2.. 1 2" 22" . : . ...... 66". 26" . :., _ .32„ .. 86" e "f WR3612BUTT F71T W2i3QL ; n 00 e f � vLO � I I Ell I rn i� ! l 11 _ ;.... ... DREP1 112.84{L}_48407 .84 — II F2EF 2D.9 DW36 - If 1 'DISH !Q6 S UTT.W BW .. ____ j ; I f •1 E M � M �.n 8921" 1 2 24„ 30" j ...18 30". 37 Z„ o z 103" - _ 27" 8216' 1916 9 u u A33 dimensions sire designations This is an original design rind must Designed: 1/29/2017 given are subject to verification on not be released or copied unless Printed: 3/29/2017 job site and adjrssiment to fit job applicable!ee has been paid or job calrditioiis. order placed. 12905892.kit i �Dra�viug f1: 1�o Scale. .............. ..................................... .... .... ........ ........ . .. ... ... ........ .. ........... :. .... ... .......... ......... ................................. �3rr. re rr _. #J '}. 4.s`t _ !� �4 r r° Y�:.r s§ #`..r� r� �f r Ssf i={ A 3 tr fir, 4 l.:n t �7'.'s .... .....� ........, - .i.:�.r_. ...>f!....... ...... .r. .al...r4r_.,�i.R..... .,�.r.i.._.,_._:.....1 is �..aMi R.h:n! <_3a. B2 UTT BPP *,"3. 6 :: BPP .824BUTT :nd sland_wr alLcabinet __. :._..... M230) and add platform for __._____ _________ _________...__..._.._____._.__ toekick. Attach door and RG 1 24i H,.B RD1t1206 '..... craw front. ....... Customer: Ventura KraftMaid �. .... tratfordimaplelcanvas ■■■Emmons 0 ■■■ ■■■■■■■■■■■��■■■■ ■■■■■■■�■■■■■�■ ■■■■■■ ■■■■■■■■■■■�■■■■■■■■� �■■■■■■�■� ■ ■��■■■■■■■■�■■�'I■■■■■■■■■■■■®■ �■ ■�i'i�■'i■■'moi®■ mmmmmsivil � . �■��i��■■moi■ ,w i ..�■■■■■■■■■�i� ■■■■■■MENNEN ■■■��■ ■■■■■■■■■■■■■■■�■■■ ■■■■■■■■ INN ■■t■■■ ■■■■■■■■t■■t■■■�■■■■■■■�■■■�■■�■■■ ■■■SEMEN ■■■ ■■■■■■■�■■■■■��■■■�■�■■■■■�■■■■■■■ SEMEN ■t■■■l ■■■■■■�■■ ■■! ■ ■■■ ---ii !i' ■ r