HomeMy WebLinkAboutBuilding Permit # 2/16/2017 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: � .. Date Received <)-
Date
Date Issued: _.__
IMPORTANT:Applicant must complete all items on this page
LOCATION
Print
PROPERTY OWNER �WC X,
Pmt 10D Year old SfructuPe yes no
MAP NO,- PARCEL , ON DISTRICT Historic Disfr'a yes
_ ,
Machire Shop Village ;Yeses -o
I
TYPE OF IMPROVEMENT PROPOSED USE -
Residential Non- Residential_-._.__-_____
0
__.______._.___--
❑ New Building -- One family _.
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: El Commercial
_ Repair, replacement ❑Assessory Bldg _ ❑ Others:
❑ Demolition ❑ Other
El Septic U Well F] Floodplain El Wetlands ❑ Watershed District
1]Water/Sewer --
DESCRIPTION OF WORK TO BE PERFORMED:
Identification Please Type or Print Clearly)
OWNER: Dame: 6an)A)A®H ETCH X tJ Phone: a79
Address: y,
OONTRAGTOR Name
_ . __. Phoney-
Address:
Supervisor's Construction License.- Exp. Date:
Home Improvement License. END. Dater
ARCHITECT/ENGINEER Phone:
Address: Idea. No.
FEE SCHEDULE.BULDING PERMIT.-$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ Y , 00 FEE: $
Check No.: C 4Receipt No.:. °��,w, _
NOTE: Persons contracting with unregistered contractors do not have access to fiuTaci
lgnture of. , iLLentlOwner .. Sig�iature of cortrgctor.�.
R
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
............................- ............................. ''I .....................................- .......... .......... �..... .......11..................... .......... ........................................................... .................... .........................
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No. A ,
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ver, Mass, _ (9 a /
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BOARD OF HEALTH
PERMIT TFood/Kitchen
LD Septic System
THIS CERTIFIES THAT .......... ....... BUILDING INSPECTOR
has permission to erect ....................... uildings on ...... I Foundation
Rough
to be occupied as .....(93M..%. .........04.Am.P............................ ................................ 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
PER EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR-
UNLESS CONSTRUCTION TARTL Rough
Service
.. ..... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupgge
1.Permit Reqy uired to OccupBuildin 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,
i
i
_no common
of 11fassacht�se�ts
De,paItment of fndu�ial el encs
Z .!Ongre's,V street ,5`�
21fA 02114--2017
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- M ', �Q�kerS' Coxnperlsation7�s�raue�-1�idavi.I:Bnxlde�r�/C�A7�3.�LOs1�:�- ..
TO BET ED }H '� please Pxn rLe 'l'oI
A. ''licax�-t�oxznaflan.
�a-p��(.�3usiz�esslOzgasaizatianl.�ic�i�dual)'
Address: 67, �
jdl SIS S P]�ora�#: q7�'S ` q1 g =
tate/Zip:Ab—AJ t AOcd�.
Type of prosect(requi�C
Axe-you an employer?q er fifie app7.
znpriate
employees Gull.anNor pat-tim").`
e cottiicfaan
1,�x am.a employer with____-_�--- fiozme in 8. ��emodeliiig
2.01asn a sole pxoprietworpattam�Pf ce reguavu 310 mPlOyees-�orking 9 � 3e�[tol eLox[
any capaei .jNo-work= p. 6CQ -
se3i n-wwkers'comp.inanaucerequired.l S 10 Building addition
3.�Iamalxomeownerclo�galfwozkzny jN rn e Iwill
copfraetorstocondnctallworkonmyp P �• jJ ❑EJeGljoalTepP3XS0117lliCiiEiOP
4.01 am,ahomeowner MCIw l be hiring F
ensurethat all eontracttus eitherhave workers'ccmpensaEon.fimmmae or are sofa 12.I �.i€7It2�ling xe Ts o a(7dC XOIls
pzoprietorswithno.er�pioyees. L!
5_�I am ageneral coniractox and I]zave hiredthe sgh-cantCactors listed Writhe attached sheet_
��'.®Kaaf repaixs
These sob-con fors have employees and hay a workers'camp.insurance 14Othex
s[]WORM a corPoratznri-and xFs,nfficershave exexcisediheirrigh�t of�empt}.on per MSL e.
152,§1(4),a04WeaQano7oyees_U7o workers'comp.iusarancarequired7
ensWon oli informalaoir
''applicancthatoosu's�a1s{rfill.outtheseciioubelowshowingthaizvdazkers'comp P cY
T homehauh
owners wha sulau�rttivs a3 ctavxtindlcatingthey are doing aU-wo*audiame o rhe sah cOuIsIcIG-keconiraetors and sfatabwh oz those tinea s have
tF:"
tCnnt£actozs that checkthis tiox zuust attached an addiiaonal b row e their workers cemp.policy number
employees. Ifthe sub-contractors have employees,theymus p
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a�ern lo,�er that is providingwar•ICe�s'ca�npetasaiiar�insu�a�cefar^� loyees Below�ihe�a2icy raid,j�o�+�sxfe
information.
Dismauce Cosrzpauy-Nhma
E�aratianData, ',
Policy if ox SON-1w.Liv-
lob Site Address: showing the policy 3iuberanalexpl atao-R(Iate).
Isttacliacopy ofthe WQ47ke1rS' eampe sa onpolicydecl25Aisa GlLu3irsal-dolationpunishable�byaf-e�to$1;,500.00
Faal-uxa to SCOU10 aoVexage as rerluixed undax MGL §
asJcllnr one year zmp�isannlent�as-well as civi),penalties in ffie,fazm of a STOW�O��R1�EK s o a hoe TAf to ls-MaW a
day Or one- ear iiopMO A ent. s state�extt may be forwarded to th'Of$ca ofSuvestigat3oils offibe D7A ox is encs
ft�
hG
ator.
w,wago Verifteatiou.
raxade trae�rxixsd penalties ofperjury that theinfor�natian oviderlc� fl�e iced corp ecz
pdo Iiere7ay ceriifyr
Date
:
S3 at"a: � 3
phone#: 7 �'
city or{tawn officiar
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fficial xcse only. -Do not-rvr�ite in Mis area,to�e co pletecl by �y
' Pex�,/iLrce7nse#
or To
f'qS g A�Rtho&y(circle one): �.Electx�.ealS�p ectax �.Plrocmb�g ectox
�.Bnaxd of health 2-I3�idiu.gDepaxtbze�tt 3.CitylTn'�a Clexl�
&.Otb.er
Phoare#.
Couta ct Perso�x-
t%ORTP# TOWN OF NORTH ANDOVER
of "sa '.
'10 OFFICE OF
BUILDING ]DEPARTMENT
120 Main Street
North Andover,Massachusetts 01845
CHUS
Donald Belanger Telephone(978)688-9545
Inspector of Buildings Fax (978)688-9542
HOMEOWNER LICENSE EXEMPTION
Building Permit Application
Please print
DAIE:
JOB LOCATION:_ ------------------------------- -—---------------------
Number Street Address Map/Lot
qj�-q-7,1 q 3 6
HOMEOWNER_ esv(Jn� Cl"XO
Name Home Phone Work Phone
PRE,SEN TMAILIN G ADDRE SS � 29 VjP(\jC_ 4zt1"------------ -------
WA'" 4s�0\)UP— MA-
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,provide
that the owner acts as supervisor.
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 andJor farm structures.A
person who constructs more than one home in a two-year period shall not be considered a homeowner. (780 CMR
Section 1.10.85.1.2)
The undersigned"homoowfier"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 lie/she will comply with said procedures and
requirements.
HOMEOWNERS SIGNATURE C?7
APPROVAL OF BUILDING OFFICIAL
Revised 9/16
Form Homeowners Exemption
BOARD OF APPEALS 688-9541 CONSERVX17 ION 688-9530 HEALTH 688-9540 PLANNING 688-9535