The URL can be used to link to this page

Home My WebLink AboutBuilding Permit # 2/21/2017 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO, 7k? /7 Date Received 1-2-..L--2---0/ 7 Date Issued: ! - -7 IMPORTANT:Applicant must complete all items on this page LOCATION... _ _ .. = AiJ _ Print PROPERTY OWNER ' I ZONING DISTRICT _H sfor�.. D strrctc{� yes no MAP NO _PARCELL� � _ _' Mach irie Shop VilEage TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition ❑ Two or more family ❑ Industrial }i4teration No_ of units: ❑ Commercial ❑ Repair, replacement I7 Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 17 Septic E we[] ❑ Floodplain E] Wetlands D;:Watershed District::: ... Watt:rLSewe-r .. - DESCRIPTION OF WORK TO BE PERFORMED: i r Identification Pleaseyp or Print Clearly) OWNER: Name: Phone: Address: t20 C+ C)L _ 4J J CONTRACTOR Name:_. _. Phone: Address: 1 Supervisor's Construetiori License t Improvement License ARCHITECT/ENGINEER 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. Total Project Cost: $ FEE: $ �CU Check No.: H-5 Receipt No.: � NOTE: Persons contracting with unregistered contractors do not.have access to the guaranty fund S�grature;;ofA entlOvvner .' -Si �ai_re of contractor. .. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ Plans Waived ❑ Certified Piot Plan ❑ Stamped Plans ❑ TYPEOF-.SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑. Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE DEJECTED - DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on 1 ] signature COMMENTS- L. �-�� ❑ �� r��}�_�� '- HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decisionlreceipt submitted yes Planning Board Decision: Gomments Conservation Decision: Comments Water & Sewer Comlii eG ion signature Date Driveway Permit DPW Tows Engineer: Signature: Located 384 Osgood Street FIRE.DEPARTMFEN T -- Temp Dumpster on site yes -no- Located-a oiocated-at l24 Main'Street- Fire Dep�rtrrmefif!§ignatufeldate COMMENTS FORTH own of . % 4 ndover No. 181 - 2011 n0 twfrE h h ver, Mass, - ,? / - a.0 t 7 ARM L D��'4T@D s � BOARD OF HEALTH Food/Kitchen E IT T Septic Systems THIS CERTIFIES THAT ....... ,,'. ;Q.Rr. ...... A... ,t,,. .A�1► I'11i, . _.,......: ,... ..�....�,Y .......:... . BUILDING INSPECTOR has permission to erect .......................... buildings on ..,....�.�.0....�.�� .r/,(�� Foundation Rough to be occupied as ......... !4: :!A .`......Alci FN!!;f r............. 1. 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 IT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS .. .4TTSRough G Service t ... ................................ BUILDING INSPECTOR Final GAS INSPECTOR Occupancy Permit Be uired to ®ccu v BuRough 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. t SN- Ae Commonwealth offfassachuse"N _ Deparhnent op-ndrasmal celdents 1 Congress greet,SO100 Boston,AfA.02114 17 = -WwW mass.govtdia cts�` l mine s. $�� aM +vQ ' �o�kkers' Com�aen�ai�.ax�b��'a�.cPa` O '�r�.cza:usl;�' TO BB ff END Vim TSPlease ' Tla bl • di�tcl.�x N'amc� (BusinessI()T9a=a-�i"'f aD Address, Cs;ZC d CzLy] = Type Oproject(NegnRed); xeycrtan e�np)opez? aeTr`ttieapriate1)Dx, prop 1.El I ara acmployer with employees{hall andlorpsrt time). 7. E]�"sVd6nstxtic On 8. ❑RCM() eli�g 2.0IamasoleproPrietoxorpazfnershipandlza.Yenoerapioyees,Gtortih�g ozmein ❑De�o13�[0]1 auy .capacity.PTo W0rl<ers'comP.insurance regraired] 9. all woAxnysell fgo"Wage comp.insarancereriuired]' 10❑$€.biding addition 3,��am ahoaneawner doing y p P �Y- contractorstoconductallwalkonm roe I-will alisO additions d.. ara ahomeowr�er ar[dwallbebanng ]1,❑Electrical rep.. ce or are sole enstare that all caIItractbrs eitherhave v�orlcera'compe sat€on ins�aan PXun 7 51ag rop*s or addifion; proprietors vtzth no en bYees. x`�'. 00frepair 5_n I�-a general con€zactox and IhaYe hirediha snb-contractors listed on#he attached sheet_ 14�Other >am a g nmat cactorshave eicploYees mclhave worko&comp.i"ancO &.❑�c are a oorpar.&,i.mad zp officer;have exercised their right e£�xemption per MGI e. 152,§1[4},audiYe have no employees_[.,7o woFkers'camp.ansvrance re zized] a lioenithatclreck oX lmu'stalsoi7 I)IZ:thesactienbelowsho-Win,9ih@ir-Workers'campensationpolioym£ouaalion` IL additional sheet all vor the name c%tire grab-conizactors and si,tawhgd7 ornotthose c ides have iHameavrnars-whodj.�9 it•ilusaf davitindicd gtlzeyarcdoingallworkandthenlaireotdsirleoontractorszuustsabmitanevraf�xdayitindicahit ane tcontractors that ohrc 4his iia monist atta y e3' t rovidet3ieir workers'come.policy n�ber. e� oyees. Ifti�e stab-c artfractors have em Io ee tit taus p aft exn layer III at i,�px'avidiajg7W0)kers'_,Ompeusatiott Msz rLWce fox•my e�gployees. $ela�v is t7aepa�icy arzdjo szte X clan P inform adon. In,^;rats oo COMPaay JqaMr, - ExPiratiOrzData:. Policy#Ox Self-ins.LIG.#:. City/State/Zip: DYj'1 PI1 lCUVL Y 1�11� 2�1y� !a o CCn Yob SiteAddress� � elite deelata-fJ'tonpage{shO�gfhePolicp number and expxr`a{�tan.data. €tacTx a copy aseworkexs conzperasaa�p y y 500.00 failure to secUxe coverage as regaaxed�tdez MGL a.X52,§25Ais a crial�Olafionpuvislsableb a foie #o off, or azie� eax iSnPrlsonT3leLlf,as 9ve11 as civLl penalties zn tTae hoz to tlZa e O ORDER of fdZe 17xA r Duran 0 a andl Y be forwarded day against the violator.A COPY af-tJ statOlnenf ntay coverage'geri'CCatIOR. I do 71ex e7xy certzfy raazdex t7ie prrixzs rrrxpenaZties ofpejarxy Haat t7xe iaxfaa rncdioxa provided uoue rx true and cortecz ' S3ate: �i afore: Pham#: _ a Of cirri rase oxx7y. Do nOt-Wite ill t7zi•s txrecc,to he coxrapleted liy city on to wn offzcial. • PerzrtidJ.Lxcex�se# City or Town: xssuiugAnthoxlLy(cixcleone}: ' ecfor -.Pli€imbiugTUSPeetOr �.T3aardof�ealfh 2-g�ldiugDepaxfMent 3,CitylzowxiCZerk �.�lectrzcalTxtsp 6.Other Phone Contact eer5on %AORTII TOWN OF NORTH ANDOVER OFFICE OF 13UILDING DEPARTMENT 120 Main Street of North Andover,Massachusetts 01845 AC14US Donald Belanger Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Building Permit Application Please print DATE: '�-o 1 -7 JOB LOCATION:_1 2-0 Number Street Address Map/Lot HOMEOWNER Name Home Phone Work Phone PRESENT MAILING ADDRESS— _&Y� ---------------- _0( _-------------- -0( Y 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. _�g_kv_ 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]ionic in a two-year period shall not be considered a homeowner. (780 CMR Section I I O.R5.1.2) 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. H E RS SIGNATURE OM OWNL APPROVAL OF BUILDING OFFICIAL— Revised 9/16 Fonn Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535