HomeMy WebLinkAboutBuilding Permit # 3/9/2017 3/9/2017
*Building Permit#23390 Construction of Additions,Alterations,and Remodeling
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Applicant Location
Tina Messina 63 MIFFLIN DRIVE , NORTH ANDOVER, MA
978-835-2841 Owner
t.tmessina @verizon.net
Tina Messina
Application Submission
Are you submitting this application as the Homeowner?
YES
Applicant Phone Number * Applicant Mailing Address
978-835-2841 63 Mifflin Drive
Will you (the Homeowner) serving as General Contractor be doiong all work yourself or will you be hiring
contractors to conduct all work on property?
All work myself
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3/9/2017
Workers' Compensation Insurance Affidavit: I am a homeowner doing all work myself. Homeowners who
submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new
affidavit indicating such.
J
I do hereby certify under the pains and penalties of perjury that the information provided above is true and
correct.
J
Project Information
Type of Improvement Proposed Residential Use
Demolition One-Two Family
Description of Work to be Performed Is property on Town water
removal of debris, taking down sheet rock for Yes
exploratory purposes
Is property on Town sewer
Yes
Project Cost (if new construction base on $125 per square foot and if addition/alteration/renovation base on
actual contract price)
2,000
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Does this project require a temporary construction trailer?
NO
Does this project require a temporary construction sign?
NO
Danger Zone Literature (MGL CHapter 166 Section 21A-F and G min. $100-$1,000 fine)
NO
Homeowner License Exemption
Homeowner Name * Present Mailing Address
Tina Messina 63 Mifflin
Phone Number
978-835-2841
1 certify, as homeowner, under the pains and penalties of perjury, that the information on this application is true
and complete.
Approval of Building Official
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To Be Completed By Town Staff
Zoning District * Is this a 100 Year or older structure
R4
Is property within an Overlay District
Is the property within the Floodplain * Is the project within 100' of Wetlands?
No Not Applicable
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