The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #729 - 47 EAST WATER STREET 6/10/2008BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: '? y I AI Date Received Date Issued: 16 0 IMPORTANT: Applicant must complete all items on this pale PROPERTY OWN 04 q: d.. ao t 3 Print MAP NO: ,orta PARCEL: ZONING DISTRICT._ ,L_Historic District Machine Shod yes TYPE OF IMPROVEMENT O? Residential Non- Residential New Building One family (_cm6_Q)4 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family (_cm6_Q)4 Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: v D l , l + v i n Identification lease Type or Print Clearly) OWNER: Name: .Phone 7g ag - C12 Address: `-) L v MR 6 qT CONT CT._OR Name: Phone: Address: Supervisor's Construction Licensees _ — ._ ,Exp. Date: F Home Impr ment License: Exp. Date: ARCHITECT/ENGINEER / Phone: Address: U ! Reg. No. FEE SCHEDULE. BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost- .$ on nln� t FEE: $ ' : Check No.: 4" eceipt No.:., l Z� NOTE: Per ns contracting Pith'unregistered contractors do not have aces to the guaranty fund Signature of Aggnt/Ownef n Lure of contractor Location 7 j c WCi`i'L7 �%— No. Date `/0 0 Check #� TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ d Foundation Permit Fee $ _ Other Permit Fee $ TOTAL $ 2 , 2 Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public SewerTanning/MassageBody Art Swimming Pools • Well Tobacco Sales Food Packagir alE'sf- r Private (septic tank, etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on (0 //0 I0 COMMENTS HEALTH Reviewed on v Signature P COMMENTS e 1 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town 1peer: Signature: -. �' Located 3134 USgood Street FIRE 'DEPARTMENNT - Tgmp Dumpster on site yes no Located at 11 tVh tin S tre, t , Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA — For department use ❑ Notified for pickup - Date I Doc.Building Permit Revised 2008 Building Department Ian # 9p/(� The following is a list of the required forms to be filled out for the appropriate permit. to be obtained. Roofing, Siding, Interior Rehabilitation Permits 3� ❑ Building Permit Application ❑ Workers Comp Affidavit Q.CY-G ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses U_�e own '-5 �d ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior WorkI�?f,J Olt�n`%a ❑ Engineering Affidavits for Engineered products �JJ All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 E `J �1 0 0 E=4 x o A ,� O Ll � 8 U) H z z � •o co O w O c� T .G U C w H w � 00 p rx Cd r iz O v U w p u: y cn q w o C7 O ob C w w w � 5 ao o z � cn O cn (A I co c w iC V � O O C H O IS v •n C R W m C Cc - O i.+ C2 CD EQ 0 u d C tj = Q ; C u �N 4 c, cm CD C CL= = E �mo C N N 3 ,\ H r V OI ; CD H Cc co N R O CO) Amocm �+ c cmc a :o �.Cos_ Cm �i LO y O � Z • � O.r Cf �r`�C d0 C_ O . N O C •C = m : o. 3 N ~ h0-21- CD cl V W EL LD .. cCD t.. •m nz`�5 z C: � +'' m •N CD o y a s ri = � �oy•� o U u Cf) fr .lzv o H CD .E CLL CD c O CD Q cc .'m CA O Q .a H C O L.3 cc O V co O. CO) C CD Q, C CD m m 3� a� L o �- C. cma c c cc J .O Zm co C. H C C cc CA C www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):,—'-- Address: ::� la e f. s/• City/State/Zip&d . &Z,1 yp h �� Phone Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. I am a homeowner doing all work myself. [No workers' comp. .insurance required.] t have hired the sub -contractors listed on the attached sheet. These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 1 1.❑ Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other *Any applicant that checks box # I must also fill out the section below showing their workers' compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' information. Insurance Company Name: Policy # or Self -ins. Lic. #: Job Site Attach a copy of the workers' compensation pol for my employees. Below is the policy and job site Expiration Date: City/State/Zip: page (shl wing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can Xad to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in t fo of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under thgpairls and that the information provided above is true and correct. Of ficial use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # " /B Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: The Commonwealth of Massachusetts Department of Industrial Accidents P.P `", . Office of Investigations 600 Washington Street ` Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):,—'-- Address: ::� la e f. s/• City/State/Zip&d . &Z,1 yp h �� Phone Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. I am a homeowner doing all work myself. [No workers' comp. .insurance required.] t have hired the sub -contractors listed on the attached sheet. These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 1 1.❑ Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other *Any applicant that checks box # I must also fill out the section below showing their workers' compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' information. Insurance Company Name: Policy # or Self -ins. Lic. #: Job Site Attach a copy of the workers' compensation pol for my employees. Below is the policy and job site Expiration Date: City/State/Zip: page (shl wing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can Xad to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in t fo of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under thgpairls and that the information provided above is true and correct. Of ficial use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # " /B Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the pennit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to -thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia 0 Z F�M(IF, Sw wN6 SET a f . � 1 r. V ei r J LL TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 North Andover, Massachusetts 01845 SAClgtgt ,4 Gerald A. Brown Telephone (978) 688-9545 Inspector of Buildings Fax (978) 688-9542 HOMEOWNER LICENSE EXEMPTION Please p�if DATE:— fSa I Ica .4 JOB LOCATION: q'7 ` Fns:i Number Street Address HOMEOWNER Phone PRESENT MAILING ADDRESS \A)(1 ago 06 �, o- X/ NFWUWV�� Work Phone City To" state zip 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 $ection. 108.3.5.1) DEFTNITTON OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside, on winch 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 Shan not be considered a homeowner. The unklersigned. "homeowner" assumes responsibility for compliances with the State Building Code and other Applicable codes, by-laws, rules and regulations. The undersigned "homeowner' certifies that bdshe understands the Town of North Andover Building E minimum inspection procedures and requirements and that he/she will comply with said procedures and HOhMWNERS SIGNATURE APPROVAL OF BUR DING OFFICLAL. Revised 10.2005 Form Homwwn= Enmptkm BOARD OF TPE.'U-S 698-9541 CONSER V. MON' 638-9530 ITEALM 698-9540 PL.VNNING 688-9535 In MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) n _4 0 Mass. Date DEC 19 a Permit # � Building Location '7' Owner's Name /Y,C-6 ✓ / �T�� Type of Occupancy— sl G New P Renovation ❑ Replacement ❑ Plans Submitted: Yes ❑ No V' FIXTURES Installing Company Name C��►�At`F��S)�d/ �J1/_ �l Addr ss Business Telephone 2,-7 c`- — C� c7t o• q Name of Licensed Plumber or Gas Fitter Chcorporation k one: Certificate %9 -//:3�— ❑ Partnership ❑ Firm/Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes i— No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy 0"' Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application walves this requirement. Signature of Owner or Owner's Agent Check one: •� Owner C Agent41 I hereby certify that all of the details and information I have submitted (or entered) in the above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. 1� Tykeof License: BY lumber Title 0 G atter Signatur of Licensed Plumber or Gas Fitter aster ) journeyman � / a"l 3 City/TownLicense tuber / � APPROVED (OFFICE USE ONLY) 6161 z z - 6161 •P > D .. :. - ■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■ EFT -170 MIT 11110VIrs Me. orT.Tweirs, M. Installing Company Name C��►�At`F��S)�d/ �J1/_ �l Addr ss Business Telephone 2,-7 c`- — C� c7t o• q Name of Licensed Plumber or Gas Fitter Chcorporation k one: Certificate %9 -//:3�— ❑ Partnership ❑ Firm/Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes i— No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy 0"' Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application walves this requirement. Signature of Owner or Owner's Agent Check one: •� Owner C Agent41 I hereby certify that all of the details and information I have submitted (or entered) in the above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. 1� Tykeof License: BY lumber Title 0 G atter Signatur of Licensed Plumber or Gas Fitter aster ) journeyman � / a"l 3 City/TownLicense tuber / � APPROVED (OFFICE USE ONLY) V) z O u W CL H Z H H W cc V O C. C6 W W H Z O F� u W a h Z Q Z 66 O Z u z Q V O O F 09 UJ m O W z O V CL CL Q u z 0 D m 0 a a F- Q Z v z 0 CID 0 z O Q u O J 66 Q O oa m CL O Z V C F Z Q U H F m W a 4 d A 0 a c cc W «- 0 a TO 2333 Date.... ,0FIT11 TOWN OF NORTH ANDOVER It .4 0 - 0 PERMIT FOR GAS INSTALLATION" This certifies that has permission for gas installation ... in the b ..... 1�e ildings of /Lett. a ........... North Andover, Ma$R. Fee'Z,r. :07J. . Lic. No.."7/.?-� ... .......................... 03 -71)q / GASINSPECTOR WHITE: Applicant &NARY: Building Dept. PINK: Treasurer GOLD: File Location 4 7/*L')w rc"/'t- No. '-� i Date . ,40RTM Ot�,,so 4, TOWN OF NORTH ANDOVER , OL zi,ogdIlkp Certificate of Occupancy $ Building/Frame Permit Fee $ sSCyiUSE "U t� A Foundation Permit Fee $ Other Permit Fee,,,, , $ Sewer Connection Fee $ Water Connection Fee _ ,$ TOTAL $ 1. Building Inspector Div. Public Works z z z a 0 0 0 :► 7 3 m N p m v D m -1 m -V m N m O m D i c m z m r m N 3 n x m ° i A n N r m m Oi = nrrrn D > ZI = r Z m ° y i m m z m i r r 0 C r r 0 C m m 41 O m v W 0 n A m y N a N i m i m N n n n 1U z Ll O A _o Z O O ° D C i m O 0 i 4 Z 0 9 m z> n r m Z N N Q 3 m v m � O N 0 m p A 3 C to p W q Z g o D m m ° m i O p m 1 M z D i 0 Z m z i i r cW r � m m c Q ; Z 0 A m p Z o m m Z N z z z a 0 0 0 :► m 0 N N N A N N N C A 0 i i z A r C C C - v D( nrrrn D r = Z m Z m n Z m p o m C A 41 O 4p1 W n n A m y y n n n r z Ll Z Ll _o Z O O O m A 0 z i i 4 Z 0 9 m z> n r m z m of m Q 3 m v y � A rr O A q W g o A m m N z D i 0 Z i r A m i m Lo .a 0 m M 2 0 A 3 0 z m 0 N N N A N N N C A 0 0 D A r C C C - D D( D D r = Z m Z m n Z m p o m C o_ o_ n n n A m y y 0 . T D° r z Ll Z Ll _o Z O r m m A m 0 N Z n i N D p Z D Z 9 m z> n r a p z m 0 3 Q 3 m a 3 y v m 3 m rr O A q � Ni A m m N z D i 0 Z i r A m i m Lo Q ; o m m 1 Z o �' �' ry c W 0 it D mm Z o O Z v ` ry C' A N ,� 0 z ,� , 0 A O m n v-, 3 tp R1 `-1 ri v N N N N 3 D N N x m p 9 D N N W D Z Q 9 c N m C m C W C W C -{ A m3 0 x Z Z m O N 3 Q A O 0 0 0 0> r 0 o m 0 N m n 0 0 0 0 00, 0 N O -4 0 A 0 0 0 O z n 1 z Q c r O A A N fm11 c A O Z Z Z N = O z O 'OI N i r 0 A m m O Z i O 1 N r N m A m Z 0 m p m O m°< 0 0 O Z p N N O OO O O A L Z N n -4 :E r m z m D m ° tN N > '� m r z z D m t 1 Z 0 N W O j A A v _ v ID m 0 n C D Z n 1 6)ON N NrUI • Z y0 NZZ Svc MXNj D n 0 0 u, v_ p3m mx -iza I(P0 tn6o �Z_ mN3 TOZ �N M 0 NCZ m 0r o0 ANO z�z =v 0 mD 0 in, mm N� �0 DO 3 m m A 0 �o v 3 O DOv cc A 0 m AOO wN-inmm nm^+ 3 IN ICZO 0r2O 0=w SZZOAAnnmxov� nnN0 vm D NAnn Ayn 0x O O O O� O OOOON00 mND O A N z z T3nA3 AZO ZZ „ z - o200' 0 C3 OO D O �c c0^ j3 D Zs Z yZ y 0 ° { ~ 10 0 z�OG)cAy O — D Z D A xN O T O v _ O N D O D D O D O y N ODD O IO ° �+_T A Z Z Z A O D V° z C N nrNyv x A Z Q< C"Dnr 3 O T r T n<mr= 2 y A H_ 0 Q A n �� S .,z x m om. D . <N z` m T_O n m = Z 80- x N O° A z x z n A w >° A r Z 0 Z n ti 3 D m A <O Z N N Z O mx A O2 ~ A 00T_<Om_N X G Z11 3'_' O x mA N x n� N r JO 0 Z N~~ 0z> J°!1 m AD -si AAO M N ��+ C C f0 r T n m DD D 70 I�sm`{I I�� I Iw 0A " X O " Z zm" 0 z0 I III I�� I I I IJ Z -LL 0 n C D Z n 1 6)ON N NrUI • Z y0 NZZ Svc MXNj D n 0 0 u, v_ p3m mx -iza I(P0 tn6o �Z_ mN3 TOZ �N M 0 NCZ m 0r o0 ANO z�z =v 0 mD 0 in, mm N� �0 DO 3 m m A 0 �o v Town of North Andover BUILDING DEPARTMENT Homeowner License Exemption (Please print) DATE c l q l JOB LOCATION 41 As 7, Number Street ."HOMEOWNER" _77f, AiYu P6-0KN,mA ame wA-1 t r- -::;% Address Home Phone PRESENT MAILING ADDRESS S/{ - Mt Section of town -R* - I Y33 4,9 1 Work Phone City Town State Zip code The current exemption for "homeowners" was extended to include owner ,-occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided ,t -hat the owner acts as supervisor. (State Building Code, Section 109.1.1) 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 to six f=amily dwell- ing, 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. Such "homeowner" shall submit .to the Building Official, on a form acceptable to the Bulding Official, that he/she shall be responsible for all such work performed under the .-building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance 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. -HOMEOWNER'S SIGNATURE ° APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0, Construction Control. -ZZ T 2. �v�v(L�IaA S 4-7 C fiJ4TE19 NJr.:r.m A-JDdvC--A rm 4 c7 i "R"4- N Pi+owa - -rq - r 33 H� S C AIS i b �LiC _ SOI,r¢ (NDO.LA) . (,.�INDpW ex! 5T/Nfn IV' t -lar :4-TcT2 H. t,J I q� wAstE2 a>zy£r� U X15TNN r C0009) V° E`KHST (N4 Power r M prtny5 '14! LTJ H L eD 00 H z r m (l� cn cu -n _n (n m T M n:1) 3 c o m o o � o m °—' ao m < M R1 -v °' v n n O Z -a . o H v a T y z v T Z v V _n _ O m Al Z Z Z T rm n r- p .^� O = O0 z m K CA v Li Z DNA 0 c c� m