HomeMy WebLinkAboutMiscellaneous - 104 BONNY LANE 4/30/2018 (2)m
rl)
Phone. 978-632-2660
JAMES A. TRUDEAU
Adjustment Service Inc.
Fax: 978-632-2662
P. O. Box 7
Gardner, MA 01440
claims(i0rudeauad i.com
Notice of Casualty Loss of Building
Under Massachusetts General Laws, Chapter 139, Section 3B
February 8, 2016
Building Inspector
120 Main Street
North Andover, MA 01845
Board of Health
120 Main Street
North Andover, MA 01845
Fire Department
Dept. of Records
124 Main Street
North Andover, MA 01845
Insured:
Sewi & Jeannie Yu
Loss Location:
104 Bonny Lane, North Andover, MA 01845
Insurance Company:
Preferred Mutual Insurance Co.
Policy No.:
PHOO100698969
Date of Loss:
February 5, 2016
File Number:
16-14187
Claim Number:
16102260
Type of Loss:
Property Damage
Claim has been made involving loss, damage, or destruction of the above captioned property, which may either
exceed $1,000.00 or cause "Mass. Gen. Laws, Chapter 143, Section 6" to be applicable. If any notice under "Mass.
Gen. Laws, Chapter 139, Section 313" is appropriate, please direct it to the writer and include a reference to the
captioned insured, location, policy number, date of loss, and file or claim number.
Claim has been made involving loss, damage or destruction of the above -captioned property, which may
exceed $5000. If any notice under Massachusetts General Laws, Chapter 175, Section 97A is appropriate,
please direct it to the attention of this writer and include a reference to the above -captioned insured,
location, policy number, date of loss and claim number.
On this date, I cause copies of this notice to be sent to the person(s) named above at the address indicated by first
class mail.
Sincerely,
Robert P. Blais
Claims Adjuster
Location a i ,�UN�v y h f► �U e"
f
No.
Date S y
V
�aR,h
TOWN OF NORTH ANDOVER
c9
'
Certificate of Occupancy $
Building/Frame Permit Fee $
s•►cMusE
Foundation Permit Fee $
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL
JBuilding
Inspector
3L61
Div. Public Works
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FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
*****************************APPLICANT FILLS OUT THIS SECTION*********************�`
APPLICANT 5,C -WT YL( / -J7/4MC#6rrO ) PHONE
6,r,vr i Cbnrc?oQ
LOCATION: Assessor's Map Number PARCEL 3/r%
SUBDIVISION LOT (S) —,9_
STREET SolV AJ y L-l4PJ E ST. NUMBER /D
USE ONLY*
RECOMMENDATIONS OF TOWN AGENTS: C>< Q
CONSERVATION ADMINISTRATOR DATE APPROVED I ul
DATE REJECTED
COMMENTS IUb tye,� L �I}/j tn! (60"
OYIA
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T WN PLANNER UDATEAPPROVEb !1JILI
DATE REJECTEDtk
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COMMENTS ��' t s
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FOOD INSPECTOR -HEALTH DATE APPROVED
DATE REJECTED
SEPTIC INSPECTOR -HEALTH DATE APPROVED
DATE REJECTED
COMMENTS
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DPIVFWAY PFRMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR
Revised 9197 jm
DATE
Lor 6A
v / FOUR SEASOIIS ASSOCIATES. IIIC.
373 T:/lww/m St. iwwronea/Tllnt. UIlVIQ
wOTII TIIII 19 NOf A GURVtt Awe 9MINO is ytte VVIR "onfuAOt{ h/Npr�ata non r. nu Nnr 1111 mrat Telelrlr•lu 1 (617) 6!1)-y171
TION 01 /f NCf{ OA GON{1AlSUReft ►ut�0{{t 1/ sunt,18108 {IIUWII I!i{ IIIAre u►.t /uOf rosy 1111 OOIl"tt Y ll Gtal$ 11 la A(IVI n 10 pr
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11"UC 1 /1111711111 Ctlltlft THAT TIIL t1111.0111Oa CON"11MCO IO fill! IONI►11T IAW{ A111/ AM(NnMF./11{.Or
t111UCf10 I /UNINIII CMTIIT IIIAT TNIt ►AOPENTT ItNOT to"11111.ON 111E EaTAtll{IIfn flOOO 11AtAN0 AREA
IiO. ANp04f.h WIIIN 011/1
BUYER
SEwi Yu
900X: 1512
PAGE: 3 2 9
PLAN NO.: 8 4 71
SCALE: I'= 40'_ 00
DATE: 11 /10/ 88_
TO THE NORTHMARK BANK ,�Ni►���
AND TITLE INSUnms ���+�lIS
MORTGAGE INSPECTION FLAN 8 IIOLZINA11
LOCATEO
104 BONNY LANE, IVO. ANDOVER MA,0,S��
TO 9E USE0 FOR monTGA(IE III InIY)i 4% ONLYt 111,
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Onlc� o1/ffY9SVgat/oas
600 Washington Street
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
city nhon "
I am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
Q'I am an employer providing workers' compensation for my employees working on this job.
addr_ua`_ tlayuc
city: �A9We6-A AM ne1 a lel
C4' nolicv M W49-11
1 am a sole proprietor, general contractor, or homeowner (circle one) and have hired the contractors listed below who have
the following workers' compensation polices:
c4mnln- name:
circ phone
lrnnrsnce cn
Failure to secure coverage as required under Section 25A ol';*YIGL 152 can lead to the imposition of criminal penald-= of a fine up to SI.500.00 and/or
oae years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I undenund that a
copy of this statement may be forwarded to the Office of Investigations of rhe DIA for coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is tree and turret:.
Signature
P; -int parr
official use only do not write in this area to be completed by city or town uncial
crry or town:
C check if immediate response is required
contact person: phone 4:
(1--1 1191 PIA)
ate LAY -
permit license # r Building Depanment
[!Licensing Board
[Selectmen's Office
CHealth Department
r^Othcr
Town of North Andover N
ORTH
OFFICE OF
COMMUNITY DEVELOPMENT AND SERVICES ° . x
27 Charles Street _
North Andover, Massachusetts 01845
WILLIAM J. SCOTT SSAC HU�r"
Director
(978) 688-9531 Fax (978) 688-95,42
In accordance with the provisions of MGL c 40 S 54, a condition of Building
Permit
Number is that the debris resulting from this work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL c 11, S
150 A.
The debris will be disposed of in:
(/ Signature of Permit Applicant
LA i , /99
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
BOP.RD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-95-40 PLAN-NING 688-9535
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Location Z�� i No. Date
OfN0RT1y TOWN OF NORTH ANDOVER
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3? '� . 0
0 ; Certificate of Occupancy $
Building/Frame Permit Fee $
CH Foundation Permit /Fee $
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Other Permit Fee $ 2S,U U
Sewer Connection Fee $ '`—
Water Connection Fee $ ------
TOTAL $ �� . S • U .
Building Inspector
6789 Div. Public Works
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A bulldi , eiiitlt i _
n9 P. 'fe.qu rod for'the installation of any solid fuel burning applfa" . 7?te•building permit
ncl
instattati6n1nspectf .n are led to the stove installation and not to the stove const, cgon.
Stave
A. New Used
B. Type!(adiant
C. Manufact.-Circulating
urer
N3tme/Model No ----Lab. No.
.�Coilar size
pimensionsrHei ht Len th . _ � h
ii � 9 ,._Width
Cplmney t/ i
A. New . —�.p Existing
8. Size (flue area)
�. C. tither appliances attar ed to flue (Number a
flue size)
0. Prefab (Manufac urername a type) d ✓P
E. Masonry/Lined II Flue liner 6
Unline O gyne a mu,w.eew«t
F. Height (rater to d agra s)
I avm to'
1 72 ' FdlK�
4. M1µ
12"M41.
12'
MIN.
eFVIWAM
Wit
� stt�
HEARTH
EIGHT
Hearth ( tible) •
A. Maierfafs j
S. Sub4loorcortstrumon
C. Mlnimumdirn.ns (r tertodisgrarn)
Ctlamncea and We I Prot coon (see Stove installation clearances chart)
A. Tree of wall prof on p ovided
8. Clearances (rete, to dia rams)
• L i
I I -
i�
FIREPLACE
�i
CORNER
••n�W�rC!•1 � CPf
I
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SAFETY TESTING
In accordance with the specifications and procedures tl:.ted in UL 1482 for solid fuel room heaters, the
Whitfield Advantage pellet stoves have been independently tested and listed by Warnock Hersey, (an
accredited testing laboratory ) to UL and CSA standards. UL 1482 states requirements for installation as
a freestanding room heater, or hearth insert for masonry or metal (zero clearance) fireplaces. The safety
listing label is located inside the hopper lid on Advantage Freestanding stoves or on the outside of the
hopper on an Advantage Insert stove. Please read this safety label carefully. It contains important
information about installation and operation of your Whitfield Pellet Stove. This Owner's Manual is provided
to you to supplement, rather than replace or update, the information contained on the safety label. Note
that your stove's serial number is located on this label. Your stove's serial number is preceded by a "WH-".
This appliance is designed specifically for use only with pelletized fuels. It is tested and listed for residential
installation according to current national and local building codes as:
• A Freestanding Room Heater
• A Hearth Insert when installed into a masonry or factory built fireplace
• A Built-in Heater
• A Mobile Home Heater
Note: This stove is not intended for use in commercial installations other than where the stove is being
sold without prior approval from Pyro Industries, Inc.
The stove will not operate using natural draft, nor without a power source for the blower and fuel feeding
systems. The appliance is provided with an exhaust connector for a 3 inch type "L" double wall vent pipe
with stainless steel inner liner (on freestanding & built-in installations), or single wall, stainless steel rigid
or flexible pipe (for insert installations).
WHITFIELD ADVANTAGE PELLET STOVE
SAFETY LABEL
WlanaxklEMNY LISTED ROOM HEATER. PELLETIZED WOOD FUEL TYPE. ALSO
�. FOR USE IN MOBILE HOMES, AND AS AN INSERT FOR MASONRY
llll`� FIREPLACES AND FACTORYBIAU FIREPLACES. OR AS BUILT IN
A
MODEL WP2 ADVANTAGE TESTED TO: UL 1482/ULC-5827/
CSA BW.2M I )ILC -5628 REPORT NO: 5515 (DEC.1991).
SMALL AND USE ONLY IN ACCORDANCE WITH THE MANUFACTURER'S INSTALLATION
INSTRUCTIONS I CONTACT LOCAL BUILDING OR FIRE OFFICALS ABOUT RESIRCTIONSANO
NSTNLATION NSPECRON IN YOUR AREA. 00 NOT CONNECT THIS UNIT TO A CHIMNEY
FLUE SERVING ANOTHER FIREPLACE. SEE LOCAL BUILDING CODE AND MANUFACTURER'S
INSTRUCTIONS FORPRECAUTIONS MOUIRED FORPASSING A CHIMNEY THROUGH ACOM-
O S11BLE WALL OR CUM. THIS PELLET FILED APPLIANCE HAS BEEN TESTED AND LISTED
FOR USEIN MMUFAMRED HOMES IN ACCORDANCE WITH OREGON ADMINISTRATIVE
RUIFS 8u -22-90D THROUGH 814-21909.
OPFILATE MY WITH FREBRIDSIN RACE. OPERATE ONLY WITH VIEWING DOOR CLOSED.
INSPECT FLUE F REOUENRC CLEAN HEAT E%OIANGERAND FLUE FREOUFHTLYTOPREVENT
ACOMAA1gN OF SOOT. THE HEATER AND FLUE MUST BE IN GOOD CONDITION. REOUREO
COMPONENTS: DAMPERSEALBIG PLATE FOR INSERT INSTALLATIONS. OPTIONAL COMPO-
NENTS: SHROUD FOR INSERT ULTRA GRATE. KEEP FURNISHINGS AND OTHER COM.
BISTIBLE MATERIALS WELLAWAY FROM NEATER.
ROUTINE MAINTENANCE REMINDER
FREQUENCY OF CLEANING AND MAINTENANCE OF YOUR STOVE
DEPENDS ON THE ASH CONTENT OF THE PELLETS YOU BURN,
CHECK THE FOLLOWING PARTS OF YOUR STOVE WEEKLY FOR THE
FIRST MONTH TO DETERMINE OF CLEANING:
A. BURN GRATE
S. HEATEKCHANGERTUBES
C.ASHTRAPSANDASHPAN
SEE YOUR MANUALAND/DEALER FOR MORE INFORMATION.
CAUTION: HOTSUR-
FACES WHILE IN OPERA-
TION. DO NOT TOUCH. CON-
TACT MAY CAUSE SKIN
BURNS. KEEP CHILDREN,
COMBUSTIBLE MATERIAL
AND FURNISHINGSACONSIDERABLE DIS-
TANCE AWAY. SEE NAMEPLATE AND
INSTRUCTIONS. TYPE OF FUEL: PEL-
LETIZED WOOD FUELONLY.
U.S. ENVIRONMENTAL
PROTECTION AGENCY
CERTIFIED to complywith
July 1990 particulate
emission standards
DATE OF MANUFACTURE
�r �r] .M .ar ,+w ,rr w, tta Wa ..m aMr rn. wx aW tB OC, nO/ OC
Whitfield pellet stoves and fireplace inserts are safety tested and listed by
Warnock Hersey Professional Services, Ltd.
4j
DO NOT REMOVE THIS LABEL
MADE IN
USA
WH—
r.�cre�a'No-N1EDwaeiwa
°av •v
c..r'.tioA,.w.�
maanm i
rirw
t•�
rnrr
an�r
rmr
c
��w
s -
l Wma ,rltlr E
tt MADE IN U.SA BY: PYRO INDUSTRIES, INC.•
!WI]]O1Rn.A
BUR�ONG:ON,
WA
CAUTION: HOTSUR-
FACES WHILE IN OPERA-
TION. DO NOT TOUCH. CON-
TACT MAY CAUSE SKIN
BURNS. KEEP CHILDREN,
COMBUSTIBLE MATERIAL
AND FURNISHINGSACONSIDERABLE DIS-
TANCE AWAY. SEE NAMEPLATE AND
INSTRUCTIONS. TYPE OF FUEL: PEL-
LETIZED WOOD FUELONLY.
U.S. ENVIRONMENTAL
PROTECTION AGENCY
CERTIFIED to complywith
July 1990 particulate
emission standards
DATE OF MANUFACTURE
�r �r] .M .ar ,+w ,rr w, tta Wa ..m aMr rn. wx aW tB OC, nO/ OC
Whitfield pellet stoves and fireplace inserts are safety tested and listed by
Warnock Hersey Professional Services, Ltd.
4j
gr/w �r
.�
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Qa►•drnor O
kent,tm'I'saut,umt t, 0,$l11c4
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Adnttrltsirat0r
FOR pR1,TM ar YN sA7Y6MNA t'NUOArrvlt PttA9kUPiIt>' TasTIN0
(PALL IPOIMTWM IPPS 11RATiNO CUSON)
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STOVE EXHAUST / INTAKE INSTALLATION
IT IS RECOMMENDED THAT ONLY AN AUTHORIZED DEALER INSTALL YOUR PELLET STOVE.
THE FOLLOWING INSTALLATION GUIDELINES MUST BE FOLLOWED TO ENSURE CONFORMITY
WITH BOTH THE SAFETY LISTING OF THE STOVE AND LOCAL BUILDING CODES.
GENERAL GUIDELINES FOR INSTALLING EXHAUST SYSTEM
FREESTANDING:
• A listed 3 or 4 inch type "L" pellet vent exhaust system must be used for freestanding installations and
attached to the pipe connector provided on the back of the stove. Use a 3 -to -4 inch adapter for 4 inch
pipe.
• The vent termination must be located no less than 48" from any opening through which combustion
products could enter the building, (i.e. windows and doors) not less than 24" from an adjacent building,
and not less than 7' above grade when located adjacent to public walkways. The exit terminal must be
arranged so that flue gases are not directed so as to jeopardize people, overheat combustible structures
or enter the building. Keep brush, plants and shrubs at least 36" away from vent termination. As in all
stoves, sparks may escape from the exhaust pipe, always use caution when positioning the vent pipe.
Refer to pipe manufacturer's Instructions when Installing and terminating your exhaust pipe.
• Ninety -degree elbows accumulate fly ash and soot thereby reducing exhaust flow and performance of
the stove. Horizontal runs of pipe collect fly ash also. It is recommended that a single or double clean-out
'tee' be installed at every 90 degree turn so that fly ash can accumulate at the bottom of the 'tee'. If a
90 degree tum connects a vertical run of pipe to a horizontal run (as you follow the exhaust away from
'the stove), a tee is not required. At any other 90 degree turn, installation of a clean out tee is
recommended to permit periodic cleaning of both the horizontal and vertical runs of pipe.
• Total length of horizontal vent must not exceed 25 ft.
• CAUTION: On all direct vent installations, care should betaken when choosing a location for terminating
the vent. It is not recommended to directly vent the exhaust on the prevailing wind side of the house.
This type of installation may cause a burn back in the stove during a power outage. This may cause
serious harm to persons or property.
INSERT:
• A 3" single-wall, stainless steel flexible or rigid exhaust pipe may be used for insert installations and
must be attached to the stove with a single or double wall, stainless 'tee' with a clean-out cap. The
stainless steel 'tee' can be inclined at 45 degrees to enable the vent to be centered on the stove, and
allows the 'tee' to be cleaned out more easily without removing the stove.
• When venting into an existing chimney (masonry or factory built) the chimney must be cleaned, with all
creosote,dust and ashes removed.
• The "L" vent or single wall stainless exhaust system must be installed so as to be GAS TIGHTi The
vent manufacturer's installation procedures must be followed. In addition, pipe connections, joints and
all pipe seams within the home should be sealed with room temperature vulcanizing, high temperature
silicone sealer (RTV).
If an insert is to be installed into an unlined masonry chimney, it is recommended that the 3' or 4" rigid or
flex pipe be extended to the tope of the existing chimney. The top of the existing chimney should be sealed
with a metal plate after the pellet vent has been installed.
if
STOVE INSTALLATION CONFIGURATIONS
YOUR WHITFIELD MAY BE INSTALLED AS:
• A freestanding unit with a pedestal placed on a non-combustible floor pad.
• A fireplace insert set into a masonry or factory built fireplace.
• A built-in stove(insert) placed on an insulated floor pad.
• A mobile home heater placed on a non-combustible floor pad, bolted and electrically grounded to the
chassis of the home.
FLOOR PROTECTION
Your Whitfield pellet stove must be installed on a non combustible protective floor pad of minimum 3/8"
thickness material or a masonry hearth. The hearth or floor pad must extend a minimum of 6" in front of
and from each side of the stove (and 6" behind, in a freestanding/inside vertical installation configuration)
or to the nearest permitted combustible material (if less than 6").
The Hearth Pad Must Extend
A Minimum Of 6" To The Sides
And Front Of The Stove. 1" In The
Rear. 6" In The Rear In A Freestanding
Inside Vertical Installation Configuration
CLEARANCES TO COMBUSTIBLES
The stove must be installed with the following minimum clearances to combustible materials.
1" Clearance From Front Of
Hopper To Back Of Stove
6" Clearance From Front
Of Hopper To The Door -
1" Clearance Behind Stove
1" Clearance To The Corner
18" Clearance Above The Stove
Although a 1" clearance to a combustible is a minimum, you
should have at least 1.5" of clearance to allow the hopper lid
to open all the way.
Keep all combustible material at least 18" (horizon (,'i"f) away from the glass windows.
LL•y
(ALCOVE CLEARANCES)
Max. Depth of Alcove 16"
Min. Width of Alcove 36"
Min. Height of Alcove 50"
11 Minimum
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Minimum 12" Distance
Between Exhaust and
Fresh Air Intake
Optional Exhaust
and Fresh Air
Intake Direction
f
Wall Thimble
V---- 45 Degree Elbow
17> Or End Cap
Minimum
Non -Combustible Hearth Pad
(3l8" Minimum Thickness)
/ 45 Degree Elbow
Type "PL" Vent Exhaust
Fresh Air Intake (Optional)
1" Minimum to Combustibles
15
Location /c-)4
No. � 1 ¢- Date
„°RTS
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TOWN OF NORTH ANDOVER
' A
Certificate of Occupancy $
Building/Frame Permit Fee $ S 0`1
S�CHus
Foundation Permit Fee $
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
r J
TOTAL $
Building ln spector
Div. Public Works
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TOWN OF NORTH A14DOVER
LOT RELEASE FUIUL
SUBDIVISION LOT(S) L07 %,4-il0 S,
PERMANENT ADDRESS ASSIGNED BY U.Y.W.
STREET %04 Nv2T14 4Nlioyrrz 1,44 .
APPLICANT S�� / S ' Yu ; �" l ' PRONE
DATE OF APPLICATION
TOWN USE BELOW THIS LINE
PLANNINJQ BOARD
��4 �� zza
TOWN PUNNER
CONSERVATION COMMISSION
V I L
CONSERVATION ADMIN.
e
BOARD OZo,IJEALTIi
TH SANITARIAN
DEPARTMENT OF PUBLIC WORKS
_DATE APPROVED----f-'�-=�`
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
i
DRIVEWAY PERMIT
SEWER/WATER CONNECTIONS
FIRE DEPT.
RECEIVED BY BUILDING INSPECTION —
DATE
This form shall be signed by the agents of the Planning and Health Isoards,
the Conservation Commission prior to the issuance of any buildinf; permits /
for the subject lot. This form shall not releive the applicant from the
compliance of any applicable Town requirement or Bylaw. /
i.
' (Please
DATE
JOB LOCATION
Number Street Address
/ NSection of town
"HOMEOWNER" 7 �-`�ivl .�• �(/ ��� 9Z � � / _ � /
game- (D 146
Home Phone Work Phone
PRESENT MAILING ADDRESS NN jV ��jv,p
City Town Q
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
that 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 familydwell-
ing, attached or detached structures accessory to such use and/or farm ell -
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.
print)
Town of North Andover
BUILDING DEPARTMENT
Homeowner License Exemption
Mal