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HomeMy WebLinkAboutMiscellaneous - 18 WATER STREET 4/30/2018-IV Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Inspector of Buildings 1600 Osgood Street North Andover, MA 01845 RE: Insured: Property Address Policy Number: Date/Cause of Loss File or Claim Number: Ramon Rodriguez 18 Water Street BBMXZX 8/28/2011, Water Damage 25236-B Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER 143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. Bobby Keeser On this date, I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. x4opooe� i;;;�r �q / Signatu and Date ANDERSON ADJUSTMENT CO., INC. 50 Nashua Road, Suite 303 PO Box 1098 Londonderry, NH 03053 ir Date..................................-� TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .. ............:`.':..LI `':' ........: / _-,, -..... f ...............I (..�...... has permission to perform f....... wiring in the building of .................. . /P'`� ' ............................ . North Andover, Mass. crcl Fee . 5..... .... Lic. No... .. .... � - - .................... �v ELECTRICAL INSPECTOR Check # y `�'�� 19-65-,, THE COMMONWEALTH OF MASSACHUSETTS DEPARTARMOFPUBLICSAMY BOAROOFFLREPREVEMONRFgIIA770NS527CNIRI2.00 APPLICANONFOR PERMIT TO PERFORMEL ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Owner or Tenant j Owner's Address AIR V361, rod , Is this permit in conjunction with a building permit: Yes © No M Purpose of Building Office Use only mit No. r! Occupancy & Fees Checked WCAL WORK 527 CMR 12:00 ��'J �j Date To the InspecQ of fres: (Check Appropriate Box) Utility Authorization No. Existing Service %� AmpsVolts Ovefkead M Underground M New Service Amps / Volts Overhead M Underground M Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Meters j No. of Meters No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA round 0 round Mi. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners No. of Ranges FIRE ALARMS No. of Zones No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local 17-1 Municipal r7 Other No. of Dryers Heating Devices KW Connections No. of Water,Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER• hwiatloeCow ago Rug =tothetegtutet icmofMmxhusettsGanalLaws Ihavaaairantliabn7itylnstt�Policyinchndn�gCotr>plete Covageoritsstab�rmalequivalent YES E3 NO E Ibaveabmwdvabdpmofofsametothe0fce. YES IfyouhavEcllecl,2dYES, pleaseir lhetypeofcovetWby drddrigtheappr coL INSURANCE 0 BOND OTHER FxpitalionDate WodctoStatt hnspearonDaleRMiesed Signed underlie Pumbes of perjury: FIRMNAME Esti WdVa1wofFleci1aWodc$ Rough Final LicffwNo. Lic=No Busin s Tel. No. A Alt Tel No. OWNER'S INSURANCE WAIVER; lam awarethatthel-mmdoesnothavetheinstuanceooverageoritsa bsmhalequivalentasopodbyMa%achugaNGeneralLaws and d>atmysignahueonths 'tapphcadonwaivesdusrogtmetrimt (Please c c one) Ovjr Agent r7 _ Telephone No. PERMIT FEE $ ��• tgn re caner or Agen Location /� �A�� 2 S No. 3 9 Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ _tea Foundation Permit Fee $ Other Permit Fee TOTAL Check # Z- 16159A�J(6�, Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING b T�ii$.�' fli!' �i�I�AI i1SC`tislrl BUILDING PERMIT NUMBER: Q DATE ISSUED: SIGNATURE: Building Commissioner/Insvector of Buildings Date SECTION 1- SITE INFORMATION / 1.1 /Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 7 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Regpired Provided ReqWred Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zane Information: Public ❑ Private 0 Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record -D5 N ` fzt: -S k /8 kb94 S7"- 17219 . Name (Print) Address for Service: -L�nn �ignat^e Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: �' / /4-& /i -? G'. &-rd '-) Licensed Construci!ion Supervisor: 23 !Y ^ /� A S' . On v 9. �� JC ��L 1' hn19 •o � pge— Address f Sign re Telephone Not Applicable ❑ C� O X58 License Number 6 .-1'2 - OY Expiration Date 3.2 Registered Home Improvement Contractor M,4 -A Not Applicable ❑ /3c)Company Name 2—?.j L14 -,,i S-/` ^_ /�n-_'d� n^ ^. Registration Number P— /37 —61/ I Address _ (,/V Expiration Date Signature Telephone Ma T ■ . ■ X z O O, R SECTION 4 - WORKERS COMPENSATION (M r_ r. r 14') c Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes ......JC No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ gti Existing Building A_ !, .. Irl • i Repair(s) ❑ Alterations(s) — � ! �N Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 8' e ARd�>O/L cr �� 6 v,ti i .sem - w�,�-� •-- .� SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed b_permit applicant OFFICIAL USE"t3NI.Y 1. Building _ S (a) Budding Permit Fee Multiplier 2 Electrical I (b) Estimated Total Cost of Construction 3echaPlumbingBuilding Permit fee tel X (b) 4 M Mechanical (HVAC) 5 Fire Protection 6 Total 1+2+3+4+5) 91,900,00 Check Number SECTION 7a OWNER AUTHORIZATI N TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTI NJb OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject propert Hereb -declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/A ent Date NO. OF STORIES SIZE -milli BASEMENT OR SLAB SIZE OF FLOOR TRVMERS 1 2ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS f IE-IGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision 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 c11,S150A. The debris will be disposed of in: p W11) -kAA7P17i4,rt (Location of Facility) a)" 6ZT=7 Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 42111 Workers' Compensation Insurance Affidavit Please Print Location: V 12 /AA . S¢ City 11/19 - Phone F-1 am a homeowner performing all work myself. RI am a sole proprietor and have no one working in any capacity aI am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone # Insurance Co. Policy # Company name: Address City: Phone #• Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify undeOPe pains and penafties of perjury that the information provided above is true and corract. S Co a -& -0 z Print name /1'l A-eA /� u Phone # c/ Z? -4/ 79--1c.5 Official use only do not write in this area to be completed by city or town official' ❑Check if immediate response is required Building Dept Contact FORM WORKMAN'S COMPENSATION Phone #.- ❑ Building Dept ❑ Licensing Board ❑ Selectman's Office ❑ Health Department 11 other Ki D d l K, BOAiD OF BUILDING REGULATIONS" License: CONSTRUCTION SUPERVISOR Number CSt a: b55584 ;, $rcthdate, 0611711Q59 _ 17f2004 24919 " Exl�r s � J-1 fi s A Y Restricted 00 t,-MARIC'E BUTTON 23 DANA ST s u ` N ANDOVER; MA: 01845• Administrator, * �', :•i logard of Building ]�egulat�on� sAd Staadrds Bo . NT C0NRACTgi� HOME tMROVEtJI T , l �, « Registration 136742 ' a 13104 y b(y Y r r h MARKELL CONST. `MARK 13UT` Q 23 DANA,, ST N. ANDOElk,"MA"01845 Administrator, - -4 ml - 2 i a 00 00 a a 0 M h O� 00 00 z 0 x on w z 0 U v rn 00 00 J TPetj 90-, MARKELL CONSTRUCTION /U• BUILDING & REMODELING 23 DANA STREET NORTH ANDOVER, MA 01845 (978) 683-8961 FAX (978) 683-0761 V 02kg " Pao Al P-/3 F -P y R-1 QA -Us moi' r . V1.l1 � r . V1.l1 � �1 < < JI- -_ Q1 ca 3 9� II sj x E~ w O C4 Oo a� C G u u O n O C z 0 w 0 cG X U m C u. O v W CG a 0 c�: m C u: O w U U a W 0 u: U v cn m C w p U a d C7 0 in w w Q a w v C 7 w o z cn 0 v 0 E U) 1' { s Ei 4, s a O O P4 GD O CO L O y.r � O O Z p,• O y � C CD CM, O •E m m CD 0 CD CL ~ ♦_-+ CD O.a 3� O � O C O cc o a CL �Q y C � � C cc CL •Q. O CD /C Z CD 0 CL V C c •C C 0 0 U) LLI LU w ccw U) 4 c r- 0 CO c c � C H it t� O V V d C ev � = O O coN m C�CD 1 � m �: N E c om o 0 c _ 1=0.S E .2 Dmm�a N- CO o N iv co 3 > L m a c . I N W; A E E � o. 5 ) m N m ; 1 sit; c x �, = oQ �accCD � co V ZO O C p C m� N CD C = m C w C O N Cl)F•— $ N mCD s W G 2tLL. w y ` E n��c v� N Z o LU � m o m� ED S Cl) Q C* O O � o) O S d r=. m zip a O O P4 GD O CO L O y.r � O O Z p,• O y � C CD CM, O •E m m CD 0 CD CL ~ ♦_-+ CD O.a 3� O � O C O cc o a CL �Q y C � � C cc CL •Q. O CD /C Z CD 0 CL V C c •C C 0 0 U) LLI LU w ccw U) 4 �aHr� Zoning Bylaw Denial Town Of North Andover Building Department 27 Charles St. North Andover, MA. 01845 Phone 978=688-9545 Fax 978-688-9542 eg M -e % .._-Street:... .. ' ... ...W /� ... E._� �..... Ma /Lot: A/ aG Applicant: .t7© `7— R4 _S << Request: S r ' D0�1�2�/� . Date: io a 2 •— d .0-� „44019 wv auvlaau a1aMa,ier review or your Application and Plans that your Application is DENIED for the following.,Zoning Bylaw reasons: Zoning Remedy for the above is checked below item # Special Permits Planning Board Item # Item Notes Setback Variance Item Notes A Lot Area Common Driveway Special Permit F Frontage Variance for Sign 1 Lot area Insufficient Independent Elderly Housing. Special Permit 1 Frontage Insufficient Earth Removal Special Permit ZBA 2 Lot Area Preexisting e S 2 Frontage Complies Special Permit preexisting nonconforming 3 4 1 Lot Area Complies Insufficient Information 3 4 Preexisting frontage Insufficient Information B Use 5 No access over Frontage 1 Allowed G Contiguous Building Area 2 Not Allowed 1 Insufficient Area 3 Use Preexisting 2 Complies 4 5 Special Permit Required Insufficient. Information K S 3 4 Preexisting CBA Insufficient Information L4 e S C Setback H Building Height 1 All setbacks comply 1 Height Exceeds Maximum 2 Front Insufficient 2 Complies 3 4 Left Side Insufficient , Right Side Insufficient Ll e 3 4 Preexisting Height Insufficient Information `!e s 5 Rear Insufficient I Building Coverage 6 7 Preexisting setback(s) Insufficient Information y e S 1 2 Coverage exceeds maximum Coverage Complies D 1 Watershed Not in Watershed e 3 4 Coverage Preexisting Insufficient Information 2 3 In Watershed Lot prior to 10/24/94 1 Sign Sign not allowed N 4 5 Zone to be Determined Insufficient Information 2 3 Sign Complies Insufficient Information E Historic District K -- Parking 1 2 3 In District review required Not in district - Insufficient Information G( -e 1 2 3 More Parking Required Parking Complies Insufficient Information A 4 Pre-existing Parkin Remedy for the above is checked below item # Special Permits Planning Board Item # Variance Site Plan Review Special Permit z6i-� Setback Variance Access other than Frontage Special Permit Parking Variance Frontage Exception Lot Special Permit Lot Area Variance Common Driveway Special Permit Height Variance Congregate Housing Special Permit Variance for Sign Continuing Care Retirement Special Permit —"Special Permits Zoning Board Independent Elderly Housing. Special Permit Special Permit Non -Conforming Use ZBA Lame Estate Condo Special Permit Earth Removal Special Permit ZBA Planned Development District Special Permit Special Permit Use not Listed but Similar Planned Residential Special Permit Special Permit for Sign R-6 Density Special Permit Watershed S ecial Permit Special Permit preexisting nonconforming The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for DENIAL. Any inaccuracies, misleading information, or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department. The attached document titled "Plan Review Narrative" shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file. You must file a new building permit application form and begin the permitting process. ��Idi 4Depa!rtmeeZnt:41icial Signature g ture Denial Sent: A� :a� -oa- // Z -0 c-,7, Application Received Application Denied If Faxed Phone Number/Date: ,..rt_... MT ""w Plan Review Narrative The following narrative is provided to further explain the reasons for denial for,the application/,. - permit for the property indicated on the reverse side: Referred To: Am NL A- cY ,� SSG�9�0� Fire Health Police Zonin Board Conservation De artment of Public Works OthePlannr n Historical Commission Other BUILDING DEPT MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) Affi-M��W r _ Mass. Date % 19 �rL� - wr8I1Ce . City, Town Permit # BuildingOwners , �� Name AT: Location (� ��' Type of Occupancy:` New ❑ Renovation Replacement ❑ Plans Submitted Yes ❑ No (Print or Type) Installing Company Name Address Check One: Certificate ❑ Corp. []Partnership ❑ Firm/Company Business Telephone, C_Name.Of Licensed Plumber or Gasfitter I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under 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 lwws. By Title City/Town: APPROVED (OFFICE USE ONLY) rGasfitter LICENSE: ber Signature of Lice sed er`Plumbe - G sfitter neyman Licen a Number Will (Print or Type) Installing Company Name Address Check One: Certificate ❑ Corp. []Partnership ❑ Firm/Company Business Telephone, C_Name.Of Licensed Plumber or Gasfitter I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under 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 lwws. By Title City/Town: APPROVED (OFFICE USE ONLY) rGasfitter LICENSE: ber Signature of Lice sed er`Plumbe - G sfitter neyman Licen a Number r Z 0 O D m 1 Z F z a v m 0 z m m m i z 0 -,+-.--.. t„+"Y.-..�,,,-.v+rr�.....eo,�$(`tit''.. "��a+--•D�,,...�+'.rtirv'^ :d'n..:.+...re:.y.,,�.. . ..... _;, . :-....�'_v''".�.. �. Date .� 40RTH, f ,: -TOWN OF NORTH .ANDOVER: 020 „•o °. ti0-a ,,, �;:,-_ - - - 1 PERMIT FOR GAS INSTALLATION �9SSACHUS�t This certifies that . ,... , has permission for gas installation tf6x� t: �e . 4fVF.N i, �V in the buildings of..... . at , North Andover, Mass Fee L;ic. Nof . . GAS INSPECTOR r WHITE.'Applicant r" CANARY: Building Dept:.' PINK: treasurer .GOLD: File Location No. , Date % TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ rigs',^ E`er ei� Foundation Permit Fee $ s�►CHu t �Q Other Permit Fee ' ` •f $ �G�� Sewer Connection Fee $ r Connection Fee $ Go�40TAL $ Building'lnspector Div. Public Works PERMIT ,40. �Ir 2 APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. MAP d40. LOT NO. 2 RECORD OF OWNERSHIP DATE BOOK PAGE ZONE SUB DIV. LOT NO. LOCATION i g �eL ��yJ�tZ-+r-' `+ PURPOSE OF BUILDING Afa,� 6; K�b �AE fA#Zr'C�.. CKGSIIZE OWNER'S NAME O' _ lngnclA,�-i�iln��lf '� 1 37A�5 NO. OF STORIES OWNER'S ADDRESS G ��� V mac"` /� ( �[� 1 BASEMENT OR SLAB ARCHITECT'S NAME _ SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME ,... SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS - DISTANCE FROM STREET "' "" POSTS DISTANCE FROM LOT LINES — SIDES REAR "" GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR ♦_ T DATE FILED SIGNATURE OF OWNER OR AUTHORIZED AGENT / FEE 035 PERMIT GRANTED 'Z0 19 9t--_ 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST :, Q� m�� EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF BELECTMEN BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS _ CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE PINE 3 1 2 13 CONCRETE BL'K. BRICK OR STONE HARDW'D _ PIERS PLASTER DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ 14 1/7 1/1 FIN. ATTIC AREA N_O B -M'T FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 �_ 3 _ DROP SIDING WOOD SHINGLES CONCRETE EARTH HARDW'D COMMCN ASPH. TILE ASPHALT SIDING ASBESTOS SIDING VERT. SIDING _ STUCCO ON MASONRY STUCCO ON FRAME _ BRICK ON MASONRY BRICK ON FRAME ATTIC STRS. 8 FLOOR _ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I� POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH Q FIX.) _ GAMBREL MANSARD TOILET RM. (2 FIX.) WATER CLOSET FLAT SHED ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd ELECTRIC _ 10 13rd NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS, WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. w F a O Mal z 'O r•; Ld ui `M Q.E O z F-' ME Ir 0- • 0 � t^ C O of C o V ` 0 y u 0 'a CL of 0 a W w 0 W W y O c ..1.. f/1 v' C H z Z W C6 � U. O Z y C a. G. G c7 H LO v h ? W o z y CCQ z � LL GO C — t t m •_ �o z o e •o o H a = N CL y a=r � � m t c J L J L V V t ~ Q m E W �' ` m c Y o cc c N U ii a: ii ¢ EO U. Q ii m a O Mal z 'O r•; Ld ui `M Q.E O z F-' ME Ir 0- • O � t^ C O C o V ` 0 y u U 'a CL 'v C 0 w 0 H y c ..1.. v' C C � C � y C a. G. H LO x y CCQ � LL GO C — t t u °� •_ �o z o e •o o H a = N CL y a=r � � L O V C V �+ V Mto e ~ Q •y E L12. Ma a i Mc C to r� L� V to C Wh co (Please print) DATE jun e_ a JOB LOCATION 1t Num "HOMEOWNER" ame er Town of North Andover BUILDING DEPARTMENT Homeowner License Exemption 0 C4-eC �. treet Address PRESENT MAILING ADDRESS Doom e ( O W - e Phone ection of town Sck �fn e_ ork 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 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 family 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 rebulations. 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. 1