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HomeMy WebLinkAboutMiscellaneous - 195 BEAR HILL ROAD 4/30/2018 195 BEAR HILL ROAD 210/065.0-0097-0000.0 1 Date. . MORTM Of TOWN OF NORTH ANDOVER 01 p PERMIT FOR GAS INSTALLATION SSACHUSE This certifies that . . . .421 l has permission for gas installation-. . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . 4 7ver, at .,�9,. . . .�� '. . . . . . . . . NorthAndMass. ov„ Fee' . . . . . . Lic. No//.`5"o . . . AS INSP�T R Check# 4722 Date... NOR7q TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ass^cHUSE� This certifies that ...... . ........... ............. . .. .......... ..... ....... .......... has permission to perform wiring in the building of;/, ,r'1��/..— � ., � '1.......... at./. ../ ,! ... .�a ........ ,North Andover,Mass. y, /r. Fee.�� ......... Lic.Nol 1/ ELECTRICAL INSPECTOR Check It Y , 5172 Commonwealth of Massachusetts official Use only ` Department of Fire Services Permit No OCand Fee Checked CCU ancy BOARD OF FIRE PREVENTION REGULATIONS (Rev. 1{1/99] leave blank) APPLICATION FOR PERMIT TO PERFOR ELdCTRICAL WORK All work to be performed in accordance with the Massachusetts Electri l Co a(MEC),527 CMR 12.00 I (PLEASE PRINT WINK OR TW 5) INFORMATION} Da�e: City or Town of: l /�/Z��� �''� To the Inspector of Wires: By this application the undersigned gives otlnce of is or her intention to perform the electrical work described below. Location (Street& Number) Owner or Tenant s Telephone No. Owner's Address 9 7J Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utilitv Authorization No. Existing Service Amps / Volts Overhead❑ Und,, ❑ No. of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Inspector of TVires. No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting OutletsI No. of Hot Tubs Generators KVA No. of Lighting Fixtures ISwimming Pool Above ❑ In- ❑ o. o mergs ency ig nng grnd. grnd. Battery Unit No. of Receptacle Outlets No. of Oil Burners 1FIRE ALAR IS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total No. of Alerting Devices i Tons No. of Waste Disposers Heat Pump Number ;Tons I few ;LNo. of Self-Contained Totals: I IDetection/Alerting Devices 1 No. of Dishwashers (Space/Area Hearin; KW Local tI uectal ❑ Other Heating Appliances K« Security Svste • No. of Dryers pP No.of'Devices E uivalent 'Yp. of Water KW No. of No. of Data to t Heaters Signs Ballasts No. of Devices or Equivalent N�,. Hvdromassaae Bathtubs I Nu. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent I OTHER: trccr:erdr:anal de!c:!if desired. or as require:(by the Cnsaec:ur of %Vire,, INSURANCE COVERAGE: Unless waived by the owner, no permit for i e performance of electrical wor'K may issue unless the licensee provides proof of liability insurance including"completed operation" coverage or its substanr,al eeuiyaient. The undersigned certifies that such cove ge is in force, and has exhibited proof of same to the permit issuing o;;tce. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) Expiration l Date Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance ,.vich -IEC Rule 10, and upon completion. I certify, undertApains and penalties of perjury, that the information on this application is true and complete FIR:r1 NAME F!&i f/ LIC. Licensee� XS z/,d Signatur LIC. NO.; (yapplicable, enter "erelnot"in the license numb ".9er line.) us.Tel. No. � Address: /575- GG QST s% 5-12 �b / / TL17, �i��G'/c�s7 Alt. Tel. `io.: OWV ER'S INSURANCE WAIVER: I am aware that the Licensee doe not have the liability insurance coverage normally required by law. By my signature below, i hereby waive this requirement. 1 am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PER1VfrT FEE: . MASSADE- USETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTI G (Print Or Type) City, Towyn PermitBuilding AT: Location ` / Owner'�'"`��'Q� . �'�- Name Fee- . > r4 yy Typ[ of Occupancy: 11 New❑ Renovation ' Replacement[]/ FIXTURES Plans Submitted Yes[] No❑ C Cn W v) U Z m u) W U)z O WMI m < cc CC D p z W m CO U) H W w O a- W <g O U) tr U) O U W = U) W < Ir O p > W ~ 0 W z f- H V) W m W 0 t— z E— z W W O O > tL E_ U _j O UJ Z W < m — H } u) ap Z O z O Q W > F w z O O W O w l— ml 3: 00 L5 � � (<5 Ulm > 0 [LW oC3 SUB-BSMT. BASEMENT 1 ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR .. 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR (Print or Type) � 0 � Installing Company Name `� Chec One: Certificate Address i ��r� P Corp- ,;7 p ❑ Partnership ❑ Firm/Company Business TelephoneName of Licensed Plumber or Casfitter I hereby certity that all of the detail and information i have submitted(or entered)in.above appii;;ation ars true and ac: urate to the,beer of my knowtedge and that all plumbing wort;and installations performed under Permit issued for this application will be in compliance vitt! all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. I have inicrfipted the ow bits agent.t that l `c not' have iiability insurance Inci6 din cErnpieted operations Cove.r��?. ALL APPOINTI0EN TS FOR INSPECTION ARE TO BE FADE BY LICENSED PWMBERS ONLY. ign tu'e of age l have rye iability insurance polis o include completed operations coverage. ❑ �-- _ lk6iZter ❑,burn€}+man ❑Gasfittel i n uredf L i c 9 used C PI or asfitter License Number /0010 �I ADDRESS INSTALLER OWNER INSPECTIONS UNDERGROUND DATE & TIME ROUGH DATE & TIME FINAL DATE & TIME i i 1, September 27, 2004 To Whom It May Concern: I reside at 195 Bear Hill Road.located in North Andover and would greatly appreciate your consent to open a home base business for floral arranging. There will be absolutely no truck deliveries of flowers. I will personally obtain my working material from the Boston Flower Exchange. I do not need an addition to my property and there will be no visits from clients or employee, it is a sole proprietorship. My property will be use for the sole purpose of arranging flowers. Sincer , Kimarie Glasgow Sole Proprietor RECEIVED OCT 7 2004 BUILDING DEPT. Date.? ,40PTpI + TOWN OF NORTH ANDOVER 10 . PERMIT FOR PLUMBING SACHU This certifies that . . . . . . . . . . . . ..i . .. . . . . has permission to perform plumbing in the buildings of . . . . . . . . . . . . . at . . . . . . . . . . . . .. North Andover, Mass. Fee . . . . .Lic. No. C . . . . . . . . . . . . LUM AP�LUMNGINSPECTOR Check # —1,11,9z' 51/ 46 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Pr' t or T ) Mass. Date (� d 2Q ermit # u `7 Budding Location S Owner's Name ✓O�x — ✓r^ je,S, �J v Type of Occupancy-j2 \ Q New ❑ Renovation Replace ❑ Plans Submitted: Yes C3No ❑ FXTU S N z F- N N N O > W t- M J >- U < N d_j CnW ¢ N z N Q ¢ Q _ ~ N z O z =_ U) a O OJ N W H O~1 = a) 1 U W N Y < N IL ¢ W0 W d H G -K CC < J N C ¢ J z O ¢ D ¢ 00 W = < S 3 O 2 = Y p O !- < Y < W LL Y W O = a O N H z O O W = z .W �' O 0 2 < t- < < = N N < d O < J J < ¢ ¢ ¢ < O < H i Y J m h D D J 3 = F N LL O O < 3 ¢ m O Sub-BSMT. I BASEMENT 1ST FLOOR 2ND FLOOR a 3RD FLOOR 4TH FLOOR 1 5TH FLOOR 6TH FLOOR ?� 7TH FLOOR STH FLOOR Installing Compan Nama) C-, UVV'� Check one: Certificate Address b h ❑ Corporation („✓ b ❑ Partnership Business Teiephone -+ZS �Frrn/Co. Name of Licensed PlumberS0 3 INSURANCE COVERAGE: I have a current liability insurance policy or tts substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you Have,6hecked yes, please indicate the type coverage by checking the appropriate box A liability Insurance policy 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 waives this requirement. Check one: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the Ge �a ws. By &gnat re of Licensed Plumber Title Type of License: Master Journeyman❑ Oty/Town APPPOVED (OFFICE USE ONLY) License Number (r,G 4p BELOW FOA O.FFPQE USE ONLY FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS - FEE NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME A TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED DATE 20 t r PLUMBING INSPECTOR ' 1 t COMMONWEALTH OF MASSACHUSETTS —DIVISION OF PROFESSIONAL LICENSURE IiJ FLUI-IBERS AWD GASFITTERSI� M_I CENS 'DhAEAH METP� oP L U M F3 E TERRANC:'E M IZESM'84b m 20 JAMES IRD IPSWICH MA Oi9738-1143 10692 05/01/04 536854 .....r....mm. COMMONWEALTH OF MASSACHUSETTS • IN PbUMBERS AND GASFITTEJZS ICENSE ASissAuEs OURNEEISMA�N PL M E TERRANCE M DESMOND 20 JAMES RD IPSWICH MA 01938-1I4f 19225 a5/UY/b4 536852 • WAMIFIRR-IIIIIIIII Driver's License_ 03-23-51 03-23-05 M 510" DM 015421176 Date of Birth Expires Sex Heigh Class Number DESMOND TERRANCE M 20 JAMES RD IPSWICH, MA 01938-.1143 its ' t O Date..... �. ...............—'�... NORTI� °�<�``°:•�"� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SACMUSE� This certifies that .. .... .......5 . . °. .. .°.u............................. has permission to perform ...../?w Ph °°% ................................................................... wiringin the building of................................................................................... 9 S 43 �►1 J (?C(..................North Andover,Mass. Fee..................... Lic.No.............. ............................................................... x ELEcmicAL IN§PECMR +iCt7heck # (?,dS14 ` 'U `r Official Use Only Permit No. fC Gdj�Z�ld�ZlUCff.C' 6� SSr�(? 21Sc�7'IS D anrrx«�°6 Pum Sam Occupancy&Fee Chou BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the,Massachusetts Electrical Code 527 CMR/12:00 (Please Print in ink or type all information) Date !/ f Z� To the Inspector of fres: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number Owner or Tenant Owner's Address Is this permit in conjunction with a building permit Yes 0 No 0 (Check Appropriate Box) Purpose of Building �/' �i.�' Z c0/ Utility Authorization No. Existing Service l 0& Amps Vofts Overhead 0 Undgmd D No.of Meters New Service Amps Voits Overhead 0 Undgmd 0 No.of Meters_ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work J Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above 0 In 0 No.of Lighting Fixtures Swimming Pool gmd 0 gmd 0 Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Diposal No. Pumps Tons KW No.of Sounding Devices NoJ of Self Contained No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices t 0 Municipal 0 Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring 1 No.Hydro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES= NO have submitted valid proof of same to the Office YES= NO - If you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANCE - BOND - OTHER - (Please Specify) (Expiration Date) Estimated Value of.Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed under the Penalties of perjury: FIRM NAME LIC.NO. Licensee Signature LIC.NO. Bus.Tel No. Address Alt Tel.No. ti OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusel General Laws.And that my signaturugnJUs permit application waives this requirement. Owner Agent (Please Check one) f � Telephone No � .���c..� —PERMIT FEE $ ' (Signature 0 or Agent) The Commonwealth of Massachusetts z � u: M M Department of industrial Accidents Office of investigations Boston, Mass. 02111 °� sy Workers'Compensation.Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job_ Comnanv name: Address Gity Phone Insurance Co. Policy# Company name: , Addregs CiCy:? :* Insurance.Co. Policy# Failure to secure coverage as required under seebon 25A or MGL 152 can lead to the errpasom of crimirw perces.of arfane3 up' and/or one years'bnprisorrrrent as viceU�ss:�7�naaies�o�heSerm�fa�3�P ���igp p�r�a�_� understand that a copy of this statement may be forwarded to the orrice of Irrvestig�Mions of the UTA for coverage verification. /do hereby cert&wider the pates and penaffies of per wY#A&rhe aNnrwhw pi►oviidear above is b e and correct r Signature Date Print name Pborle# Oficial use only do not write in this area to be completed by city or town dikiar City or Town phi ` � BJt/djfJ9 CJ0mck if immetkate response is regubed boansill Contact person: Selectm Phone# Health L Other 1 o C Date... N- ;� 3 f 2v . ..3. .......� 1 t NORTH, r 3:°•_'�``°:'_�"�c� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SACHU`�f� This certifies that .......4.�.��. . >.'`f Y r1'PC ............ ...................................... t ..q.�has permission to perform ............................... ....... . . .............. wiring in the building of......C.U. .rh.�....�.�........................................... � at...... o rf �... ..!` a�North i/A/nd� ver„ I9s? Fee. 15 _.0 Lic.NJIM/..... ! / ELECTRICAL I9SPECTOR Check # WHITE:Applicant CANARY: Building Dept. PINK:Treasurer The Commonwealth of Massachusetts FOR OFFICE USE ONLY Permit No. 7P- Department of Public Safety BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Receipt No. 'ham APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work will be performed in accordance with the Massachusetts General Code.527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INF RMATION) Date d Z`S/�� City or Town of A/0 r� oU e r— To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below: Location (Street and Number) 12 9 ea�- /10 PC,Ck A Map: Lot: Owner or Tenant---..K Gt Y e V\ ed v►n vh e ��G'. Zone: Owner's Address _54 P" Is this permit in conjunction with a building permit? Yes ElNo l (Check Appropriate Box) � � 1 Purpose of Building � l r t V)9 Utility Authorization No. 0 A, /�6-`5— existing Service 2 CJ Amps f 2- / `��, Volts Overhead❑ Underground ©� No.of Meters New Service Amps / Volts Overhead ❑ Underground❑ No.of Meters w Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work � e� ,(,\(�S ey- Stl No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above grnd. ❑ In-grnd.❑ Generators KVA No.of Receptacle Outlets No.of Oil Burners No.of Emerg.Lighting Battery Units No.of Switch Outlets No.of Gas Burners FIRE ALARMS No.of Zones Ng.of Ranges No.of Air Cond. Total Tons No.of Detection and No.of Total Total Initiating Devices No.of Disposals Heat Pumps Tons xw No.of Sounding Devices Nb.of Dishwashers Space/Area Heating KW No.of Self-Contained No.of Dryers Heating Devices KW Detection/Sounding Devices No.of Water Heaters KW No.of Signs No.of Ballasts Local❑ Muncipal Connection❑ Other No.of Hydro Massage Tubs No.of Motors Total HP I Low Voltage Wiring OTHER: INSURANCE COVERAGE:Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including CompJeted Operations Coverage or its substantial equivalent.YES P'�10 ElI have submitted valid proof of same to this office.YES O ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box. INSURANCE 69.56ND❑ OTHER❑(Please Specify) (Expiration Date) Estimated Value of Electrica Work Work to Start �,��/Q/ Inspection Date Requested:Rough Final / r' Signed under the penalties of perjury: FIRM NAME LIC.NO../ ���`� Licensee-&tan �a'a/7/Lei./ Signature LIC NO. is 5 70 Address �U ,n ) TeCj% j �J /211)9 /S/9 d 3 Bus.Tel.No. 9 7�-7 9� Alt.Tel.No. OWNER'S INSURANCE WAIVER:I am aware that the Licensee DOES NOT HAVE the insurance coverage or its substantial equivalent as required by Massachusetts General Laws,and that my signature on this permit application waives this requirement. Owner❑ Agent❑ (Please check one) �s, G 0 Telephone No. PERMIT FEE$ (Signature of Owner or Agent) Location J q'� 3E'a'' a No. 3 F' Date x NORTH TOWN OF NORTH ANDOVER • ; ; Certificate of Occupancy $ Building/Frame Permit Fee $ 00 �cHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # (•A 169 '17 `� Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVAT5 OR DEMOLISH A ONE OR TWO FAMILY DWELLING MOMg M BUILDING PERMIT NUMBER. DATE ISSUED. ' f / Lo X ic SIGNATURE: At Buildi Commissioner/I or of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: lip Map Number Parcel Number ��} 1.3 Zoning Information: 1.4 Property Dimensions: I Zoning District Proposed Use Lot Areas Frontage 11 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 34) L.S. Flood Zane Information: 1.8 Sewerage Disposal System: Public ❑ Private p Zone Outside Flood Zane ❑ Municipal ❑ On Site Disposal System ❑ J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No rT1 2.1 Owner of Record ay S ��rvso•� /moi 5 �5�2 �'�i'�� � -�.. Name(Print) Address for Service -075 e Telephone 2.ZOwner of Record: T ame P ' Address for Service: re Tele hone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable Licensed Construction Supervisor: O License Number mn Address Expiration Date ic Signature Telephone r 7 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name M Registration Number r Address r Expiration Date /1 Si nature Tele hone 0� SECTION 4-WORKERS COMPENSATION(NLG.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result jn the denial of the issuance of the building permit. tl S' ned affidavit Attached Yes.......0 No.......R" too SECTION 5 Description of Proposed Work(check all a Ucable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify B 'ef Description of Proposed Work: 'Z-No--g-�Lo--�-S Or &WeWrn— N c 42 9! LiKe rrtoc,+ 4A.4 A4& F w� A(iAMAX' &6 -.r ^ '05Z41 �r�cLy vYicl�� SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost Dollar to bex � . Completed by permit a licant 1. Building I (a) Building Permit Fee 0 O 0 Multiplier Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X(b) 4 Mechanical HVAC Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 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 SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I ,as Owner/Authorized Agent of subject pr rty ,-Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Pr' t Udne ature of Owner/4e Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST2ND 3RD SPAN r DFAENSIONS OF SILLS DEVIENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT 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: (Locatio o Facility) re 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 i i f µORT{f q O Stereo e�A, o A Town of North Andover Building Department 27 Charles Street �9SSac►+uSEt�� North Andover MA 01845 Tel: 978-688-9545 HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION Number Street Address Section of Tc "HOMEOWNER_��J� GG �N ��O�czV j� �-/6f/ Number Home Phone Work Pho PRESENT MAILING ADDRESS ��✓ 1 H7G c //L1 City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings of 1 or 2 units 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 (108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which of two there is, or is intended to be, a one family dwelling,attached or detached structures accessory to such use and 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, a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 108.3.5.1) 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 No.Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATU dr APPROVAL OF BUILDING OFFICIAL Note:Three family dwelling 35,000 cubic feet, or larger,will be required to comply with State Building Code Section 127.0 Construction Control. i Revised 4.30.03 Home owner Exemptions Form 175 1/2L .......... J�, SB 36. R(S$33 `T ( fi'iras321SB ' Options t Sh � 3/4"Panel 1 1/2"filler z it Yr D/W Space p M/9J Space edisMff#068g QS Trash Slide OuE(2�u 5 Tp: NGnamite . fauc K F N Y �1 5 C1�T;I'B�6 BF F03 - Cook Top Space Ref Space Double Oven Space P 03.5 PF03.: x y } K c 9f xa'cs tf �yy w x x r OCD 13842 2Y'� 3 Bz36 �R b ji73684 455 Yz I3Q$424 x� kms. �$ } t ✓xzYi 4Slf( Tf$}$ yAdjusablS�fielZ�sk r 71 36 1/4 f �oRTH i I O 4yio gee ti0 NORTH ANDOVER BUILDING DEPARTMENT 27 CHARLES STREET �SSncHust I I Tel: 978-688-9545 Fax: 978-688-9542 DATE: i loq NAME �j✓F�l�'�� ��t-�.�`�C��� — %�� . '7 J�,/ r �O/� ADDRESS ZONING DISTRICT: ff( , TYPE OF BUSINESS: BUILDING LAYOUT PROVIDED: YESy NO AVAILABLE PARKING SPACES: I ZONING BY LAW USAGE: �� YES NO BUILDING INSPECTOR SIGNATURE I Iv t, c/1zj C�,�K S ,�j'G7 ISP [ ,- enIes-v JE I k AL. V V ♦ A6 i V i �A -.:V, "r � err . . -qlwp� No-344S o dover, Mass., COC HICMEWICK y1. ADRATED `r LJ BOARD OF HEALTH PERMIT T-- D Food/Kitchen Septic System S4 THIS CERTIFIES THAT..... .. ...............j............................. ..... pN BUILDING INSPECTOR ................................................ ... .. ... Foundation has permission to erect.. ... M� ... buildings on ....1.. .5....... �.�. ` .... • Rough ............................ �ir 1 T , �il � AS#*W% *A) + Chimney to be occupied as.... .................. .........�...... ................... .. .. provided that the person accepting this permit shall in every respect conform to th�terms of the application on file in Final 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. w 1&1#4+ Dew s b Ot r) PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. ( Ise) 00'-• Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION iTARTS 6 Rough .. .. ..............:.............:::..:; Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough 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. SEE REVERSE SIDE Smoke Det.