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HomeMy WebLinkAboutMiscellaneous - 56 WAVERLY ROAD 4/30/2018Ed 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance -with the provisions of M.G.L. c. 143, § 3L, the Permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall -be limited as to the time of ongoing construction activity, and may be_deemed_by_the ,Inspector_of_Wires abandoned_and_iavalid if he—. or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or -the installing entity stated on the permit application. . ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. 8 — Permit/Date Closed: [/ ��j /J�/! Note: Reapply for new permit 11 Permit Extension Act — Permit/Date Closed: Date TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....... ........... ...... .. has permission to perform ... 54� <-A � 7.—y ... ... 11 ... wiring in the building of ... 4?vb.0 ...................... i .... at ..... 57.6... WX Y-. 49 ........ Nort�Andover, Massi Fee. tic. No... RICAL INSP C ELECT M2T Check # 11220 comm0nweaA 0/ va"a'1welb T epa,fm..t 0/ —7i. S., k., j BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. cmZ r Occupancy and Fee Checked [Rev. 1/071 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CM,12.00 (PLEASE PRINT IN INK OR TYPE ALL F RMAT 111 Date: 1 f 6 l 1 2. City or Town of:� �U�C�( To the Inspector of Wires: By this application the undersigned .gtv(es nonce of his or her intentio to perform the electrical work described below. Location (Street & Num76-,T S �Q Owner or Tenant Telephone..No. -� - Owner's Address 'sW-P-- Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters I Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install residential security system ian u"r.nwnac aecau v desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start:_ Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no perryit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including `completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) I certify, ander the pains and penalties ojperjury, that the informadon on this application is true and complete FIRM NAME: NI htwatch Protection Inc. LIC. NO.: 7024C Licensee: Paul Delsionor Signature LIC. NO.: (Ifapplicable, enter "exempt" in the license number line.) Bus. Tel. No.� 8-722-9282 Address: 22 Briarwood Drive Westford MA 01886 *Per M.G.L. c. 147, s. 57-61 securitywork Alt. Tel. No.: requires Department of Public Safety "S" License: Lic. No. SS -001696 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) Qowner Q owner's agent. Owner/Agent Signature Telephone No. J PERMIT FEE. $ Bb 025 �•�.. �uuuwIn caoce may oe warvea Vy the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans INO. or ota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ n- . ❑ red. d. o. o mergency Lighting Bauery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners NO. Of etection an Initiating Devices No. of Ranges No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heatfunip u....er............ o. o e ontaneTotals: Detection/Alerting Devices No. of Dishwashers S ace/Area Hestin Space/Area g KW Local ❑ Municipal ElOther Coonnection No. of Dryers Heating Appliances KW ceNes of Dtevic E oroNo. Water Heaters KW o. Signs Ballasts or uivalent Dae it nng: or Equivalent Nd.?Hydromassage Bathtubs No. of Motors Total HP ecommumcationsirm gg: Na of Devices or E ivalent OTHER: ian u"r.nwnac aecau v desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start:_ Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no perryit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including `completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) I certify, ander the pains and penalties ojperjury, that the informadon on this application is true and complete FIRM NAME: NI htwatch Protection Inc. LIC. NO.: 7024C Licensee: Paul Delsionor Signature LIC. NO.: (Ifapplicable, enter "exempt" in the license number line.) Bus. Tel. No.� 8-722-9282 Address: 22 Briarwood Drive Westford MA 01886 *Per M.G.L. c. 147, s. 57-61 securitywork Alt. Tel. No.: requires Department of Public Safety "S" License: Lic. No. SS -001696 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) Qowner Q owner's agent. Owner/Agent Signature Telephone No. J PERMIT FEE. $ Bb 025 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, Mass. 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual) Address: UJ e - n t wa-�C� �r O til . I n C City/State/Zip: SCtiLL � 3� Q Phone#: Are you an employer? Check the appropriate box: 1 I am an employer with 1 4. ❑ 1 am / ' .5 a general contractor and I employees (full and/or part time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp, insurance ` comp. insurance. $ required] 5:0. We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself [No workers' comp. right of exemption perm MGL insurance required] t c. 152, § 1(4), and we have no employees. [no workers' comp. insurance required.] *A Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12. ❑ Roof repairs 13. W0ther3PC iLt ySk, - �_ow v'ot44,3e TnOmeowner3 who submit this affidavit indicating they are doing all work and thea hire outside contractors must submit anew affidavit indicating such. $Contactors that check this box must attach an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' com . volicv number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:_ QY 1' 'T 5 CGS Policy # or Self -ins. Lic. #: —1A)� `1 CJ Expiration Date: o Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration (date). Failure b secure coverage as required under Section 25a of MGL 152 can lead 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 the form of a STOP WORK ORDER and a fine of $250.00 a day against violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do herby cerdty under the pains andpenalties ofperjury that the information provided above is true and correct. CUA o Print Name. Date: I I / 9 ! I 6_1 Phone#: 88B- tL0�j-- 9C�8 vpiciat use onty Uo not write in this area to be completed by city or town official City or Town: Permit/Iicense #: Issuing Authority (circle one): LBoard of Heath 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact person: Phone #: p 9SSACHUSBK Zoning Bylaw Denial Town Of North Andover Building Department 27 Charles St. North Andover, MA. 01845 Phone 978'688-9545 Fax 978488-9542 -Street:.. ".6. �_ . _ u,•.cl.�..,� L ......... _ ... _ . _... _ . Ma /Lot: i8 /b q Applicant: w Y- Request: 8' 435 ►= r;o N -F ,r=a>` r.,� s P2 rC _ Date: 1 l - 6 - o Q, MMOV LJO auv1aeu urdL dILM review or your Appucation 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 Dri eway Special Permit F Frontage Variance for Sinn 1 Lot area Insufficient 1 Frontage Insufficient 2 Lot Area Preexisting `t -e S 2 Frontage Complies 3 4 Lot Area Complies Insufficient Information 3 4 Preexisting frontage Insufficient Information y e s B Use 5 No access over Frontage 1 Allowed �-(p G Contiguous Building Area 2 Not Allowed 1 Insufficient Area 3 Use Preexisting_ 2 Complies 4 5 Special Permit Required 1nsufficient.lnformation 3 4 Preexisting CBA Insufficient Information e S C Setback H Building Height 1 All setbacks comply 1 Height Exceeds Maximum 2 Front Insufficient ti S 2 Complies 3 4 Left Side Insufficient Right Side Insufficient 3 4 Preexisting Height Insufficient Information S 5 Rear Insufficient I Building Coverage 6 Preexisting setback(s) 1 Coverage exceeds maximum 7 Insufficient Information 2 Coverage Complies D 1 Watershed Not in Watershed 5 3 4 Coverage Preexisting Insufficient Information 2 3 In Watershed Lot prior to 10/24/94 j 1 Sign Sign not allowed 4 Zone to be Determined 2 Sign Complies 5 Insufficient Information 3 Insufficient Information E 1 2 3 Historic District In District review required Not in district Insufficient Information H'e S K 1 2 3 Parking More Parking Required Parking Complies Insufficient Information 4 Pre-existing Parking Remedy for the above is checked below Item # Special Permits Planning Board Item # Variance Site Plan Review Special Permit C —a Setback Variance Access other than Frontage Special Permit Parking Variance Frontage Exception Lot Special Permit Lot Area Variance Common Dri eway Special Permit Height Variance Congregate Housing Special Permit Variance for Sinn Continuing Care Retirement Special Permit Independent Elderly Housing Special Permit --Special Large Estate Condo Special Permit Planned Development District Special Permit Planned Residential Special Permit R-6 Densitv Special Permit Watershed Special Permit Special Permits Zoning Board Permit Non -Conforming Use-ZBA Earth Removal Special Permit ZBA Special Permit Use not Listed but Similar Special Permit for Sign Special Permit meexistinq nonconformin 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. 7 uilding Department ficial Signature 2 Ll*_�_ Application Received A/ -V/'©_-2 Application Denied Denial Sent: If Faxed Phone Number/Date: Plan Review Narrative 'a The following narrative is provided to further explain the reasons for denial foc the application%` permit for the property indicated on the reverse side: ' N�•' S � t < llf :�,viY�y,Y.. �,,11 YSft•f�{. , .�i�f1��r"Sx ,,.�,' w.. .k��... u �e�'E'✓�5�:4Zav jIy Me -„((!►�R -CC� }� x: ;taAd�- .Y .,.v.S *r; 5"'i. (� - bilS }'6C � « l `b 1 ';a 1 rta 3rg���M4 ! �G�4 ✓�"iiM,�ts�Z. 6'd%J����.�V 4�iy.�Rg1a lr�i-4i�ib Aph�'�"b y. t t �V #r oarq)T•.�q{. ���. •'G �� Y� � � °ti �3 � {��"sy �� '�`��"��4. s� ¢ c iii t S� ^��j $��iT+�.5 i t��fy �'�r Ufa v$�fr?�i 3��� ¢k3„�n ..�h�21{ �N� �,,t}�i� s�R..}�.. ;.,�±Sb,; ¢.j> sh�. ; g�gr>). PY�F �1�Si{�� h�e'�57 iFJ'E��a�r - ��^v.K�dr� �'�',y i. yl�,r�'.�,.'v,7W na`i h5' ��c !}ay¢ �i r: ,aaly Y�$��t�i fJH tY�rT Yy�".yF�a^�.{�w�'.� LD� }'{�._F� � n�,�'w 5`t ✓.b. Y' y�i..4, l�i`74 S' �'tia.S�ni�,y� 1;e�,�t�".� ;x� e���1 �. rs J i� $ .,E'@ j"7�ka'9`�ij f rS��'�i'', v A k '� d' i}.54,i�7jAS{'�`,`�1 4 ,4�, Police ��S /s /2,e q•' 0-1 Conservation Department of Public Works Planning 6&_GUS af'l',l- ” . dOae%, 2o/A) Other 'DEPT Referred To: Fire Health Police Zonin Board Conservation Department of Public Works Planning Historical Commission Other 'DEPT ?/, WC 16111 . o`No Pt6 O < 9 Ss'1CHus -Street: cant: Zoning Bylaw Denial Town Of North Andover Building Department 27 Charles St. North Andover MA. 01845 Phone 978=688-9545 Faz 978�6U-954,2 8 /b 9 , ,r Please be advised DENIED for the fol I do rher.S �® r`G Il-,fo�0 at after review, of your Application and Plans that your Application is Kemedy for the above is checked below. Item # Special Permits. Planning Board- Item # �S�b riance Site Plan Review Special Permit Access other than.l=rent-r. m c..e...,i __ �:. _a ack Variance IMIL I I Parkin Variance Permit Lot Area Varianc( Variance for Si Continuing Care Retirement Special Permit n Inde endent ElderC Hous n . S ecial Pe[mit Special Permits Zonin Board S ecial Permit Non-Conformin Use-ZBA 'Large Estate Condo S ecial Permit Planned Develo ment.DiStrict S .ecial:Permit Earth Removal Special Permit ZBA S ecial Permit Use not Listed but Similar Planned Residential`S ecial Permit R-6 Densit $ ecial Permit S ecial Permit for Si n Watershed Special Permit Sped Permit reexistin nonconforminc 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 anddocumeritation for the above file. You must file a new building permit application form and -begin the permitting process., ;Y q, lJ- uilding Department ficial Signature Application Received Application Denied Denial Sent : If Faxed Phone Number/Date: N' r . ,a,._ •fid 4 Plan Review Narrative The f�l ging narrative is provided to further explain,theareascnsfgr denial far.the application pe ►m ,t 46 r6perty indicated on the .reverse side: pp C _a Ur4�lAA)C`e— � ov #K4s��nA t�al�.3 .d• �6+ % t l r t i ' ...s %Q.f'C 1° C. - _X ?PrOVA [ tq ��=�,��f- zVt�ler 5 �Pi^cit RM U - LOT RELEASE FORM C _c),. 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 (J`I GCS V LOCATION: Assessor's Map Number SUBDIVISION_ PHONE(�22)(,k,3— P. —S_ PARCEL_q LOT (S) I_ vSTREET (&kAV` % ��J )�30<_A ST. NUMBER ************************************OFFICIAL USE ONLY*********************************** IiRECOMMENDATIONS OFTOWN AGENTS: ERVATION ADMINISy�tATOR DATE APPROVED DATE REJECTED COMM TOWN PLANNER COMMENTS DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIO rol 7►9:%TT1_1 'Aa40iii1I1 A1.04Q4:7_1:idih142kI RECEIVED BY BUILDING INSPECTOR Jfu (-CA, DATE Revised 9\97 Im MORTGAGE INSPECTION AT 56 WAVERLY ROAD PLAN NORTH ANDOVER, MA. NO. ESSEX RE�FISTRY OF DEEDS.' BK. LCC, 32 PG. 317 PLAN.' NO. 19865B CERTIFIED T0.' NEW ENGLAND NATIONAL MORTGAGE CORP. SCALE.' / "- 40` ,�, DA TE.' JULY /2, /996 J WO NOTES.' I) DO NOT USE OFFSETS TO ESTABLISH PROPERTY LINES OR TO ERECT ANY STRUCTURE. 2)PROPERTY LINES ARE DETERMINED FROM COMPILED INFORMATION TO BE USED FOR MORTGAGE PURPOSES ONLY. CERT/FICATIONS.' BASED ON MY KNOWLEDGE, INFORMATION AND BELIEF, I HEREBY CERTIFY THAT THE PERMANENT STRUCTURES INDICATED ARE LOCATED ON THE GROUND APPROXIMATELY AS SHOWN AND ARE CONFORMING TO THE ZONING SETBACK RECUIREMENTS OF THE MUNI CIPAL/T Y OF NO, ANDOVER WHEN CONSTRUCTED AND THAT THE STRUCTURE SHOWN /S NOT LOCATED /N A FLOOD HAZARD ZONE AS PER FE. M.A. MAP, COMMUNITY NO. 250098 EFFECT/VE DATE.' 06 -02-93 ZONE'X JOHN ABAGIS B ASSOCIATES, PROFESSIONAL LAND SURVEYORS 07 CHANDLER ROAD, A NO0VER) MA. (508) 688-4899 APPLICANT.' ANDO NO. P 2791 . TOWN OF NORTH -ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING r+..- J?^sY} .fid S .' r9 .ti�, .* +S �.�.- .f...•2 tM�,y� 3. -HC's✓ BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/1for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property/Address: CA 1.2 Assessors (Map and Parcel Number: Map Number �b— Parcel Number J 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: . Lot Areas Frontage 11 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R 'red Provided ReqWred Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public 0 Private ❑ Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record SV Name (Print) Address for Service: 3 - 57?3 Signature . - - Telephone 4(- 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name Registration Number Address Expiration Date Signature Telephone O T • - z O O Z M 90 0 r M r r a z ^ Q SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 & 2506) 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 .......❑ No ....... ❑ SECTION 5 Description of Propoised Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: ,tea CS 4) f C_12 n ,'4 SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed b permit a licant s OFIi') CSL .', Ute+ p,y 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC 5 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 1, as Owner/Authorized Agent of subject property Hereby authorize YI.to act on My be h I in to wo a s building permit application. Signature of QjAier Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby 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 NO. OF STORIES Date SIZE - BASEMENT OR SLAB SIZE OF FLOOR TINIBERS 1 2 ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS 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 D. Robert Nicetta Building Commissioner (978) 688-9545 '978) 688-9542 Fax Town of North Andover Building Department 27 Charles Street North Andover, NIA_ 0184,5 HOMEOWNER LICENSE EXEMPTION Please print DATE_ ioe LOCATION Number IOMEOWNER S �1 05' c0Co9 j r 15P Code ESENT MAILING ADDRESS City Town State The current exemption for "homeowners" was extended to include Owner of two units or less and .to allow such homeowners to engage an in �ocupred dwellings not possess a lic ense, dividual for hire who does provided that the owner acts as s�Pervisor. (State Building Code Sec5on DEFINITION OF HOMEWOWNER: 108.3.5.1) Person(s) who owns a parcel of land on which Wshe resides or intends to reside, on which there is, or is intended to be, a one or two cessory to such rise and/or farm structures. A dwelling. wed or delachect struo ac - two -year period shalt not be .considered a person � ane in a homeowner one The undersigned "horneowner" assumes responsibility for co Applicable codes, bylaws, rules and regulations, mp ance w the State Building Code and other The undersigned "homeowner" certifies #Mt h&she understands the Town p/ No Andover Building Departrnertt minimum inspection procedures and reauirrmp,tr _j ►� , L RPh' with said procedures a IOMEOWNER'S SIGNATURE I'PROVAL OF BUILDING OFFICIAL 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: of Facility) W/,W� , UNA �A�, r J �f T� of Pe'rmit • • n � NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector "i