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Home My WebLink AboutBuilding Permit # 7/15/2015 0 ... BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMIN, Permit NO: Date Received Date Issued: ACH IMPORTANT: Applicant must complete all items on this page / 1, , / / rii// ✓ / / ,.,,, /air... / , �/ //. �t � /, � , r � /r, „ / ,/ r� <, ii/�/i.,. /,/i/r/� �%� r,. ,// %i✓/ /ilii r I, / r ,/// 1 r r, o, ,,,„ / /,,,// r, � � � G r' //, rrr r, ✓rill,„/, / rrr r r / / r r r r / // ✓ / � r r /i TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ❑ One family .Addition ❑ Two or more family Industrial Alteration No. of units: Commercial ❑ Repair, replacement ❑ Assessory Bldg Others: Demolition '.,Other Albo\nc (2Ln-t v. b Y®OL- r 1t1S'T” l- .t�i°tlt7h.� C�7� 1. ' 'p11pr�/l�l�f2- 54i� 0 :}o A'bo\e Ca tZ-tssU�30 Identi cation Please Type or Print Clearly) OWNER: Name: Phone: Address: 2 e I S S-K-9-ee1 r r r, .., r �i /�. / s. r // /is.i ,/., r .,,./ // / ,i.:✓ r,, /i,„ '/ i /./ r Iii ,<.,,rr / //, r r / / � r/� r rr r ✓ / / f ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project C st: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contr ctin with unregistere40 utractors do not have access to the guaranty fund mature'of'Agent/Ow Lure of contractor �R, 1 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swunming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF o H FORM PLANNING & DEVELOPME Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on signature LJ COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision. Comments Conservation Decision: Comments Water& Sewer Connectionisiglnature & Date Driveway Permit DPW'Tows Engineer: Signature: I Located 384 Osgood Street � FI_RE'DEPARTMEN7 Temp„pumpster onsite yes no ,, r Located at 124 MamStreet ,/, i Fire,Dppgr,,Ment s�grtatu�e/date COMMENTS i NORTH own of EAndover a z 5 2A I y to C, Ver, Mass, coc.ac«ew�c� �1 A�4ATE0 S V BOARD OF HEALTH PER..MIT T LD Food/Kitchen Septic System 6 '� �') Aso ') BUILDING INSPECTOR THIS CERTIFIES THAT ........ K .... ......................................................................................... has permission to erect buildings on ..Z t�1 J,�Q�� Foundation .......................... ............................................................................. Rough to be occupied as ....... `!.C.....AVONrbt.. . . `^ ..... ?1..................................................................... Chimney provided that the person accepting this..ermit shall in every respect conform to the terms of the application Final on file in 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR N/ UNLESS CONSTRU 10 STAR Rough Service ........................ ................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. 00RIsl TOWN OF NORTH ANDOVER OFFICE OF % BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 North Andover,Massachusetts 01845 Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE: -7 JOB LOCATION:— FLL–i S S-T1zqz'T Number Street Address Map/Lot HOMEOWNER je'Yz1Xq t1J\.�S60 1i -�s-I - I t q R Nam 6 Home Phone Work Phone PRESENT MAILING ADDRESS �2_ C_L-LAS ST 974=eT euro A P JOVE- KA t,r- o 18 14 43 City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) 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 or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances 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,require ents and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homeowners Exemption BOARD OF APPEALS 688-9541 C.0114SFRVATION 688-930 HEALTH 698-9540 PLANNING 688-9535 The Commonwealth of Massachusetts Department of Industrial Accidents a I Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERIMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): r�e:yt-�(Lta Address: lZ GWS S'r City/State/Zip: VJo\t:CL-\ "61v� Oeq phone R$-7 -/I q Are you an employer?Check the appropriate box: Type of project(required): I. I am a employer with employees(full and/or part-time).* 7. New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 3. Remodeling any capacity.[No workers'comp.insurance required.] 9. L1 Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Q Building addition 4X1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.F]I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 6.❑We are a corporation and its officers have exercised their right of exemption per MGL,C. 14. Other f�gG G(1,Di.�Dvn1 U 152,§1(4),and we have no employees.[No workers'comp,insurance required.] (®0 L_ IL *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I atn ati etttployet•that is providing iporket•s'eo»tpensation irtsurattce for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.11: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c, 152, §25A is a criminal violation punishable by 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 up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage ve ' cation. Ido Iter yIcer under the pains attd pet aloe ,petjuty that the information provided above is trite oral correct. Signature: Date: O i 5 Phone#: Official use only. Do not write in this area,to be completed by city or towtt official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: