HomeMy WebLinkAboutBuilding Permit # 7/29/2015 �I
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BUILDING PERMIT �} ��Kt�ao ^ .4�°0�
TOWN OF NORTH ANDOVER °
APPLICATION FOR PLAN EXAMINATION # -
Permit NO:J Date ReceivedATOD 10
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DateIssued: gcHu�
PORTANT: Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building [ One family
❑ Addition ❑ Two or more family ❑ Industrial
[XAlteration No. of units: ❑ Commercial
X Repair, replacement ❑ Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
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Remove termite damaged sill under dining room. Replace 4 joists. Remove 2
windows in dining room, replace with 80x72 french patio door.
Replace 9 windows.
Identification Please Type or Print Clearly)
OWNER: Name: Daniel Crevier Phorie: 978-771-3127
' Address: rsame
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ARCHITECT/ENGINEER NSA Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Ca t:,$ 3500 FEE: $
Check No.: Receipt No.: I, C
NOTE: Persons contracting with egistered contractors do not have a ess(tWtla guaran.r fund
Si r►afiu a of A ent/O er /
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BOARD OF HEALTH
Food/Kitchen
PER MIT T
Septic System
THIS CERTIFIES THAT ............... �N® C e 0,e--A e,&
.. ............ ........................
..... .......D...��... BUILDING INSPECTOR
ts
has permission to erect .......................... buildings on � Irk �- Foundation
..................................... ................;.. Rough
to be occupied as FQ�:c .._11.o.li..... N . �. .
FU��' ' ! Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Final
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
LESS CONSTIf STARTS Rough
........... .,(.... .... Service
.. BUILDING INSPECTOR' Final
Occupancy Permit Required t® Occupy Building
Rough GAS INSPECTOR
Islay 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.
Daniel Crevier
75 Mifflin Drive
Repair/Replace 39' of sill from preexisting termite damage. (33' SE rear- 6' NE rear)
Repair/ Replace interior dining room wall from termite damage Jan-15
Repair/Replace selected floor joist + subfloor under dining room
Close closet in second bedroom and relocate in portion of Master bedroom.
Relocate toilet. Repair subfloor in bathroom 300
Replace dining room windows with 72x80 french door 650
Replace 9 windows with vinyl replacements 2 each bedroom (6) 3 in living room 1800
Replace 6 basement windows with vinyl replacements 360
Total 3110
MIMAP April 24, 2014
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Honzontal Datum:MA Stateplone Coordinate System,Datum NAD83,
a gonsrfTOWN OF NORTH ANDOVER
o OFFICE OF
BUILDING DEPARTMENT
1600 Osgood Street Building 20, Suite 2-36
It®" g�� North Andover,Massachusetts 01845
CHO
Gerald A. Brown Telephone(978)688-9545
Inspector of Buildings Fax (978)688-9542
HOMEOWNER LICENSE EXEMPTION
Please print
DATE: 07 aq ZCiS �
JOB LOCATION: 75 Mifflin Drive"
Number Street Address Map of
HOMEOWNER Daniel Crevier (978) 771-3127
Name Home Phone Work Phone
PRESENT MAILING ADDRESS 75 Mifflin Drive
North Andover MA 01845
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"ce 'fies that he/she understands the Town of North Andover Building Department
minimum inspection procedures and uirements an a e/she will comply with said procedures and
requirements.
HOMEOWNERS SIGNA
APPROVAL OF BUILDING OFFICIAL
Revised I0.2005
Form Homeowners Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
The Commonwealth of Massachusetts
F Department of IndlustrialAceldents
a. f tl X Congress Street,Suite 100
Boston,MA 02114-2017
sy,�• www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE MED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print LeObly
Name(Business/Organizationadividual): �Dam 1 Wil. 6 tie 1/i e tt `
Addxess: GI
City/State/Zip: 106,,1%IV A4010 v�,ele_- Phone#: g 7�' 7 -71 3 I�2^7
Are you an employer?Check&e appropriate box: Type of project(required):
1.❑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 8. [1 Remodeling
any capacity.[No workers'comp.insurance required.]
3M I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
9. F1 Demolition
10 0 Building addition
4.E]I 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.❑Electrical repairs or additions
proprietors withno employees.
12.[]Plumbing repairs or additions
5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet.
❑ 13. Roof repairs
These sub-contractors have employees and have workers'comp.insurance,#
6.F1We are a corporation and its officers have exercised their right of exemption per MGL c. 14.El Other
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information.
Homeowners who subn if 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-con§racfors fiave employees,they must provide their workers'comp.policy number.
I am an employer that is pfoviding ipork6,s'compensation insurance for my employees.'Beloiv is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins,Lia#: 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 again the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage ver cation.
I do Hereby cer ' under the pa' andpenalties ofpeiYwy that the informationprovided above is true and correct.
Signature: Date: -2 Z/�
Phone#• 7 7 3/-2 7
Official use only. Do not write in this area,to be completed by city or town official..
City or Town: Permit/License#
Issuing Authority(circle one): i
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#: