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Home My WebLink AboutBuilding Permit # 8/28/2015 BUILDING PERMIT �aoaara� o�R-�1..E� yl;;ad, TOWN OF NORTH ANDOVER � APPLICATION FOR PLAN EXAMINATION Permit No#;°°° Date Received �SS�aCNus�R Date Issued: MPORTANT: Applicant must complete all items on this page LOCATION 3-S7 Print PROPERTY OWNER4 e, tom- P4 vs Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT:_ Historic District yes no Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition El Two or more family Li Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other � ,/ >_ , /r s ❑r Watershed Dstnct� , // ood lain „ ❑, , , /, 1 ,> „ , , ,,,, //r, r ,"; ,. / / //. a /. .� /. „r �, r ..//✓ �, �. r r / if r /r / ✓ / r ,,r alb., An, /. / ,.� r,�i ,� >/ / /r.✓ ///. �i / /,/.ir i,a,,,r � ,,,, , f ;VVa�e'��eWerk%�rrrii/rr/ii%/i�Oj��//j/f��j/� f/%�J��i/r✓/,!�i//i��//�r///��, ,r,,,,/,�li, ,� ,��o,/i✓, ,i„��/i, ,/o% �,r ,//„„ DESCRIPTION OF WORK TO BE PERFORMED: Cm. .a ✓"L I C' .11 , �7 � .L__1!�eLC V_S lot e:S � 7�.� 6 R ,4*. i w�.Fa `"J` �,"� ^'j ea r^°� Y, c'_ Identification- Please Type or Print Clearly OWNER: Name: ,�,�- N��r Phone: y'” a Address: ” n✓l�,w� 1� Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date: Horne Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ 2 v u FEE. $ t �' � Receipt No.�� ry � �,.µ Check No.: .w "� `�� DOTE: Persons contracting with unre ister"ed contractors do not have cessto the guaranty fund `.1ORTH Tow' n of2 1117",_ 0 ® _ o �AK�.1.1c.� ver. X53, cocwicR' 9a ,9 0OA rE® P,�``,��(� S U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THATBUILDING INSPECTOR ................ftk.!;�AV............ ......... .. . ................................................ Foundation has permission to erect ..... ............. ..... buildings on .. ......................................... Rough tobe occupied as .... ..... ........ ...... ........................................................................................................ Chimney provided that the person accepting this permit 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 $000 - UNLESS I Rough Service ................ ... ............. ............................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® 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 Approvedthe Building Inspector. Burner Street No. Smoke Det. NORTH TOWN OF NORTH ANDOVER Of tt�e° i6'�1' OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street,Building 20, Suite 2035 ,..° North Andover,Massachusetts 01845 �SSACHUSE� Gerald A. Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION GUIDING PERMIT APPLICATION Please print DATE: A,>!, c� JOB LOCATION: 33 7 /✓I b Number Street Address Map/Lot HOMEOWNER marl- N0ye_s c7726V 336 '76- Sa F ? •PZ /S— Name rHome Phone Work Phone PRESENT MAILING ADDRESS C r ,_ Anptover l P City Town State Zip Code The current exemption for"homeowners"was extended to include owner occupied dwellings of one or two family dwellings and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. 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 dwelling,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. (780 CMR Section 110.R5.1.2) The undersigned"homeowner"assumes responsibility for compliance with 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 requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 8.2015 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 The Commonwealth of•Mowsgchusetts Department oflndlustPi dAeddents 1 Congress Street,Suite 100 Boston,MA. 02114-2017 v° t•vww.rnass.go-p1dia sy. Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH TBE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): L• t\,/o 5 City/State/Zip: /��;r-(�l. V��e �� r�► o 3'��-Phone#: 1� 7,? G7 C Are you an employer?Checktlie appropriate box: Type of project()Vequired): 1.❑I am a employer with employees(full and/or part timeM 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. '�Remodelfiig any capacity.[No workers'comp.insurance required.] 9. FI-Demolition _ I❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Building addition 4.Y`� am a homeowner and will.be hiring contractors to conduct all work on my property. I will r"ensure that all contractors either have workers'compensation insurance or are sole 1 L[j Electrical repairs or additions proprietors with no 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. Roofre airs • These sub-contractors have employees and have workers'comp.instuance.t p 6.E]We are a corporation and its officers have exercised their right of exemption perMGL c. 1d•❑Other 152,§1(4),and we have n4 employees.[No workers'comp.insurance required.] *Any applicantthat checks box#1 must also fill out the section below showingtheirworkers'compensation policy information. i Homeowners who submit this affidavit indicating they are doing all work andthen hire outside contractors must siibmit a new affidavit indicating such. ?Contractors 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. Ifthe sub-con[rad6rs have employees,liey rimst provide their workers'comp,policy number. I am an employer that is pioviding workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: Policy#or Self ins,Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation•policy declaration page(showing the policy number and expiration(late). Failure to secure coverage as required under MGL o.152,§25A is a criminal violation punishable by a tine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the forms 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 verification. I do Hereby certify under tli ains andpenatties ofpes jury that the information provided alcove is true and correct. sign 0: Date: A. 1 Phone#: 9 e P' 3- 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): ; 1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector 6.Other Contact Person: Phone#: