The URL can be used to link to this page

Home My WebLink AboutBuilding Permit # 9/16/2015 RTH BUILDING PERMIT V, F..D TOWN OF NORTH ANDOVER ® APPLICATION FOR PLAN EXAMINATION Permit No#oDate Received s��cHuse Date Issued: I PO TANT: Applicant must complete all items on this page LOCATION 6 PROPERTY OWNER t Print 100 Year Structure MAP PARCEL:_ZONING DISTRICT: Historic District yes Machine Shop Villag `w e 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 ❑ Septic p Well ❑ Floodplain ❑Wetlands, ❑ Watershed District El Water/Sewer ® SCI TION,O ORK O E,ffRF RIVIE�&) ,, 7 J C4 ldentificati - Please'Type or Print Clearly . OWNER: Name: f hone: Address: ri. / t / Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement Licenser Exp. Date ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE,BULDING PERMIT,$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: 11,4 Receipt No.: NOTE: Persons contracting with u 'Neg,Isteredcmitractors do not heave access to the guaranty fund Signature of Agent/Owner Signature of contractor t%O R TH W-moft Art, nclover ® "1 � Z h ver, Mass, O LAKE 1 COCNIc"t WICK S U BOARD OF HEALTH Food/Kitchen rvERMIT L U Septic System THIS CERTIFIES THAT ® BUILDING INSPECTOR . . . . ....... ..... has permission to erect . .................... buildin;*74M ..... . ...... .. .......®.... . .. . ...... ...... Foundation. • Rough tobe occupied as ....... ............ .....0.. ...... ................ ..........pi.we&l ....a. .. . ... ... . • 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 the Inspection, Alteration and Construction of Buildings in the Town of North Andover U W ® PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMITI IN 6 M ELECTRICAL INSPECTOR UNLESS600 TI R Rough Service ..................... ........I ... ...... ......................... 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 Approvedy the Building Inspector. Burner Street No. Smoke Det. "ORTH TOWN OF NORTH ANDOVER OFFICE OF fo BUILDING DEPARTMENT 1600 Osgood Street,Building 20, Suite 2035 North Andover, Massachusetts 01845 S ONUS Gerald A. Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION 13UIDING PERMIT APPLICATION Please print DATE:- 9110 JOB LOCATION: Number Street Address Map/Lot HOMEOWNER Name Home Phone Work Phone PRESENT MAILING ADDRESS_ 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,provide 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 110.85.1.2) The undersigned"homeowner"assumes responsibility for cornpliafiee with State Building Code and other applicable codes,by-laws,rules and regulations. The undersigned"homeowner"certifies thathe/"she understands the Town of North Andover Building Department minimum inspection procedures and requiy, ts a thatjho/sImwi1l,,comp1y withsaidpmcoduL qsAnd requirements. ............. HOMEOWNERS SIG %t`URE N, je APPROVAL OF BUILDING OF61 Revised 8.2015 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 the Commonwealth Of Massachusetts Department offlulust-Wal Accldezats n F .1 Congress Street, Suite 100 `K Boston,MA 02114.2017 v www.mass,go v/dia Wo3*,ers'Compensation Insurance Affidavit:Builders/Contxactorsi.Elgctricians/Plu bees. TO B>1 ELG tTH THE PERM L C'i'[NG AUT}TORTZ S. Aplilicauffnformation Please Print Le 'bl Name(Sttsiness/Oxganization/lndividual): � C' � l Address: ., rC, _.. Pho City/State/Zip Axe you an employer?ChecktIie appropriate box: 'Type of project(Tgquired): 1.FJ f aur a employer with employees(full and/or part time).* 7. E]New construction 2,E]Z am a sole proprietor or partnership and have no employees working for me in 8. Remo deliAg any capacity.[Noworkers'comp.insurance required.] 3 9. Demolition T am a homeowner doing all work myself[No workers'comp.insurance required,]t ❑ 10❑Building addition 4.E]S am a homeowner and will be hiring contractors to conduct all work on ray property twill ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12, Plumbing repairs or additions 5.❑Z am a general contractor and l have hired the sub-contractors listed on the attached sheet, 13.E]Roof repa` These sub-contractors have ouzployees andhave workers'comp,msruance,t 6,E]We are a corporation and ifs officers have exezcisedtheir right o£exemptionperMM c• 14. Others m 152,§1(4),and we have nq employees.[No workers'comp.insurance required.] z'Any applicantthat checks box#1 must also fill out the sectionbelow showingtheirworkers'compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work andthen hire outside contractors must submit anew affidavit indicating such. tCoutractors that cheekthis box must-attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. lftha sub-contractors have employees,they must provide their workers'comp.policy number. lam ars employer thatispi'o`vzding-workers'compensation Insurancefor my employees'Below is thepolley andlob site information. Insurance Company blame: Policy#or Self=inns,Lic.#: ExpirationDate; Job Site Address: City/State/Zip: .°�ttacb,a copy of the workers'c'onapensation•pol ey declaration page(showing the policy number and expiration(late). Failure to secure coverage as requixed under MGI;c.152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonrnas well as civil penalties in the farm of a STOP WORD ORDER and a fine of up to$250.00 a day against the violatoo opy of tbis°°sWement may be forwarded to the Office offhvestigations ofthe DTA.fox insurance coverage verifxcatio �.w,w • "'"' Ido hy er?�Y or tliepai�rs artclperaalties ofperyztry Haat the inforrytati Date. a eovzcle ore r and correct; er elr c , Phone#• Official use only. Do not write in this area,to he completed by city or town offzciar City or Town: PermitlLicenso# Issuing Authority(circle one): i 1.board of Health. 2.BuildingDepartm.ent 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6,Other Contact Person: Phone#: