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Home My WebLink AboutBuilding Permit # 9/22/2015 N A BUILDING PERMIT TOWN OF NORTH.ANDOVER APPLICATION FOR PLAN EXAMINATION ;; - Permit NO: Date Received �./ py9SSACNUSf� Date Issued: i!' �� IMPORTANT:Applicant must complete all items on this page ��i�/� i,� ,�io�ii // / ///////i /i, ,/ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential Ll New Building ❑One family F1 Addition ❑Two or more family ❑Industrial ❑Alteration No.of units: a Commercial (Repair,replacement ❑Assessory Bldg ❑Others: ❑Demolition ❑Other ' !�r/hdDlsErj iipi.,,i/.: OWNER: Name: i pp No '�„` Date x'PN' /d Address TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame PermitFee $$^ _� Foundation Permit Fee _ Other Permit Fee $ ARCH ITECT/ENGINEEAddress: TOTAL $ .. R' FEE SCHEDULE'aULDING PER Cheok M �` ! Total Project Cost: _ .. Check NO"--- (ding Inspector NOTE: Persons contracting N i �igriature of'Agent(Owif --�. "' `""�Sigrr�tiide of eiinfractor " " � �I -town Th of Andover h No. ver,Mass, S U BOARD OF HEALTH PERMIT TO I L D" Food/Kitch_ "'ti,Syrtem THIS CERTIFIES THATBUILDING INSPECTOR A!�has permission to erect..........................buildings on.�ke. 1.uhd.,i.n Tough to be occupied as .................................................... hn—y ............P..........provided that the person acceptinglithis permit shall in e respect conform to the terms oftheapplication j,.1 on file in this office,and to the provisions of the Codes and By-Laws relati ng 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 Hu.] ® PERMIT EXPIRES IN 6 MONT-WS ELECTRICAL INSPECTOR UNLESS CONSTRIN ST FRioru.g 'Z" ....... . .... . .... ... BUILDING INSPECTOR h GASINSPECrOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises—Do Not Remove Pi-I No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burne, Street No. Smoke Det. t%ORTH I . Town of V.1 Andover No. 01 h ver,Mass, U 6- BOARD 01 HEALTH PERMIT T I L D _SePtl'sy' BUILDING INSPECTOR THIS CERTIFIES THAT ..................................... Foundation has permission to erect..........................buildings on to be occupied as 02-owie. ...........P Rough .�'Orw. A................... cht—Y provided that the person accepting is permit shall in respect conform to the terms of the application R,,1 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 N.1 w INSPECTOR PERMIT EXPIRES IN 6 MONT ISELECTRICAL. UNLESS CONST R U N STA Rough Service BUILDING INSPECTOR Final GASINSPECTOR Occupancy Permit Required to Occupy Building R..gh Display in a Conspicuous Place on the Premises—Do Not Remove rml No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector, ROfOe Street Na. Smoke Det. The Commonwealth of Massachusetts Department oflndustrialAceldents 1 Congress Street,Suite 100 Boston,MA 02II9-2017 www.mass.govldia Workers Compensation Insurance Affidavit:Builders/Contractors/Electriciam/Plumbers. TO BE FILED WITHTHE PERMITTING AUTHORITY. Applies tlnfurmation Please Print Logib Name(Bns;uess/organtzanowinaivianat): Address: V`C•�ty-w AUe N City/State/Zip: Ajol�Fv, A Z hV 1 l)I� hone#: Are yon an empla,-Cees¢the appropriate box. Type of project(required): IQ Ion employer with emplayeae(ffill and/orpa,m-).s 7. New—t—tion 2QIs asole proprietor or pminemhip andhave no employees working forme in $,❑Remodeling capacity.[Noworkera'comp.insurance required.] 3 alromeormer doing sllworkmysalE[No wnrkecs'comp.aremm�ce regruedj t �- 1 ❑Dildi.ion 4-Q Sema hmnemmar and will be hirin tractors Weonduot all work ovm twill lOQEuiltling addition g con YProperty. re tbaeau conuacmm oidrerlmve workere'compensavon n,smance or ora cote 11. Electrical repairs or additions pmpaatomwiurnoemployeas. - 12.QPhunbirrgnpab,oradditions 5.Q tour¢general wnhaotor and I have Idwd thesab-coa tors listed on d—sachedch,, 13.QRoofrepais ' TI—o srrb-covhactors have employee and have warkem omp.insmance.t 6.Q Wen acorpora[ion snd its officers h¢ve exeroisediheirriglrt of'exemption per MGl,c. 14.F Other 152,§I(4),and we have no employees.lNo worlsrs'comp.insurance mgviced.l *Any applicantthat checks box91 must also fill-fla,sectionbelowshowing theicworkcrs'comperuationpolicy information. t Homeowners who sotim7t'thie aP6davitindioa[Ing they azo doing ell wodcandtlren lilre outside contcactars one[submitnnew affld¢vlt lndiaating such. 'I iConhactors that chcckkhis box must attached an additional sheet showing the name ofdre.n�b-conhactors and state whether or vet those cvtities have . —play—Iftheseboonimctars flava employees,OVmoat provide thea warkeis omp.pellcymmaben Zara an employer that is piovidingnvor]rers'conrpensaaoaa insnrmace fm my employees.'1w1ow is lhepolacy and job alt, information. Insurance Company Name: Policy#or Self-ins.Lic.#:,t //t� _..Expiration Date:: �1 Sob Site Address: A,-I° City/State/Zip:lv//-_AA5O(,fn A-iA q Attach a vopy of the workers'compensation policy deduraflon page(shoving the policy number and expiration date). Failure to secure coverage as required under MGI,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 o£this statement may be forwarded to the Office oflavestigations of the DIA for iasunmw erage verification. I do he..by certify under thepalna andpmalfies ofpetjay that the befrmaGonprovided above Is bee orad correct. Date: �'-�-•� — 5 Ofjirial use only.Do mu write in this area,to bs ee naloWed by city to-town official:- City or Town: _Peranit/License# Issuing Antimrity(circle S.Boaxd of Health 2.)3uilding Department 3.City/fawn Clerk 4.Electrical Inspectar 5.Plumbing Inspector 6.Otho Contact Person: phone#: e 'TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street,Building 20,Suite 2035 North Andover,Massachusetts 01845 GerahlA.Brower Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please'rent DATE: A-)2`-G1 S JOB LOCATION: p 3 2c,Z'�j_ A S C Number Street Address Map/Lot iioMEowNER A,0&cw L�cp YSeII� X77--s )-2� Name Home Phone Woilc Phone PRESENT MAILING ADDRESS City Town State Zip Code The current exemption for"homeowners"was extended to include owner occupied dwellings or ono or two hardly dwellings and to allow such homoowners 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,ma 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 mare then one home in a two-year period shall not be considered a homeowner.(780 CMR Section I IOR5.1.2) 1'he undersigned"homeowner"assum 'eu es responsibility funpliance with State Building Code and other applicable codes,by-laws,ndes and regulations. The undersigned"homeowner"certifies Brat he/she understands the Town of North Andover Building Department romarrom inspection procedures and requirements and that he/she wilt comply with said procedures and requirements. HOMEOWNERS SIGNATURE - --}_ APPROVAL OF BUILDING OFFICIAL_ Ravued 8.2015 FormHomeE—ptiov BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 683-9540 PLANNING 688-9535