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Home My WebLink AboutBuilding Permit # 10/1/2015 1 �1ORT11 qp'. ............... m...,,•,.i+.wry Q��.q 4 0 0 f g g�•r� ""`" BUILDING PERMIT TOWN OF NORTH ANDOVER � < � APPLICATION FOR PLAN EXAMINATION - - �' : Permit NO: Date Received Date IssuedAtm 1 �pSSAcwu5�� IMPORTANT:Applicant must complete all items on this page n ri o r� / / Irk . ,/ ,i/,,,,, ,r r: ri .✓,/,� / //�, .,,, , r,/ /, r / /./ 11 / r: r / o r -7— r / / fir, r // ✓i/ r� r �r r / � / r, / / r / rrr, ,. TYPE OF IMPROVEMENT PROPOSED USE Re 'd tial Non- Residential ❑ New Building One family ❑Addition NIT= or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other r rr,r rr r >, r ,r Yr r ;r r -r ,:. /. ._„ r""/r r r,./r. r.,r.., e r .';/ / r,r ur r r,r ✓%,../+ „rr. /i. r, rr.,.,. r.. / 'r / /.rl,, r .r1.r� r! „/,.r,.,,r//,/ r a.. r,...r,. /i ./r,r/ ,�f/� r,. r ,,.///cr,,r,/, ,v +...,i/r! /21':r r /ill /... i Cr,L // /// -� // / l. (/ //i J r„r ✓�r e'FShe'd,,D r t' // r .Se 1:1c*✓11L�1 W I // / ,rr � , r l r r r r I/lr r ✓ / / r .l / / i „J✓ r. r , /, 1 �,r// r r r ,// /„/ it// i / / r li �, ,, r / }} y' ,1.. %/� 1. /.. 11 / r✓ / / /; /// r .f r,//! r r...../.. /d //// ,r,r r,, //��-'�„W�te,}r.��,rP.,�>,.�,�✓F/,/iilrir��r��if/0,/G��/ll�!,�//rl�il�r�ir rr r„/r/„rl oyri/�rer,ii�i,��/.,,r.i,/%ciii�;,dr,1,r,///r„,,,,,,,,,c4r,,,,a/,,.,,,,,r/b/!//�r„r�/�,,,,i , ...,,,.,,, rr.. Identification Please Type or Print Clearly) .' OWNER: Name: Phone: `- Address: ” rr rr J rrr/ / ru % I ( � � /r ri 1 / 1 1, /r / (1 ?✓ ,✓1 !J 1/�%/r,�/ )r/( l/ f/) J -/I i r r rrl ./ / J, / I,r,� � �,,°;� i l ✓ r�, /r r 1, � r /� it / � 1 /r, ,r re; r, '-.g � r � /l�� r r�y,"�/� �I. /� ry��a� ,r��rl 0 „II'�ll��i��!!✓%i�� / U/ r/ //,r � e rrr ,/... r r-n.r r ✓,I � / ,r i� f- f 1 .� i ✓ E �'I/rllfr l/,/ JI%// F li 1, /�% � � 1 r/ r � '�,�,I r ��;�� /�/1��" ri; '� 1�G� r(l� J 1 f�'��r��/iif ✓/�/fr%/�//y/rill r n �f�(r/, .r r, /%l .fir ll,lll.✓/ / ,� ,...d.// r r i/ r / / / / r j ✓ / 1 � /. � r �, / / l � rr r r i,- rr, / r r rar, r;r/r / l , r ✓ r /,l r./, 1 r, I , J � l / /�/� ��/ I � r ✓/ r/, , I l i„ / , /� .✓ i r,a1 l �f / ( , 1 / J / r r „ r 1r l r ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED C ST BASED ON$125.00 PER S.F. Total Project Cost: $ i FEE: $ Check No.: 'l Receipt No.: '2 ”" NOTE: Persons contracting wit unre istered contractors do not have access to the guaranty fund S Signafiur „of Agent/Owrier r” ignature"af contractor' mow_ , FORTH Town of ndover i ® � h �A«� h ver, ass, COC MIC«l WICK ,9 AoRATEO p .�CJ BOARD OF HEALTH Food/Kitchen PERM Septic System jT T LD O C BUILDING INSPECTOR THIS CERTIFIES THAT .................6................................................................................................ 4 has permission to erect .......................... buildings on ..... �........CA0%.A4^.............................................. Foundation Rough ......... ......................................................... to be occupied as ........ ...... ......... ... .. .. .. ........... Chimney provided that the person ccepting 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 EXPIRESPERMIT IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS Iq TI Rough .... ............................. Service ...................... .. .... ... . . Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® OccupV Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing r Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. The Commonwealth ofMassaehusetts Department of IndustrialAecidents 1 Congress Street,Suite 100 Boston,MA 02119-2017 www.mass.gov/dia "t VWorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/PIumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. A licant Information Please Print Le ibl Name(Business/Organization/Individual): - Address: slruL City/State/Zip: wv Np� one#: �e_, Areyou an employer?Check the appropriate box: Type of project(required): 1.F1 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. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3. I am a homeowner doing all work myself[No workers'comp,insurance required.]t 9. F1 Demolition 10 ❑Building addition 4.❑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 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. ❑ x 13.n Roof repairs These sub-contractors have employees and have workers'comp.insurance, b 6.❑We area corporation and its officers have exercised their right of'exemption per MGL c. 14. Other �]('�t i 4 („Y 152,§1(4),and we have no employees.[No workers'comp.insurance required.] ` *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 am ari employer that is providing lvorkers'eoniperisatiort hisiu'aiice for niy employees. Belolp is the policy and job site information. Insurance Company Name; Policy#or Self-ins.Lic.#: 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). i Failure to secure coverage as required under MGL c, 152,§25A is a criminal violation punishable by a fine tip 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 verification. I do hereby Berl find Ire pains and penalties of perjury that the information provided above is true and correct. Signature: a Date: 9— o-"' Phone#: Official use only. Do not sprite in this area,to be completed by city or to1Vn official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: of %AORTH TOWN OF NORTH ANDOVER .tl * ".. - OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 North Andover, Massachusetts 01845 C us Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE: JOB LOCATION: 1 210 jap r,0. o6. ,l Number Street Address Map/Lot HOMEOWNER I Wllk /_93?_�6jznl Name Home Phone Work Phone PRESENT MAILING ADDRESS VC41i 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 requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE (74 Z& Z\ APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535