HomeMy WebLinkAboutBuilding Permit # 10/16/2015 ,aoRrH
BUILDING PERMIT ®�_q`FD
TOWN OF NORTH ANDOVER o
APPLICATION FOR PLAN EXAMINATION
> n oR A w,
s l� Date Received �0 �Ol A�RA7EDep4RySy
Permit Flo#: cwus`�c
Date Issued:
1 ANT:Applicant must complete all items on this page
LOCATION 2® j kE
Print
PROPERTY OWNER PrintJ 100 Year Structure yes no
MAP _ ____PARCEL: __ ZONING DISTRICT:_ Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE Non- Residential
Residential
❑ New Building A One family
❑Two or more family ❑ Industrial
El Addition ❑ Commercial
❑Alteration No. of units:
❑
Bldg
Others:
❑Assesso
Repair, replacement � g
❑ Demolit►on ❑ Other
"111 77777 ❑ Floodplain ❑Wetlands
❑ Watershed Dstnct
❑ Septic "❑ 1/VeII �� t h g
O,Water/Sewer " NOR
, ._ .
DESCRIPTION OF Vl1ORIC TO DE PERFORMED:
41-74,V17 e9"
,,,,Identification- Plea se'Type or j rmt Clearly Phone: � �`��2
OWNER: Name:
Address:
Contractor Name: Phone:
Email:
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER S� Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
Total Projeot Cost: $ /-3.
FEE: $, / "/)o
Check No.:
Receipt No.: ` _5
NOTE: .Persons contracting with unregistered contractors do not have access to the guaranty fund
F�
NORTH TOWN OF NORTH ANDOVER
OFFICE OF
BUILDING DEPARTMENT
�o b 1600 Osgood Street,Building 20, Suite 2035
North Andover,Massachusetts 01845
�SSACHUS��
Gerald A.Brown Telephone(978)688-9545
Inspector of Buildings Fax (978)688-9542
HOMEOWNER LICENSE EXEMPTION
BUIDING PERMIT APPLICATION
Please print
DATE: b �2 O
JOB LOCATION: 20l Z'700,6 je�Ee
Number Street Address // n Map/Lot
HOMEOWNER s -A5 ��'�S�/� / e, V3, .SS 50S, ?j95S
Name Home Phone Work Phone
PRESENT MAILING ADDRESS 2v( 9s-o®v_,n J�-F_
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, ron vided
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