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Home My WebLink AboutBuilding Permit # 11/13/2015 BUILDING PERMIT p�� sb TOWN OF NORTH APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received ��pafiATRo Date Issued: L U,-� J IMPORTANT:A licant must complete all items on this page LOCATION , PROPERTY OWNEh '; '1 Print . MAP NO, PARCELQL6.j0 ZONING DISTRICT: Historic District yes rr Machine Shop Village yes na' TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential Addition g wo or mor New Building CSne fam e family Industrial Alteration No, of units: Commercial Repair, p acement , Assessory Bldg Others:. Demoli rs Other Septic Well FloodplainWetlands Watershed District Water/Sewer' w C,K V0 V1_ C"J Identification Please Type or Print Clearly) OWNER: Name: Phone: av` e Address. ~cc_` ( ,•, CONTRACTOR Name: Phone:: Address,: $uperuisor's Construction License: Exp. Pate: Home improvement License; Exp. Date: i ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.MOO PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ Aa ,LFEE: $ Check No.: " Receipt No.: NOTE: Persons contr cting with unregistered contractors do not have ac ess tote aranty fund Signature of Agent/Owner -- "` ' . ignature of contractor ttORTH W „ 4 v ""'6' r nclu C ® .�.. ® 'T Aq] r- o �..cE h ver, ass, COCNICe4t WICK 41. �.Q AERATED 0'Pfi�,�5 � U BOARD OF HEALTH E Food/Kitchen IT L. . D........... Septic System THIS CERTIFIES THAT ......... , ,, ,, BUILDING INSPECTOR ..S"ISN *......... ..... ..` ... .. . .... . �.. has permission to erect ... ... buildings on .... �,. .., .. .. . Foundation ............ �� ...... .........t. ........... . . ... . . . .... Rough un to be occupied as .. ... .... .... ..... ... ... .. ......�.�,. .. .�.. ....... ... .... . ............ Chimney provided that the erso ccs tin this permit shall 6n eve respect conform fo the terms of the application p p p g p every p pp 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 I N p S ELECTRICAL INSPECTOR UNLESS C CTI A 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 Approved by the Building Inspector. Burner Street No. Smoke Det. The Commonwealth of Massachusetts Department oflndustrialAccidents w.P 1 Congress Street, Suite 100 Boston,NIA 02114-2017 www rnass.gov1dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Eleetricians/Plumbers. TO BE FILED WITH THE PERMTT TNG AUTHORITY. Applicant Information Please Print Le0b Nalne (Business/Organization/Individual): " • Cry-� Address: L,4� e_w .. .. � City/State/Zip: Phone#: �.. Are you an employer?Check the appropriate box: Type of project(required): 1.❑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 ani,„capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3. I am a homeowner doing all work myself,[No workers'comp.insurance required.]t 4.F]I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 E]Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.[]Electrical repairs or additions proprietors with no employees. • 1Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ 13. Roof repairs • These sub-contractors have employees and have workers'comp.insurance.$ 6.❑We are a corporation and its officers have exercised their right of exemption per MGL G. 14.❑Other 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 submif#Iris affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1Contractors that check this box mustattached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-coniracfors have employees,tkey must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for•nxy 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 date). Failure to secure coverage as required under MGL 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 WORD 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 under the pains andpenalties of p rjury that the information provided above is true and correct. Si nature: Date: Phone#: _ r5 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.Plumbing Inspector 6.Other Contact Person: Phone#: TOWN OF NORTH ANDOVER OFFICE OF BUILDINGEh EN 1600 Osgood Street Building 20, Suite 2-36 North Andover,Massachusetts 01845 maw Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE: Novermber 11, 2015 JOB LOCATION: 267 Waverly Road Number Street Address Map/Lot HOMEOWNER Dennis & Vicky Gallagher 978-6863895 978-771-8598 Name Home Phone Work Phone PRESENT MAILING ADDRESS 267 Waverly Road North Andover MA 01845 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 _a)L�Ic� APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homeowners Exemption B )dh1W OF APPEALS 688-9541 CONSERVATION C"iON 688-9.5:30 141"A1,11-1 688-9540 PLANNING 688-9535 November 13, 2015 Addendum to Homeowner Exemption: Job: Roof Shingle Replacement (front side only) The Job entails removal of a single course of shingles on the front side (facing Waverly Road). A layer of Grace Ice and Water Shield will be applied and then covered with GAF Lifetime Charcoal Shingles and/Aluminum Drip Edge. Two good friends with extensive construction experience and knowledge of Massachusetts Building Codes will assist the homeowner. One of these friends has done roofing for over twenty years. All materials removed will be placed in a rented covered container as approved by the North Andover Fire Department. The approximate date for this work will be on 2-days between November 23-30th 2015. I am best reached on my cell phone 978-771-8598. Dennis Gallagher Homeowner 267 Waverly Road North Andover