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Home My WebLink AboutINSULATE WALLS ON FIRST FLOOR, TAKE DOWN OLD PLASTER BUILDING PERMIT NaRx TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION permit%#: �'�` "`�� Date Received I '� �Ssgct�us�, pate Issued: , LNIPORTANT:Applicant must complete all nems on this page LOCAT,1ON ._ .. =_ G u y -: . :. A n PROPERTY.OWNER_.__ _.... n t >: 1{7(l:Wet-.Structure yes " no MAP PARGEL-. U _ ZOhI1NGDISTRICT ; HisfiorlcDis#riot yes no -Machine Shop Village, yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ Ode family ❑Addition Enwo or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others., Demolition ❑ Other Septic q W611 ❑ Floodplain b Weti'a`hd P. Watersl-ed District 0.V.Vat6r-SeWer._- DESCRIPTION OF WORK TO BE PERFORMED: tool— tA Identification-- Please Type or Print Clearly' OWNER: Name: ;C �i+ ✓� 5 Phone: —70,R— Address: vv�pC��S Contractor Marie _: Phone; Address: Supervisor's Corisfirucfiari L'c e -- Exp. Date: _ _ Home lamp,9v4Went ice'nse€ Exp. Date - ARC-{ITECT/ENGINEER- Phone: Address: Reg, No. FEE SCHEDULE:-8ULL)ING PERMIT. $12-00 PER$1000.00 OF THE TO.7"AL ESTIMATED COST BASED ON$125,00 PER S.F. Total Project COSt: $ 1 FEE: $— Check No.: 31-3 Receipt No.: 313 !7 NOTE: Persons contracting reit r�nregiste�ed contracto�� do not hare:access to the gaga r arty fund Signature of Ager�tlQwhe:r _Signature of cohtracfior 'T t%ORTH own of a 4 T "1dover No. :�x. h ver, Mass, 17016 COCHIC MRWICK V Q�"ATE U BOARD OF HEALTH PERMI T L �D Food/Kitchen Septic System .... THIS CERTIFIES THAT ...� �.. ........... � . ~.. �. ....................... .............. BUILDING INSPECTOR 41111111111110 p.,. . . ...... r Foundation has permission to erect .......................... buildings on ... .. .......... Rough 040 111 to be occupied as ....,.� � ..........�,,.........� .V...�. ........ .. .. ...... 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 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 IN 6 MONTHS ELECTRICAL INSPECTOR TANTS Rough UNLESS CONSTRUCTION Service ............. .......... ...... ......... .. ......=.s,......... Final BUILDING INSPECTOR GAS INSPECTOR 0ccup_anjqV Permit Required to OceugE 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. t tkaary TOWN OF NORTH ANDOVER ° �,`•° ,'�"� OFFICE OF w A BUILDING DEPARTMENT r »» 120 Main Street North Andover,Massachusetts 01815 ACHUS Donald Belanger Telephone(978)688-9545 Fax (978)688-9542 Inspector of Buildings l-IOMEOWNE'R LICENSE EXEMPTION Bnilding Permit Application M Please print DATE: JOB LOCATION: 2,�" �(�tJ✓�1 —� ��-� Number Street Address Map/Lot HOMEOWNER. � C�_-�.�-ev� -....... Name`-a Houk Phone Work Phone PRESENT MAILING ADDRESS v �s City Town State Lip 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,prov_icicd that the owner acts as su erp visor. 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 IIO.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 minirnum inspection procedures and re u' e nts and that he/she will comply with said procedures and requirements. i HOME,OWNERS SIGNATURE, APPROVAL OF BUILDING OFFICIAL i i Revised9/16 i Form Homeowners Exemption i BOARD OF APPEALS 688-9541 CONSLRVXHON 688-9530 HEALTH 688-9540 PLANNING 688-9535 The commonwealth of Massachusetts .Department o,f IndastrialAccidertts - Street, .�`Oi 100 1 Congress Boston,.MA 02114 X 017 qWt www mass.gov/dice 'p QSM �yti ' �gt�?Lkers' CoznpensationXnsuxance,A,�davit:Bni[dexslCori�'actvxsl��.ectxzciartsl�lYxmbers. TO BE MED VMBI`T:SE PKRMUTaxa Please Print Lo "bl, A ''licant laforxnatzOn Namo(Businessi6igariizatioiaftdividual): Address---3 n Citylstate/Zip Type oProject(recluixed); ,Axe you ap empToyez Y Cl?eek the approprlata box: .. • ' �]Nevi oonsix'€iciio� l..❑I wn-a employer wifh_ — _ employees(full and/or pant-time)-- 2.111 mu asole propzietoz or parfnerslziP and.have no empleyaes)NO'king for me in $. �Reanodelisig capacity.E7oworkers'camp.insurance zegnirad.J 9 ❑Delno3ltiau 3.�I am ahomeov ner doing all wozk myself.V1d workers'comp.insurancereguiredl t 10❑Building additiOR 4.E]I am a homeowner and will ba hiring contractors to coz}ductall-work on my property. Iwill 11.❑B1eC 1e rep xs off'addi'dQPS ezisurathat a>l c mtracfbts eitherbavework-e compensation insurance or azo solo plrimbing rop*s or additions pzoprietorswithzto employees. n~ '`�• 5.❑I am a genezal cmtr�ctoz and Tbave hkedthe sub-contractors listed on the attached sheet 131.Q Roofrepairs These sub-coniracfozs have employees and have warkcTe comp.insruance.# 1 Other �,❑We are a corpoz�voriand ids,o�cershaye exercisedtheir Tight of'exeznption perMC�Z c. 152,§7(4},and v1e have na employees.po wa*6&comp.irvsurance required 7 a heantthatchecksbox#1rriustalsoMoutihesectionbelowshowingthair-Yorkers'oorffationpolicyirr£ormation: Homeawners-rho submit ttais affidavit indicatimg'they are doing allwork andthen hire outside contzaafors must submit a new affidavit indicating sue :,. additional Sheet sho%vingibe' Contractors that check tliisabct have employees,they must pr vide their wormers'comp polic e of the naunrber.ctors d sEafevrhothar oz pott[�ose entities ava employees. Iftho sub-con# f am an employer thatispr�oviding-WIGAexs'compensation irzsurancefox my employees. Below is toh"site liepolicy aradj infoxmatian. jsuranoB Company Name: • ExpirationD�,tez policy#k or Self-ins.LIG.#:. City/State/Zip- lob Site Address: .Attach a COPY ofthe-Yorkers' compensatzOn'Polxcp declaxatxompage(sTaly�a�np°fib bl by a�b Up to$1,5n0.0o}. Failure to sacs a coverage as required under MGL c.152,§25A is a crnznn p aAd a fine Of to �250-0 and/or one,year`imprisonment,as we'll as civil p enalties in eto the OMGG form of a STOP O InvOg��of the D7A for ixasuzanc�a day against thG violator.A copy aftbb statement may bo forwarded cevezage Veli catiOn. I do AerebY certx rxder tliepains andper�alties of perju tliat the znforrnation pr ovided above is true ar-d correct Date: Si atrn'e: Pbana#: O Official rise arxly. Da not write in t/sis area,to be completed by city Ortoxvra official permit/License# City or Tovru- .ssuingA.nthOALy(dreleOne): ' ector 5.plumbkigTnsPector 1. Board of ffealtb, 2.Building,)eparhment 3.CztylTovt+xi.Clerk 4.BlectricalSnsp b.Other Phone#- i Contact Pexsox�•