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Home My WebLink AboutBuilding Permit # 3/22/2016 µ4U�Tb{9 BUILDING PERMIT TOWN OF NORTH ANDOVER Permit ° APPLICATION FOR PLAN EXAMINATION fi t NO: C Date Received Date Issued: orf ° 1 i '�+�i, IMPO complete all items on this P,ge Print PROP�RT1'OWNER w t � , Print MAP NO. PARCEL: ,BONING DISTRICT HistoricDistrict yes no li °M tt '0 Machine Shop Village yes n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential_ ❑ New Building ❑ One family 11 Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: I:] Commercial Repair, replacement Ci Assessory Bldg ❑ Others: ❑ Demolition ❑ Other D Septic, `❑WeII . ❑�'Fiaodpieil ❑'Wetlands ❑ Watershed District Q Water/Seaver A) I Identification Please Type or Print Clearly) OWNER: Name: 1")tsr, I ped Phone: 9 6, PV..Y Address: CONTRACT'b Marne: Phone Address Supervisor's Construction'License: -Exp. Cate: H me Improvement Llcense: Epp pate: ARCHITECT/ENGINEER NO Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$126.00 PER S.F. Total Project Cost: $ -t FEE: $fir Check No.: Receipt No.: ttr NOTE: I'ersans contracting,,#h unregister d contractors da not have access to the guaranty fund gnature of Agent/C7wner` Signature of contractor <.w Plans SubT,itted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL. Public Sewer ❑ Tanning/Massage/Body Art D Swimming Pools ❑ Well ❑ Tobacco Sales Ll Food Packaging/Sales L1 Private(septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FOR PLANNING & DEVELOPMENT Reviewed On ❑ Signature COMMENTS CONSERVATION Reviewed onSiq ature COMMENTS",."), 6" ' HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: -Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street mp ........... qg z, ........... 11� Z, Comm T, E,N �",srl NORTH Town of ? Anctuver No. A& h ver, Mass, 22 coc"Ic"tw.ck x,95 RATED /P��,�S 1J BOARD OF HEALTH Food/Kitchen E RT WL �D®� Septic System THIS CERTIFIES THAT Vim„ ,, ,,, ,,., BUILDING INSPECTOR ........... ..... .....� .... .........d , ...... ................... has permission to erect ....... buildings on Foundation .... ... . . . .. . ' Rough to be occupied as .... ..... .... ..........� .. . . Chimney provided that the person accepting this permit shall in every respect confor�to th "terms of the applica ion 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 LESSSTR CTION TARTS Rough Service � — ............. .... . . ........................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to 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. *Top View LQ �7 C" N i (D 2x12 PT stringers rc It 3" 911 2x5 PT41 i 1 , N _t 2x8 Joist Darioer JUI-;28,TZ IJIL— A 1 -F o V' Side view i Anthony & Joyce Volpe 50 Granville Ln . Forth Andover , Door x r d." 2X8 PT ------ `. Metal � f�D ( f ! Hanger 10 #IkS5H2ti1 1 11 3 4 7 (55in) step ruse 7/8° _ll step runes 1,0° Past base#t Caaa-Tz Q concrete O�� ', m t V C� rt O 8"sono tubes i ------concrete footing 4' deep t d A, w k F � g i F S I t Y µ y 1 � NORTH TOWN OF NORTH ANDOVER 01 41, a" � OFFICE OF h BUILDING DEPARTMENT 1600 Osgood Street Building 20,Suite 2-36 North Andover,Massachusetts 01845 �9Ssgcuu��'�h Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE: 7L26& JOB LOCATION: E20 p Irly i I l e I lit 1z,10/1 USP C- - 0060,-)- 0 0o®,0 Number Street Address Map/Lot HOMEOWNER Y C V '7"I1 -�2_-7,5 7� —P Name Home lone Work Phone PRESENT MAILING ADDRESS(I� 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 ply with said procedures and requirements. HOMEOWNERS SIGNATURE 2� - APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Fonn Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 r` wwmmass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/E lectricians/Plumbers. TO BE TILED WITH THE PERMITTING AUTHORI'T'Y. Applicant Information Please Print Le ibl Tame(Business/Organization/Individual): ) Address: ) j D 1" 1 a City/State/Zip: & Phone#: ° , Are you an employer?Check the appropriate box: Type of project(required): 1.Q I am a employer with employees(hill and/or part-time).* 7. 0 New construction 2.Q I am a sole proprietor or partnership and have no employees working for me in 8. VRemodeling any capacity,[No workers'comp.insurance required.] 9, El Demolition 3. I am a homeowarer doing all work myself.[No workers'comp,insurance required.]t 10 0 Building addition 4.E]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 1 I.❑Electrical repairs or additions proprietors with no employees. 12,E]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.Q We are a corporation and its officers have exercised their right of'exemption per MGL c. 14.Fl Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out thu 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. IContractors 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 air an employer that is providing workers'compensation insurance for n:y employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: _ Y b Site Address: 1 "oaf f° i n �- City/State/Zip: M ,,"ttach 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 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 cert fy der the pains and nalties of perjury that the information provided above is true and correct. �� Si nature: m�, ' �� Date: C)l Phone#: Official use only. Do not sprite in tills 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 Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the cityor town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if•you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617•-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia