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HomeMy WebLinkAboutBuilding Permit # 12/20/2016 BUILDING PERMIT 01sTLE� TOWN OF NORTH ANDOVER - APPLICATION FOR PLAN EXAMINATION `' tl Date Received - /� Permit No*. _ . SACHus� Date Issued: Il1ZP RT.A.NT: Applicant must complete all items on this page Print PROPERTY OWNER ' = - Pr[nt i pe Year Structure Yes no MAP ��«�� - _PARCEL ZONING D[STRI T: H Isteric D'str�ct ye:s no Machine Shop Village y_ no TYPE OF IMPROVEMENT PROPOSED USE Residential Note- Residential ,&r New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: Commercial 11Repair, replacement ❑Assessory Bldg ❑ Others: A Demolition ❑ Other Ll Septic n 111 e ❑ Floodplain D Wetlan s ' Vllatershed Distitct ❑.Walar/sewer - DESCRIPTION O®FWORK?'O BE PE F®RNIED: Identification- Please Type©r Print Clearly OWNER: Name: Phone: 2C Address: Contractor Narhe.-C_r�.. RhaH.e Address:I Super-Visor's Construction License: -_ � ' - - _ Exp. Date: n-- t. _- Hai°ne lr-nprovement I�icens� -_ - -_ -_ Exp, Date_:.. .... ARCHITECT/ENGINEER iq Zk Address: IL Reg. NO. FEE SCHEDULE:BULDING PERMIT.$92.00 PER$1000.00 OP THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. � Total Project COsfi: $ C� FEE: $ ` Check No.: a Receipt No.: ' NOTE: Persons contracting witli unregistered contractors do not have-access to the guarantyfun :Signature of AgentlOwner`" Signafiure of caiitrsctei - Plans Sub-nitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ -TYPE bF SEWERAGE DISPOSAL Public Sewer ❑ Tauning/Massage/Bod�+A ❑ SWr7r,7�„ngpools ❑ Well ❑ Taba co Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc, ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTr4L. SIGN OFF - U' FORM PLANNING & DEVELOPMENT Reviewed On � j ZV� i nature l .COMMENTSiff CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on (/ Si naur c COMMENTS 1 r Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection nature&Date Drivewa Permit DPW Town hngineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT- - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signatureldate COMMENTF) 14ORTFl r Town �� _ over O �'' 0 No. % LAKE h , ver, Mass, fOCH AKIE �pa ¢�V RATED S U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System m .... THIS CERTIFIES THAT ... .,. . ... ...... . .,.. ., .... .. ,. �.. . BUILDING INSPECTOR ..... ........ ........ .... . ............. .... ....... has permission to er t ... buildings on ... . Foundation .................. .. .`. ... ........ ..................,. Rough to be occupied as . . . . , ...., ............ .. . .... .�.. ... ... . .4�. .., . . .... ........ ............. Chimney provided that the person accepting this permit shalt 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 . a VIOLATION of the Zoning or Building Regulations Voids this hermit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS 10 Rough Service r .. ... ... ..... . .. Final BUILDING INS CTO 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. � The Continontvealtlt of Massachusetts LL`ti7 Department of Industrial Accidents a ' Off ice of In vestigations E j 600 Washington Street. x Boston, MA 021.11 ` 1 www.mass.gov1dia Workers' Compensation Insurance Affidavit: Buildet•s/Contrr•actovs/Electricians./Plumbers Applicant Information Please Print Le ibl Name (13uSjiiess/Orgatiication/Individtial):C Address: r City/State/Zip: c5 Phone#:� � '`' Are youan employer? Check tht appropriate box: Type of project(required); C.❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time), rk have hired.the sub-contractors �. Q New construction 2..❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g• ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building.addition [No Workers' carp, insurance comp. insurance.$ . qu 5. ' We are a or and its 10.❑ Electrical repairs or additions required.] 3,El i a lloineowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions thyself, [No workers' comp. right of exem�tior�per MGL 12.❑ hoof repairs insurance required.]i c, 152, §1(4), and we have no employees. [No workers' 13,® 4then parking lot comp. insurance required,] "'W y applicant that checks box#1 nittst also fill out the section below,showing their workers'compensation policy information, I loincowners who submit this Affidavit indicating they are doing all Wolk and theft hire outside contractors Inust,submtt anew affidavit indicating such, 4.'ontractors that check this box must attached an additional sheet showing the name of the sub-contrnctors.and state whether or not those entities have eml3loyces. If the sub-contractors have employees,they tniist Provide their workers'comp,policy number. I rtrrt an employe)-that is providing workers'compensation ins'ura nce fir,iny employees. Below is the policy and job site i i f r;rmation. Insurance C":ompany Name; h6.r,-e) 1 Pol icy 9 of Self--ins.Lic. �a. Z. { 2U _'�_"[t-1+�1j 4 Expiration Date._T 351 Willow Street South p North Andover, MA 01845 Job Site Address: Cit y/StatelGi :� f Attach a copy of the workers' compensation policy declaration page (showing; the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGI-,c_ 152 can lead to the imposition of criminal penalties of a Fine up to $1,500.00 and/or one-yeas imprisonment, as well as civil penalties in the forrrt of a STOP WORD ORDER..and a fine otr up to$250.00 a clay against the violator. Be advised.that a copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance coverage verification. 'u I do hereby certify a ler the pro' s and pMaldes of'peijury that lite inforaaaation provided above is true and correct.; Si n<tIl rc: rT C-r_ Date: October 21, 2016 Offrcial use only. Do not tvrite.in this area,to be completed by city or town officinal. City or Town: Permit/License#i 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 4. Initial Construction Control Document M To be submitted with the building permit application by a w d Registered Design Professional for work per the 8t1' edition of the a Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Bake `N Joy Trash Room Addition Date:12/13/2016 Property Address: 351 Willow Street South, North Andover MA 01845 Project: Check(x) one or both as applicable: x New construction Existing Construction Project description: This project consists of the relocation of the existing trash compactors,and the addition of a small room to facilitate their use. The room will be approximately 250 SF, concrete masonry unit construction,with structural �s, steel roof beams. I Mark Carnicelli, MA Registration Number: 9156 Expiration date: 8/31/2017 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: x Architectural Structural Mechanical Fire Protection Electrical Other: for the above named project and that to the best of my knowledge, information, and belief such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMA),and accepted engineering practices for the proposed project. I understand and agree that I(or my designee) shall perform the necessary pt•ofessional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. n When required by the building official, I shall submit field/progress reports(see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a `Final Construction Control Document'. Enter in the space to the right a"wet"or electronic signature and seal: J,_ 4U7. Phone numn ber: (617)328-7899 x219 Email: iearnicelli@cmcdesign-builds Building Official Use Only Building Official Name: Permit No.: Date: Notc 1. Indicate with an`x' project design plans,computations and specifications that you prepared or directly supervised. If`other' is chosen, provide a description. Version 06 11 2013 Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional atl for work per the 8t1i edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Bake `N Joy Trash Room Addition Date:12/13/2016 Property Address: 351 Willow Street South, North Andover MA 01845 Project: Check(x) one or both as applicable: x New construction Existing Construction Project description: This project consists of the relocation of the existing trash compactors, and the addition of a small room to facilitate their use. The room will be approximately 250 SF, concrete masonry unit construction, with structural steel roof beams. I Mark Carnicelli, MA Registration Number: 9156 Expiration date: 8/31/2017 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning': x Architectural Structural Mechanical Fire Protection Electrical Other: for the above named project and that to the best of my knowledge, information, and belief such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR),and accepted engineering practices for the proposed project. I understand and agree that I (or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perforin the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being pet-formed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official, I shall submit field/progress reports(see item 3)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a `Final Construction Control Document'. Enter in the space to the right a"wet"or electronic signature and seal: Phone number: (617) 328-7899 x219 Email: mearnicelli a cmcdesign-build.cor 'E Building Official Use Only 13uilding Official Nance: Permit No.: Date: Note 1. Indicate with an `x'proiect design plans,computations and specifications that you prepared or directly supervised. If`other' is chosen, s provide a description. Version O6 11 2013 i Massachusetts Department of Public Safety~ Board of Building Regulations and Standards License: CS-094656 Construction Supervisor KAREN F cuRRAN TO UNION ST MARSHFIELD Meq 0 � Expiration: Commissioner . 1010812447