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Home My WebLink AboutBuilding Permit #223-15 - 1 FAULKNER ROAD 9/2/2014 . NORTH q BUILDING PERMIT O � LEo ti TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION H L,5— np _: O Permit No#: aD�, � Date Received �y°0q,T.o,pP��S SSACHU`-+� Date Issued:01 1(w I ORTANT: Applicant must complete all items on this page LOCATION "( I kA f PROPERTY OWNER 1(�(Zvt� M 1 cG�ee�rfnt ayI t, h✓/SMA t" Ct VP f Print 100 Year Structure yes no MAP PARCEL:_ZONING DISTRICT: Historic District yes Machine Shop Village yes n 3 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District 11 Water/Sewer DESCRIPTION OF W RK TO BE PERFORMED: e •I ,n sfoeoon & o ►'den,n b I o I SCo v&v, J) s _r3 h��-e , e�vilr9tl�n ti 21c,��h�a► w o� ,•t r o . Iden ' icatiion- Please Typd or Print Clearly OWNER: Name:�' 1✓) H-rLr-pkc` Phone: Address: Contractor Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �T�(� FEE: $�� Check No.: Receipt No.: NOTE: Persons contracting with unregistered con Tactors do not have access to the guaranty fund Signature of Agent/Own T Signature of contractor Location 1 T-A 1 ) L_ J No.�?•_� , Date • - TOWN OF NORTH ANDOVER e , • �� 1646 • , Certificate of Occupancy $ Building/Frame Permit Fee $_ �U Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# I 1 Building Inspector Plans Submitted ❑ Plans Waived El Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature 1 COMMENTS 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 FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 ■ Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 NORTH Town of 0% No. h ver, Mass, coc.hcwt_' �1. S tl BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ............... ..... .. .�:5 ........ .. �. . .... .............. . Foundation has-permission to erect .......................... buildings on ..I........ ... .. .... ...,.\ Rough to be occupied as ...... ........ N • ...... 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 ' UNLESS CONSTRUCTI "" TARS 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. The Comonweaft o,fffassachuseits • , O.flee o,fbves igafeovs 6600 Washington Street Roston.,HA 82111 wm must'go-PIdia _' tlou Insurame Affidavit: o ex�a . '�'Q�c�ex� � �.p Ain Ze'ant h-mation Name(Susinoslorganizatfon/Tndz`uiduaD: ISI rJ7�� .�0 r Address. � �-a v 1 ►�ne� � f V 4d'u/t�il' I� a fy5 Phone: q1t- �P ��'- t�Syr Are you-in employer?Checktfto approprzate hox*' Type of project(regpirecl): �, X anz a general contractor andx 1.Q �am.a employer with.______ 6. New cbnstxuc-L&n employees( zlland(oxpax�tixne).T havenedthesub-contractors 2.1 t am a sale proprietor orpartnex listed on the attached sheet. 7. �(Remodeling _ shzp and`Iiavano.e�nployees These sub-contCaetoxshave 8. (Demolition working forme is any capacity, workers'comp.insurance. 9. 11$�&g addition [No workers'comp.insurance 5. We axe a corporation audits 10.]Electricalxepairs ar additxom xecpzixed.1 officers have exexcised,theix add 3. ,Z am a homeowner doing allwork right of exempiionperMOL 11..�PI mbingrepairs or additions myseL�loworkexs'comp. c.152,§1(4),andwehaven.o 12.PR.00£xepairs insurancexe ed. � employees.LN'o workers' 1g,[]Other • comp.insurance required.] �t�nyapplicantthaxchecksbox#sSmusEalsa�Ildnithesectinnbelowshowingtfieirwbrkers'eompensafion.policyinformafion. ' • 7�omeovrners�vha suhmitthisaffiidaYitmdtcatingiheyaredpingall.worlcandthenhireoufsideoontracforsmusLsu7�mitaneviafCxdagitindica�igsuch. Untaotmsthat clicAthis boxmustattached Via additional sheetslowingtho name ofthe suh-eontacfors andthokworkera'comp.poffoyiufoimafion. 1r aver proyagalisproviding'workers,compe�2�atzonirisr��ar2cefb�xa ergloyees�, �3erot�a��he�oticyr�r2ci�o�,s��`e in•fo�matio�t. . ksuxance Company Tame;. policy#or BeI�ins.�c.#. Expixation.Date' ' ob bite A ddxess; PRY/State/zip, ' Affa.ch a copy oft�ewoxkers'cont)PensationTolxcy'cleclaratzonpage(showing•the policyxtmnl�er acct expiration crate). Nailure to secure coverage as regwaclunder Section 25.(x.ofMGL o.152 can,lead to the impositicn of exh alpenalties of a faze�to$1,500.00and/or one�yeax.�npxzsonment,.as well.as czV.itpenaltzes in the forn.o�'a STOP�'OR�ORDS.and a�v.e ofup to$250.00 a day against&e,MD1atoz: Be advised that a copy ofthig statementmay be,fomudedto the Offzce i0f Investigations of the DIA fox ihmanca coverage Volitication. tto lie 6Z cer - zrricle,�tlie�iair�s od, evaftieg of pperrJury tfiattrie ire otanati�Data. vic�ecla ove%s t ue anc eortee�, Si mire• a Phone# % 7 t Ojf1elal use gnly. vo not write in dais area,to lie conVfeted by city or torte 0 lei I City or Town: Rermzt/Lzcense# Issuing Anthority(circle One) 1.�aard of ealtlx 2.BrxzlZdingJf�epartanent �.CRyf- o"Clerk 4.Mectxzcalinspector 5.I'mblugInspector f.Other - r TOWN OF NORT RA"OVEp OFFICE OF • ' o� s e , TYXN ` '7600 Osgood&reetBuff& ` g20,•Surte?36 7s� c�iu5��5 •North Andover,Massachusetts 01845 , Gerald A.Brown - Telephone(978)688 9545 Inspeetorof$uildings - Fax (978)688-9542 HQMEOW.NER.•LICENSE PXEYkTION PLICATION Pleasa pr . DATE: ' IOB LOCATtN.' T�v 1L►r cam' Number StreetAddress A dress MaplLot �IOAMDWNER C�;✓isi�� Name. Home.'hone �5 (e0``7 L e v T`t.q-7 WorkPhone PRESEN c`MAR NCT ADDRESS, S ---------------- The cuzrent exemption for"homeowners"was extended to fo aJ.low su.Ei,hoTAIC-O T ue- - ()ide s ner~DCcupied dtuelings to two units-OT less and as to engage an iudzviaual•for hire cWhNAo does 3otpossess a license,provided That the owner acts as supervisor), ,�iafel3uilding (Code Section 18.3.5.7 . DEFMITION OFH MEOVMR Verson(s)who awns apamel of land on which die/she resines or iufeuds to reside,an which fh=is,or is iufeuded to ' bb,aone Ort wofafflysfruefures. -1�.persor�wh.oconstrucfsmozeffiatQnehonzein�af�va_yearpesxodshalluofTie considered ahomeowner. The undersigned"homadwner"assumasresponsibilityfor-cbmpRances wifh the State Building Co Applicable codes,bde and other by-laws,Mes andzegrdafions. The undersigned"homeownex"cez t f pues that he/she imdarstauds the Town of North.AndoverBuzlding Deliartment -requirements, menfs,rm•inspection procedures and requirements and that he/shD will comply with=said procedures and , HOMEOWNERS SIGNATURE ------------------ A I)R.OVAL OF$UMDING OFFICIAL Revised 7.2009 P'orm.Home4wners Lsxempfion . 'POARL)OF APPEALS 688-954IOOItiSEr R�rATION 688-9534 DEALTH 688-9540 PLANNING 688-9535