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Home My WebLink AboutBuilding Permit #507-15 - 1 OAK AVENUE 11/26/2014 O� HO oT BUILDING PERMIT j? e! �. ^_.•6 °oma L TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION Permit NO: U Date Received CHU Date Issued: �9Ss, T.P RTANT: Applicant must complete all items on this page LOCATION 1 Oak Ave Print PROPERTY OWNER Tracy L. Frazier Print MAP NO: 059. 0 PARCEL: 210 ZONING DISTRICT: R3 Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential Ll New Building Z One family U Addition U Two or more family u Industrial XAlteration No. of units: U Commercial U Repair, replacement U Assessory Bldg U Others: A Demolition U Other U Septic U Well U Floodplain -i Wetlands U Watershed District U Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: Tracy L Frazier Phone: 978-989-3066 Address: 1 Oak Ave North Andover MA 01845 CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER James R. Pierce Phone: 978-535-4459 Address: 32 Murray St. Peabody MA 01960 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: S-40 1 D 0 ° FEE: $ Check No.: L.) UZ Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund - ISig s nature of Agent/Owner mature of contractor ' h NORTH BUILDING PERMIT o* t,Eo No TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION '' O 4� Permit No#: Date Received p�gA7ED I.Pa`.�5 ACHU Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 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 ❑ Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: a Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date:-, I 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: $ FEE: $ , Check No.: Receipt No.: NG"fE: Persons contracting with unregistered contractors do not have access to the guaranty fund - ---------- Signature of Agent/Owne_r Signature of contractor t 1 Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑ l �t TypF nF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ ? Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM I PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature 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 a DPW Town Engineer: Signature: Located 3.84 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) 4k � I IN U- -WLi2 P,� ❑ Notified for pickup Call Email Date Time Contact Name j'__.._..._.._............... __ ____....._._.._...... _ _- 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 Location d �=- ►�!�C-•— No. �JV�' �� Date . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $�" i Foundation Permit Fee $ Other Permit Fee $ TOTAL $ - Check# 1 o Building Inspector 1� 3" 9 y;'�,�(.�`��,��r�r"�r t,..'� a-: ''�`•: G�' �.. k • S"'"' {..'J�{ '�'. ,q "$a, yY inn r{d "^2}'vw'm,,.' T„X4� qa� � �,j•S� 'k' "4 H q7 ��; +•�ai`" -r _' v �#m t i , �� k• d '!.r ;�p a j sl�' f C ;-q' t*'x'h✓ If, �,� Lh 7" � t' a'•', '�,.,r,§ -R['�4t'r r�' �y ,f L t r ,41k S�'rQ; rF.,+,• � my 1` .td F."'(1 zL ;yµ�at�:¢. rye 3 '• 1 i � t7t 1. rw � f t � iq�i aY- Y x rR t u"+"tl.�t e�` •Cti.'� .st, .I. h,J� d�` �� rrh r x'� -f / � zti c♦ E nG.. al 3 i` .t na9it' rld . : tete q "i�6yte'a�v 5r p�tt �� ch`ii' i , ..:.• 1 r. t. :1' sir ^ }r t r rr o- sk s} �, x x t st r r7 g+N �'T;+r` �f,.,,t'a}11 t S� ' � ��. �' r +'' •�,�� i��>f y' .v?ut� �.tt}yF�y`�$�r "�1 y., .,.:r' x vk1yL,'.+ �w k4'l.�r j i & .#F +� ��,,,pH4 il�r ,fit,f•. •d �'oc•�A � ,�� ; r r � ��, �'i.'t ti+ +'��: �"tL n'+M^1 r d.. ` 4aM +,� r '�.r. ��. '� ..t".•�'r 'Lr G^ rv,. �ry 1 rig! r 'npavxe5 { r +A � xda f °'� ,}=;a � 3 L r 4. X t �•[ Y�'6.�i t r; ,AORTM TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 North Andover, Massachusetts 01845 �SsACHUS� Gerald A. Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE: 11/4/2014 JOB LOCATION: 1 Oak Ave 059.0/0000.0 Number Street Address Map/Lot HOMEOWNERTracy L Frazier 978-989-3066 978-322-7249 Name Home Phone Work Phone PRESENT MAILING ADDRESS 2 Stoneybrook Large Salem NH 03079 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 _J!6A��..... APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 I Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 401,00 '.00 m $ - $ 480.00 Plumbing Fee $ 60.00 Gas Fee 100 comm. $. 100:.00. Electrical Fee $ 60.00 Total fees collected $ 700.00 1 Oak Avenue 507-15 on 11/26/2014 Interior Remodel - - The Commonwealth of Massachusetts IF—Print Form Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):Tracy L.Frazier Address:1 Oak Ave City/State/Zip:North Andover MA 01845 Phone #:978-989-3066 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑✓ Remodeling ship and have no employees These sub-contractors have 8. ❑✓ Demolition working for me in any capacity. employees and have workers' 9. E] Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. ❑ We are a corporation and its l0.❑ Electrical repairs or additions 3.2 I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §l(4),and we have no 13.❑ Other 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 submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors 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 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under the pains andpenalties ofperjuiy that the information provided above is true and correct. Si nature: Date 1 Phone#:978-989-3066 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#: NORTH . � ° T( wn of ndover No. I - KLh ver, Mass, 1 coc"Ic"IWICK 1' x.95 4ATEO U BOARD OF HEALTH PE IT Food/Kitchen Septic System THIS CERTIFIES THATq#- . .. ......... «„,_,�, !!,,,,,,,,,,,, ,,,, BUILDING INSPECTOR has permission to erect111 .... buildings on ...I......... �, Foundation 6..... ..... A*or Rough to be occupied as ... .... �.................,..................................... ........ 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 MON L ELECTRICAL INSPECTOR UNLESS CONSTRUCTI T Rough Service MOWN ....................... 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. NORTH owndover 0 l ~� No. I C, -Akh ver, Mass, 1 COCHIC"IWICK �I• I.9 ADgATED 01-f �5 s V BOARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES TPE !j# 1T .........rBUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ...I.........I . ..... .. ...... .................. � Rough to be occupied as ...441ww .... �!r. .rr....................................................... 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 Ito PERMIT EXPIRES IN 6 MON H ELECTRICAL INSPECTOR UNLESS CONSTRUCTI T S Rough Service ................. ... ... ......... ....................... Fina 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. t%O R TH own of : Andover No. KI h ver, Mass, coc Ic"IW1C'K 1' J*5ke RATED ..P5 rc i 4 S U BOARD OF HEALTH Food/Kitchen PER IT T Septic System LD THIS CERTIFIES THAT JA.ftl BUILDINGINSPECTOR ............. ............ ...... ... L.... ................... 0 E+.�r� Foundation has permission to erect .......................... buildings on ..�............ ,....&��.................................... ",-- Rough to be occupied as v J ........................................................ 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 PERMITEXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION RTS 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. Dear Brown and Mr Leathe I was asked to draft up this letter to explain the circumstances behind the work not being done at my property located at 1 Oak Ave ion North Andover Ma since the permit to build was issued on 11/24/2014. In Dec of 2014 I was diagnosed with skin Cancer(Melanoma) on my back as well as in my lymph nodes. I immediately underwent surgery to have it removed. The main part of the cancer was on/in the middle of my back on top of my spine which once removed and stitched back up did not allow me to button my shirt let alone do any work on Oak Ave. I expect all work to start within the week and hope to have everything done within 3-4 months. Thank you again for working with me. Alan N Bingel &Tracy Frazier