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Home My WebLink AboutBuilding Permit #943-15 - 100 SUTTON HILL ROAD 5/20/2015 NORT{{ BUILDING PERMIT OF�tLen bgtio TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ~ ' T b Permit No#. Date Received ��Ssgo'? cHu Date Issued: ,- Ito MPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER I �'�, `�. `15�.•SIDIL Print 100 Year Structure yes ' MAP PARCEL,., ZONING DISTRICT: Historic District yes Machine Shop Village yes. TYPE OF IMPROVEMENT PROPOSED_USE Residential Non- Residential ❑ New Building VOne farAily [Addition ❑Tw"r more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: R Demolition ❑ Other Ci�ept� OaWell: � Floodplain �Wetlands �` t7 Wat�rshed;iDistrict 01Nater/Sewer DESCRIPTION OFWORKTO BE PERFORMED: f Ut ( Identification- Please Type or Print Clearly OWNER: Name: �L 6 -s zlL Phone: "1 1111 Address: Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $_ - 1�0 , daa FEE: $ LZy Check No.:(� -� Receipt No.: 0 NOTE: Pei ons contracting with unregistered contractors do not have access to the guaranty fund ry _ t. i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ I � TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Swimming Pools Tanning/Massage/Body Art ❑ g r Well ❑ Tobacco Sales ❑ Food Packaging/Sales E! Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On ^Signature_ COMMENTS CONSERVATION Reviewed on )'S Sinature ' COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No; Zoning Decision/receipt submitted yes Pl&nning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Drivewav Permit DPW Town Engineer: Signature: FIRED Located 384 Osgood Street } �=,Temp D_ umpstefo'ns �`, Yes ;- - 55 Q, at 1P24 MainSt�eet�, '�" " Fire De artmentai C,®MMENT4S . r + {{ t 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 q pp requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10o-$1000 fine NOTES and DATA-- (For department use) ® Notified for pickup Call Email Date Time Contact Name Doc.Building Penxut Revised 2014 r i 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 OTE: 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application 4. Certified Proposed Plot Plan 4. 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 I NORTFj own of sAndover 0 - No. o h ver, Mass, COC NIC NE WICK �� S BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System THIS CERTIFIES THAT fl.wn'.0AW BUILDING INSPECTOR ......... ............ ....U�S.I. .��. ...... . .. .......................... . . . .. .... II cc�� . has permission to erect buildings on ..l.b.0.......s�i„!. . . . . . �c ....... ....... Foundation Rough t0 be occupied as .C<4ov .....r?.Ge� f;JYY n S}.1Y.s.�!!l�..-......6.41A. . .... ................................... 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 CONSTRUCTIO T S 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. _ h ou w�-61 �y log g4c LS j i North Andover MIMAP May 20, 2015 i r� 1 � Y'-kr�. ;� t Mt tom. �y` s•�'�;y , s, � � w f - P , M G { j y7 II o v, �. •i . a49 ' t . > G � Interstates —I —SR Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, Roads Meters Data Sources:The data for this map was produced by Merrimack NORTH Valley Planning Commission(MVPC)using data provided by the Town of t t Easements Of 4�`90 s'9� North Andover.Additional data provided by the Executive Office of E3 MVPC Boundary =. bf, �e�O Environmental Affairs/MassGIS.The information depicted on this map is 7 Parcels 3 L for planning purposes only.It may not be adequate for legal boundary Op definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING 4t THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY • s ^ * OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT ,► o�q ,�,� 1 ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION SSACMUS� V=45ft TOWN 6�tF�^ra D ten Offj�OR•rlHtMDQ +P OFFICE 0F . .1600(Js90odSireetBOdiug2Q •Sliite236 � A ius� `5 • .: Noith Andover,Massaahuseiie 01845 Gerald A.Brown � Telephone(978)689-954-5InspectorofBuildings _ aX (978)6889542 . O1VJ OWI LICB EEA PTION pleaseurint ', • DATE Zb/7,015 -B . Number SizeetAddress Ma p/xot . 1�0MMOWNBR -1 t-'3 l�-l21 �1 L-315�-12��• Name. . Rome,Phone WorkFhone PRESENT MAR iNGADDRESS— h5— DDRESSh5— - C� JTOM . of p �..at..• ��Cods The current extended io ., uehzde ovinex occtipzed divelings to tvo units ox:ess and fo allow such homeo-wers to engage au?nti�viaual.forit 7 acts as supervisor). State Building (Code lection o eoes nofpossess a 1 c�alse,provided that the owner DEM-ITION O.FHOMEOVMF, , Persons)who Awns aparcel.of land on which ha/site resides or intends to reside,on WM, there is,oris Md to conende be,a one cr two Family strnctares. A p erson,who constrc cts more that one home in:a twoyearo d shall not be considered a 11.omeDwneI; p The lmdersigned"homeowner"assumes responsibility forcbmpliances wiflz the State Building Code and other Applicable codes,by laws,roles and-xegulations. The undersigned"homeowner"omtdies that he/sheuuderstauds the Town of North Audoverl3uild3ng De&ztment x1in 'am.inspection procedures and requirement.-and that he/She WiR camply with sand pxocedures and requirements, H0Affi0WXBRS SIGI*IATM ' APPROVAL OF 33UMDMG QF ILIAL Revised 7.2009 Form Romeowners Bxemp6on - 13DARD OF'APP.EA7-688-9541 CONSERVAMN 688-9530 BEALTIT 688-9540 PLkNNWG 689-9555 i -\ The Commonwealth of Massachusetts F Department of Industrial Accidents d 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia v bV' Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lelzibly Name(Business/Organization/Individual): Iww 'C' Address: ty p s .. Vt l\R4 ( �� Phone#: "3 I S-IZ,'] Ci /State/Zi oa Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.Q I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 9, [Demolition 3.�I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 VBuilding addition 4. 1 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 11.❑Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 14.gOther ! e"y- 6.❑We are a corporation and its officers have exercised their right of'exemption per MGL c. 152,§1(4),and we have no 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. I 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 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 herebycert der the pains and penalties of perjury that the information provided above is true and correct. Date: 5—`2r) /J — Signature: � Siature: Phone#: (^ �— Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# LLBoard ority(circle one): ealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector on: 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 city or 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