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Home My WebLink AboutBuilding Permit #527 - 101 BRUIN HILL ROAD 4/7/2009 f NORTF� q BUILDING PERMIT o ttL6D ,6 do i TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received A7ED F' �,y pDAPP�'(y Permit N0: ITS gcHus� Date Issued: ,- DJ IMPORTANT Applicant must complete all items on this page ti^7` r+ 2. n _.,� t-.- .� r" •s.. f Y, +� 5a� .� }� ra,:d�F r` c.., �i e LOCATION � � ,��,�� . � •� �.� Y �r .� �'' 77.7 At €t �€� �,�.t,•� r. ..p s a'i.� �'>�'�.� } z+,. . d PROPERTY OWNER /� ' / '! � � � x T �' w+ : � zVarPnnt r zIVIAP NO Vj;fl"P,ARCEL z ZONING:DISTRICT 5 'Historic Distract s v:. 's.»s 3 „k. .r•-4 ...n 't 1- y y. i Machine ShoprVilhage. °yes nom„ TYPE OF IMPROVEMENT PROPOSED USE Residen ' Non- Residential New Building ne famil Addition Two or more family Industrial Alteration �'�✓ No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other ' WatershedDistnct Septic Well F Floodplain Wetlands w= 4 Wax ate�ISewer.�. DESCRIPTION OF~WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: �f�% �' ='� Phone: y/ Address "i .z,,,, x^�r x sxFa. y"'` `.r^,;e;^q •z.S xY -.,n' ^z"`Yn-� ,ti rte' ,$�'r 4 '•��:r vr�-�r^�a' :,#Y„. �: r..l �, "'yr .fix.: -..,. h. 4.0. - Yom ' r ref r.6 CONTRACTOR i-Name r ¢ Phone r b bre i/,�x 4ddresS � ' AM �a� �( � ��S�upervrvisor s,�Construction L7cense� z 4�� N �� -` �.�� -„ Exp Date _> �,. z- trr.-'` ,�Home�fmprovernerat�License -5� �:.�Ma��M; ,-.-�,Y..r�� .�� .:��, •��.. _. Exp��Date,.,�._ �- _ �.._.�` _ N TE G IN EER Phone: ARCH / Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �' FEE: Check No.: o?� _Receipt No.: C> 33 NOTE: Persons contractin with nr gi r contractors do not have access to the guaranty fund nature4- cofcoJ�., rat r SFignature of Agenwne t/Or ,�9-� Location �/1 J�r Date No. RT TOWN OF NORTH ANDOVER LORT , O 9 Certificate of Occupancy *,..°.%'`�� BuildinglFrame Permit Fee $@ Foundation Permit Fee Other Permit Fee 3, TOTAL $ # W� � Check ` Inspector 211 d� Building Plans Submitted Plans Waived 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT 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 DPW.Town Engineer: Signature: Located 384 Osgood Street FIRE�DEPARTMENT mpDumpster Teon siteyes ono - �, -- `Located'ata 24 Main Street ` 2 i Fire Dep i MenUsigna#ure/date { 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 - Date Doc.Building Permit Revised 2008 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 a . Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan .Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits .require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses Li Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) o 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) L3 Building Permit Application o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit a Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract - - ❑ Mass check Energy Compliance Report o 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 �� ._. ._ . _.....__. . ._. 1- v.�_._._._�_. _�,..�.�._.�..�y._. _ �_......a�. .__ . .�-- j. .�� -- � � o� �. � rn � 5 I � a 7 N I 9 �-- '' —� � �___. � 1 a 1 O �� - � r 1 � ��.. �_ _ _ _ _ _� a � � � � �� , �®RT H omm Of over No. LAIII E dover, Mass., COC.1CKEN/ICK y�. ADRA7ED P. �Cy S BOARD OF HEALTH Food/Kitchen PERMIT . T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......Ir/! 1. /............................ .... W �............... r Foundation has permission to erect..... g .a./•.... &•..•...�•••• p buildings on ../.a./ ...... • FYI.... ...... .. . ............................... Rough t0 be Occupied aS............. �. Chimney .........� !!�!�/. ........................................................ Ch' e provided that the person accepting this permit shall in every res conform to the terms of the application on file in Final 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 CONSTRU STARTS Rough Service SPECTOR Final Occupancy Permit Required to OccuPy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. The Commonwealth of Massachusetts �lf Department o.f Industra Accdents Office of fnravdgatio ns 600 W ashinglon Street ` Boston,n, MA 02111 Wim'-muss.goi�/dies Workers' Compensation Insurance.Affi& vit: $uilders/Conitraetors/Etectricians/Pium Applicant Information hers Please Print Leaibiv Name (Business/Organizes]ion/individual): /G>/fi�� ` ffoD6=%t/ Address: City/State/Zip: /�6 Phone#,: ,? Areou an y m io er. Check t P y he appropriate box: I.❑ I an, a employer with 4. f] I am a o� Type of project(required): 7 employees full and/or part-time).* have hired the I sub-co�on�oer rs P ) 5• E3 New construction 2.❑ 1 am a sole proprietor or partner- Iisted on the attached sheet$ 7• ❑ Remodeling. ship and have no employees These stub-contractors have working for me in any capacity. workers, insurance.kS ❑ Demolition (N P �o workers' comp. insurance 5..7 We are a corporation and its 9• ❑ Building addition required-] officers have exercised.their 10:❑ Electrical repairs or additions I am a homeowner doing all work right of exem tion myself. [No.workers' comp, 152 P p�MGL 3 c �1(4), and we have no I I.❑ Plumbing repairs or additions insurance required.] t employees. END workers' 110 Roof repairs comp, insurance required_] 13•7 Other Any applicant.that checks box#1.must also fill out the section below showing their workers'con -nsaiion ii t Homeowners who submit•this alffidevit indicaing iiie}are uuifi•.erl cvca$: at. _ p` po cy information. $Contractors that cbecl:this box, art attached an additional sheet showing the name ofthe u�: eonuaelors roust su'omii a new.b-contractors end their workers'comp.policy infatntation I asr art employer that is provu{ing workers'comp and insurance for�'a to ees. Below is the Policy information mP Y P cy and Job site. i Insurance Company Name: Policy#or Self-.ins. Lic.#: Expiration Date: Job Sitz-Address: Attach a copy of the workers' compensation' liCity/state/Zip: pocy deciaration Page(showin;the policy number and ex lies ' .Failure to secure coverage as required under Section 25A of P tion date). fine up to 51,500.00 and/or one-year imprisonment. MGL c. 152 can lead to fine imposition of crimina y as well as - A 1 penalties of a of up to X250.00 a day against the violator. Be advise civil penalties in the form of a STOP WORD ORDER d that and t a copy of this statement may a fine Investigations of.the DIA for insurance coverage verification. be to the Office of t do hereb�i certify er � of perjury that the information provided abo a is rue and correct Si-nature: Date: �® Phone#: Official use ordp. Do not write in.this area, to be completed by Citytown or off City or Town: issuing Authority(circle one): Permit(License 4. I. Board of Health 2. Building Department 3. CifylTovvn 6.Other Clerk 4. Electrical inspector 5. Piumbiug Inspector Contact Person: Phone#: i 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 "..very person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as`pan individual,partnership;association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and inciuciin.g 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 ap artments and who resides therein, or the occupant of the dwelling house of another who employs persons to do ma intonance;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 a r local licensing agency shall withhold tie issuance or renewal of a license or permit to operate s business or to construct buildings in the commonwealth for any appiicantwho 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 poiiticai subdivisions shall enter into any contract for the performance of public wor)le until acceptable evidence of compliance with the instnnce requirements of this chapter have been presented to the contrasting authority.", Applicants Please fill out the workers' compensation affidavit comPI-etely,by checking the boxes that apply to your situation and, if necessary'supply sub-contractor(s)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 affid.a.vit may submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the.affidavit. Theaffidavitshouid be returned to the city or town that the application for the permit or license is being requested,not the D--partm ent of Industrial Accidents. Should you have any questions reg*�rciir_g the Nava,or if you are required to obtain a workers' compensation policy,please call the Department at the nmynber:Iisted Mow. Self-msmmd companies should enter their self-insurance license number on the an line. City or Town Officials Please be sure that t6"afiidavit.is complete and printed leo-lb)v. The Department has provided a space at the bottom of the affidavit foryou to fill out in the event the Office of Investigations has to contact you regarding the applicant: Please be sure to fill in the permitliicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/hcense applications in arzy given year,need only submit one affidavit indicating current policy information(if necessary)and under".lob 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 Iicens� 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 Office of Investigations would like to.thank you.in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The CommonwwEdth of Massachusetts I3epartment of lmdustrial Accidents. Office of Envestigations 600 Wash. ngtan Street Boston; MA 02111 Tel. # 617-727-4900 C=406 or 1-977-MASSAFE Revised 5-2645 Fax 4 617-7-7-7749 Www mass.govldia f pORTN TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT " + 1600 Osgood Street Building&dlding 20 Suite 2-36 North Andover Massachusetts 01845 SSACHU`��t Gerald A Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-19542 HOMEOWNER LICENSE EXEMPTION Please ndpt DATE: JOB LOCATION: Number Street Address MWIjot HOMEOWNER Name Home Phone Work phoee PRESENT MAILING ADDRESS 54�� 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) DEFINTI'ION 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 n APPROVAL OF BUILDING OFFICIAL Revind 10.2005 Form Homwwms Exemption 110ARDOF \PPFAIS 68R 9541 CONSERVATION68-3-9530 I1EA ;FII 6X8-9540 PL.-N-NING 6R8 X1535