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Home My WebLink AboutBuilding Permit #838-13 - 107 GRANVILLE LANE 6/10/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: I 0 11 IM ORTANT:Applicant must complete all items on this page ''PR®PERTjY�:O{WNER�:�I� �+N._ �� _ r✓.��-2Srz/� - -- ----s� Print _ F100 Ye Id Structu e yes MAP fVOP?JvG C.. .PAAR-`GEL �6�ZONING�®ISTRIOTt- #Historic®Istnct) - _ MaclilneShoVJlage) yes rim TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building WOne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial M-Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ---•� � •-,�.� ,� rw-;-ate ..+r• -.-� p� ._..,� �,-,_ >.. _-•.- ,-� � r-t� ®ISeptic DWelli �1Flood lain) ®�1Netlanstrlct I ❑tlNater/Sewerr. DESCRIPTION OF WORK T BE PERFORMED: 10— ol Please Type or Print Clearly) OWNER: Name: cl�Identification ,� �� s� � �- Phone: 2— - Address Ze r? i GONTRACTt®Rl Name �ti, +Phone _ A r 'SO -or.. License=;` E e: Home iin-rovement�License:; ..i.g- V-_ ,p ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Cell '; 'Total Project Cost: $fU jOcJ FEE: Check No.: �� Receipt No.: `�'1. NOTE: Persons contracting ith u ' egistered contractors do not have access to the guaranty fund 'Signature:of A ent/Ow* <:.G 'SI -iature of contractor, g ... g.._.�.-.__..._ . . - - - Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Location No. Date e • TOWN OF NORTH ANDOVER -�' e J ate , Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ 'Props TOTAL $ Check#5bLY�) 26476 Building Inspector Plans Submitted ❑ PlansWaived-E] Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE.DISPOSAL Public Sewer ❑ Tanning/MassageBodyArt ❑. - Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ permanent Dumpster on Site ❑ f 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 Decisionlreceipt submitted yes_.. Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature&Date Driveway Permit DPW Tow;!Engineer: Signature: i �Ea Located 384 Osgood Street FIRE Temp Dumpster onsite yes no Located at-124 Main'Street Fire Deparitiherit 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.$10041000 fine NOTES and DATA— (For department use B Notified for pickup - Date r Doc.Building Permit Revised 2010 building Department The fohowing 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 COTE: 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/Crossection/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) u Building Permit Application o 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 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 app>al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording li rnust be submated with the building application Doc: Doc.Bui!ding permit Revised 2012 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 W . www.mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leizibly Name(Business/OrganizatiorAndividual): Address: City/State/Zip: Gl g 4LDl 90- Phone#: �i��— 2 —y�92- a/ 69,7/3 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 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors e 7. ❑Remodeling 2.❑ I am a sole proprietor or partner fisted on the attached sheet. ship and'have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. workers' comp.insurance. Y p tY• 9. E]Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10. Electrical repairs or additions r�e9uired.] officers have exercised their ❑ p 3.R am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' comp.insurance required.] 13.�Other �� *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 aie 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 their workers'comp.policy information. 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.Lie.#: 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cell,"", the pal S ndpenalties ofperjury that the information provided above is true and correct. Si atur Date: /u Phone 6 C Z — Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: TO"OF NORTH ANDOVER ��6 .`4L OFFICE OF D ri BUILDING DEPARTMENT 600 Osgood Street Building 20,-Suite 2-36 �qss°T'°je ��5 •North Andover,Massachusetts 01845 AF+rus . Gerald A.Brown Telephone(97$)688-9545 Ins ector of P Buildin s f g - Pax 978 E ( )688- 9542 HOMEORNER-LICENSE EXEMPTION BU.LDZNG PERMIT•AP'PLTCATTON • r Pleasevnnt JOB LOCATION: / �'. �;, ,✓ ;Il L�, 1 Number Street Address Map/Lot WMEOWNER �6 Z Name Home Phone WorkRhone PRESENT MAILING ADDRESS_J6 ✓,�� Lam✓ - mei S C;t;To•_�„ Sta+w. Zip Code The current exemption for"homeowners"was extended to h-iclude owner-occupied dwellings to t1v0 units-or less and to allow su;b homeotMers to engage an ilndividual•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 gwus 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 perio d sh consideredalt not be a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules andregulations. The undersigned"homeowner,,certifies that he/she understands the Town of Forth Andover Building Department minimum inspection procedures and requirements 3 mat he/she will comply with�said procedures and requirements, HOMEOWNERS SIGNATURE APPROVAL OF BUILDING FICIA)_, Revised 9.2009 Poen Homeowners Exemption 'BOARD O.PAPPEALS 688-9541 CONSERVATION 688-9530 HEALTH 698-9540 .PLANNING 688-9531 LEGAL NOTICE 4#VfoaAif d��7�`op�- Date Article , Section of the Zoning Ordinance WHEREAS, VIOLATIONS OF Article , Section of the Building Code have been found on i Article , Section of the Code these premises, IT IS HEREBY ORDERED in accordance with the above Code that all persons cease, desist from, and STOPWORK at once pertaining to co strNP alter on *repa, on t premises known as All persons acting contrary to this order or removing or mutilating this notice are liable to arrest u less such action is authorized by the Department. CODE OFFICIAL NORTH own of t E : �, Andover O - 0 No. �.° h ver, Mass, �D " '1 • t COC641CORWICK os sOATIEV � BOARD OF HEALTH PERMIT . LD Food/Kitchen Septic System THIS CERTIFIES THAT ............. .... lw..�r.......... � ,,,, .,.�Q�................................. ........ BUILDING INSPECTOR . ... . ...... . • ohno Foundation has permission to erect .......................... buildings on ...xQ ........ .. .. �.(�r......... . Rough PVC. M.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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONT S ELECTRICAL INSPECTOR UNLESS CONSTRU S TS Rough Service .......... .. .....I............. 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. SEE REVERSE SIDE