The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #118-13 - 109 NUTMEG LANE 8/10/2012 NORTH BUILDING PERMIT o` X616 - TOWN OF NORTH ANDOVER �24h '' o� y APPLICATION FOR PLAN EXAMINATION Permit NO: 1 Date Received Z 7��0 RA7ED �SSACHUS�� Date Issued: - /0 . 2-- IMPORTANT:Applicant must complete all items on this page LOCATION /� /lur�16� 1r4,1�� /t/ /�NdoyEC' dy/ ss b Print PROPERTY'OWNERoc�-r Print -MAP'NO: 3k PARCEL: _ZONING DISTRICT:- . Hi storic.District yes no MachineShop 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. .i DESCRIPTION OF WORK TO BE PREFORMED: (�iVE 02S X _Rm :27ArG,P_ocu,,P � r� S c Identification Please Type or Print Clearly)OWNER: Name: �2oBe��7 Cxoe-�Aa Phone: y7k- 6Irl S6 r Ll Address: CONTRACTOR Name: ow,.Jz C L3� as2 Phone: Address: Supervisor's Construction License: Exp. Date. Home Improvement_License: _ Exp.: Date: ARCHITECT/ENGINEER /J/liZCW,af,1d 4 Assoc Phone: >�(- +9 Sr 6 I Address: 6� 6�c%v�L�' A[✓t Reg. No. FEE SCHEDULE:BOLDING PERMIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ Zz coo FEE: $ Check No.: Receipt No.: NOTE: Persons contracting egistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor 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 A U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Y. �7— Si nature . 44 3k 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 Vater & Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT_Tern ' 'Dumpster on site yes no :Locate_d at 124 WiriStreet " Fire'Departinent'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 used ❑ Notified for pickup - Date E I Doc.Building Permit Revised 2008 M Building Department i The following is a list of the required forms to be filled out for the appropriate permit to be obtained. i I Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses f ❑ Copy of Contract f ❑ 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/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) j ❑ Engineering Affidavits for Engineered products r 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 I n ❑ 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 k Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report Li Engineering Affidavits for Engineered products M 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 DEPARTMENTMFORM07 Revised 2.2008 Location/ (� 9 ` No. /�l �� IJ Date /�•— • - TOWN OF NORTH ANDOVER 96 • • Certificate of Occupancy $ Building/Frame Permit Fee $ 2(,o OC) =- - Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �_ a Check# 25604 Building Inspector NORTl1 oven of - to No. x T Z b o h ver, Mass, Q Q� coc Mlc NlwK y1. AOR STE Cl) S V BOARD OF HEALTH Food/Kitchen PER IT T LD Septic System f � THIS CERTIFIES THAT ..I i� ... ,,,0,,.. BUILDING INSPECTOR ............... ... .. ....... ......rM�.. �/....... 4 has permission to erect .......................... buildings on ./.0.. ........ Foundation Rough to be occupied as ... ... ..... ./. �A/.4 �!.!�.. ...... ..� ......................... Chimney provided that the person a ting this permit shall in every respect con to a terms of the application Final p p 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 THS ELECTRICAL INSPECTOR UNLESS CONSTRUCT R Rough Service ................. ............................................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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 F NORTH 0TOWN OF NORTH ANDOVER t�eo^6'S.yO } 09 OFFICE OF BUILDING DEPARTMENT *� 1600 Osgood Street Building 20 Suite 2-36 North Andover'Massachusetts 01845 Sgc►+use Gerald A.Brown Telephone(978) 688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PER UT APPLICATION Please print DATE: 7- JOB -JOB LOCATION: i o Z In Af Al- /9Af4LIEe r o r gra 3 fl PA k.4ef_ 2S t f..,,;.Z t.13 Number Street Address Map/Lot I OMEOWNERa13f/ t,_—L�Z4,GE7Fs GO 678 0 8�{- Name Home Phone Work Phone PRESENT MAILING ADDRESS, l A.clda vF� ss 6 City To wri Zip Cede 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 fancily 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 A he/she undersfandsfthe Town of North Andover Building Department minimum inspection procedures and re gnthat he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 T X The Commonwealth of Massachusetts Depairtment ofindustrial.Accidents Office of Investigations 600 Washington Street Boston,MA 02J11 www.mass.gov/d'ia Workers' Compensation Insurance.Affidavit: ?builders/Contractors/JEleclriciansfplulmbers Applicant Information Please Print Legibly NaMe(Business/Organization/Individual): jV 6/e7' EL C2_4 4E`t4 <-,Ole n^.s,J- Address: /05 1V c1-r 1t1- hl� City/State/Zip: n/ /giy�u��cfC , M n . k45' Phone#: 5 7 ff- 6 f-!- J 16t 4 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 2.El am a sole proprietor or partner- listed on the attached sheet.? 7• Remodeling . ship and have no employees These sub-contractors have 8. ❑Demolition wor . g forme in any capacity. workers'comp.insurance. 9. E]Building addition. workers'comp.insurance 5: ❑ We are a corporation and its equired.] officers have exercised their 10.❑Electrical repairs or additions 3. I am a homeowner doing all work right of exemption per MGL 1 I.❑Plumbing repairs or additions myself. [No workers'comp. c.152,§1(4),and we have no 12.0 Roofrepairs insurance required.]Y employees.[No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information- 7 Homeoiyners 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 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.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 ofup to$250.00 a day against the violator. Be advised that a copy ofthis statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. I do hereby c ertify under the pains andpenallies ofperjury that the information provided above is true andcorrect. Signature: Date: Phone#: 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.PIumbing Inspector 6.Other Contact Person: Phone#: