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Home My WebLink AboutBuilding Permit #984-15 - 11 CAMDEN STREET 5/29/2015 BUILDING PERMIT TOWN OF NORTH ANDOVERlow „ APPLICATION FOR PLAN EXAMINAT (' h Permit NO: 0 Z'� / Date Received dr �� "�9 « Date Issued: �9IV AcHUs�t�y MPORT T:Applicant must complete all items on this page j LOCATION_ ► r7 lfz� f l%/ Ardave myl res P , t PROPERTY OWNER rI J('�(t ;t,'� S Print MAP NO: _ fPARCEL: f ZONING DISTRICT: Historic District yes Machine Shop Village_ yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building XOne family ❑Addition ❑ Two or more family ❑ Industrial A Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic -❑Well 0 Floodplain ❑Wetlands ❑ Watershed District" Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: �G Ia)i� QS Phone: ,.22)-OJT L Address: CONTRACTOR Name-Name: Phone: Address: s Supervisor's Construction License: Exp: Date: I Home Improvement License: Exp. Date: F ARCHITECT/ENGINEER_ �� Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED CQST BASED ON$125.00 PER S.F. Total Project Cost: $ ksq.9A W FEE: $ !' Check No.: Receipt No.: NOTE: Persons con ractin ith r gistered contractors do not have access to a guaranty fund Signature of Agent/Owner Signature of contractor � c • BUILDING PERMIT NORTy LEO TOWN OF NORTH ANDOVER 02 y` ''- APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received o ;y �RM1TEO I.PR .�5 �SSACHUS 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 E]Well El Floodplain ❑Wetlands ❑ Watershed District_. ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: 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.$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.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Mnature- ..._ i Location Date S� J No. TOWN OF NORTH ANDOVER Certificate of occupancy Fee $ Building/Frame Permit ? Foundation Permit Fee ET �' Other Permit Fee TOTAL $ Check#= r ng Building inspector f Plans Submitted ❑ Plans Waived.❑ Certified Plot Plan ❑ Stamped Plans ❑ TYP 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS 1 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& DateDriveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FAIRE:DEPENT -fi.T�ernkp ®umpste� onsite �Ve ono a - a, AfLocated at12"4MairS#reef: . ' =' FYire'D partmentsignature,datey "- u i . _ �� - 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 ❑ ❑ COMENTS CONSERVATION ❑ ❑ /S "�- COMMENTS �,a � [� �.-n I�-�l c' cam' s A -C U DATE REJECTED DATE APPROVED HEALTH ❑ ❑ 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 Located at 384 Osgood Street a `t FIRE DEPARTMENT Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS e n Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, avast 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) 1 ® Notified for pickup Call Email Date Time Contact Name Doe.Bnilding 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 o 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 ❑ Building Permit Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o 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 o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o 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 NORTy TOWN OF NORTH ANDOVER or d°`•`�t� �a°oR OFFICE OF p BUILDING DEPARTMENT "4 1600 Osgood Street Building 20, Suite 2-36 �y* North Andover,Massachusetts 01845 9SSACHUS�t Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE: JOB LOCATION: �� bpfl 9"f- dlo1oh: D_( Number / Street Address -y�� Map/Lot HOMEOWNERqa&�Ca "-3 92P-,00,0j`- 91,337-6J Name Home Phone Work Phone PRESENT MAILING ADDRESS // Catn&n Cf , af_� in ®VJ 7rJ 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 r uirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE g,___" APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 00RT#j Town of E I, ndover O No. h ver, Mass coc NIc Hl WIcN �P .c5 S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System • THIS CERTIFIES THAT 1 BUILDING INSPECTOR ............... ...�e. , ,,........ ............. 1................. .......................... Foundation has permission to erect ..... C.Prm*1-*A................ buildings on ..1. ...... ....Slve�................................ g Rou h ^' D 1 to be occupied as .� .. ...... .... . .. .. ............ ..Y4 l�+.,II�lf...... .... A............................ Chimney provided that the person accepting this permit shall in ever�spect 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 MONT S ELECTRICAL INSPECTOR UNLESS CONSTRUC ST TS Rough Service .......... ................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy.Buildin 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. as. io i g0 •c7 CAMDEN STREET 5/8""1.ROD SET) 5/81/.ROD(SET) 75.00' fvl h(j, L 0 TS '� �'°) 62, I , 64 L O T : 67, 112, . I PLAN 11,3, 114 1195 PLAN ,#195 L 0 TS 68, 69, 110, . .4.,,. o � 5/B"l ROD 5Q,00' � � W rH 0 �W PLAN 195 CAP(FD) 1"""l P1PE(FD) _ LOTS 65, 66 0 PLAN 1195 V 1.43" TO 1.ROD(FD) 5/81/.ROD(SET) 2 0' 5/8"1.ROD(SET)l 1/2"l.ROD(FD) PRINCETON STREET SKETCH OF HANCOCK DATE- Survey Associates, Inc. 3/7/12 OF LOT STAKING 185 CENTRE STREET, DANVERS, MA. 01923 1N VOICE (978) 777-3050, FAX (978) 774-7816 SCALE: I" = 30' 1/05 NORTH ANDOVER, MA No. 0 15 30 60 16827 F. L.d A.1.is R2�16827 dwg� 16827ws.dwg Mor 07,2012- &21 an t RENES (�ORAN Ti�fN�.N MORTGAGE INSPECTION PLAN � '1 F IST RED LAND SllFf10E1rORS N DEBORAH M. ZARZOUR w Ji 75 CEsTER,STREET010101 FLOOR IOC MN 11 CAMDEN STREET - �" t RHONE- 508-752—ONS �1 FAX: 508-752-8855 NORTH AND R A � RMT #STGROU '.€VET A DIvIsion of H. S. & T. Group, Inc. SCALE 1 " = 30 � —DATE-01-19-12 `-, REGISTRY ESSEX NORTH 5631/92 ' ; ray 195 aauaAU No WaLmos , s~� of xis To y WE truer )ME WT mm i . s: I Mm" ,l,; a ' .w wr To .,tt0.V< a r i 3 C arc 06-w02-93 mew is mm Rm waft we ws am mmmm BY m"Aw fFi l6 1 6fA Cif a �:�, ��,,.e,,ra�r ES W 00=MY AMML WdifL 09MM RAS RM i�6iB�r Bt.:YY11;E.W.QW M.7 !D E8 MWfCPR A 4R� MW 93 YHA' I . MEMM TW FFMM Y66A1TW �� s y LOCM AWN Sb YHA vim. PRINCETON STREET CERTIFIED TD FIRST FEDERAL SAVINGS BANK i l J t n Ham � k � 3F '. -1 CAMDEN STREET MWOM 'RMLYCYddM Ml.E $ ESCM SSWM MAW :PrP �s zCBS= or: 1 North Andover MIMAP May 28, 2015 O i ys z ti °>er r / 0 4 t i I 31 R , x •, '-;yam r�- a` i Interstates —I —SR Horizontal Datum:MA Slateplane Coordinate System,Datum NAD83, Roads Meters Data Sources:The data for this map was produced by Merrimack %t EasementsNORTH Valley Planning Commission(MVPC)using data provided by the Town of Of ,,ILD 'q�. North tt Andover.Additional data provided by the Executive Office of. 0 MVPC Boundary ? e� ��+a�� Environmental Affairs/MassGIS.The information depicted on this map is _]Parcels 3 _ L for planning purposes only.It may not be adequate for legal boundary FO -• to definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING It • THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY 4L �o # OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT # ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION 9SSACHUS�t 1"-66ft w�E North Andover MIMAP May 28, 2015 �85 0 0002?. 085 0 O� 085 0 0008s *t T5;LEXINGTON EStTa O� 1 1 - 085`6;0- 0,4�22�CAMDEN'�T_r' 0_��' -� 45 ';085 0 0024: �. \.. . 20,G'A�MDEN515;4CAMDENIS� ti 08510,0009': 085 O 000,725),;CAMDEN1ST� r . 444�C'AMDEN�ST ,222;�P E SANTTTTTTTTTST' -065-'.6=4023 80 �a Ga yo 085:0-00171 1 CAMDEN& I 085 O 0014 228'IPLEASANTST / 422.i0*RINC_ETONST�' ME_Sr �J 085 00052 � O_85�0 0022 �. 085:000201; �� do ,R \� yo OS_5'^�0 0030 "` ,�h f 1085!0003,;7 ? 7 PLE'ASANT'STf i" t085 0 0036 � ,985 a:0046 4246"�PLEASiNiTST" �0 085;0 0032 '0j ss, SGP' L%PMINCET U 235�{P.E,E `NST ST S � N 24ly�PLEyASAN�TS�Tj os5 O 0'031, 085=0'=0038 os5zo 0006= �25'4iP,,tLEAS'A`NT�SS•,T 085 o Og4_9 X01 326kOSGOODST'�� 1 RR , 085 0 004iF 085 Q;0040; 58�PARK�S�T 085:U 0050' 25;1�PCJEASANT Sill262)(-P�LE4SAAAAAAA T Rail line Wetlands Zoning Interstates 0 Exempt Lands Busine s 1 District — D Busine s 2 District Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, Busine s 3 District Meters Data Sources:The data for this map was produced by Merrimack D Busine s 4 District NORTH Valley Planning Commission(MVPC)using data provided by the Town of Roads O Gerena Business District Ot t`tO q� North Andover.Additional data provided by the Executive Office of O Planne Commercial Dev rb O Environmental Affairs/MassGIS.The information depicted on this ma 1s 1 r Easements j. bt *e O P p C Corrido Development Dist 3 L for planning purposes only.It may not be adequate for legal boundary 0 MVPC Boundary D Corrido Development Dist O to definition or regulatoryinterpretation.THE TOWN OF NORTH ANDOVER 0 Municipal Boundary D Corrido Development Dist h p MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING Industri 11 District THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY Zoning Oveday " O Industri 12 District 0 Adult Entertainment • 's .^, � OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT ❑Downtown Overlay District D Industri 13 District * o �� • ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF ©Historic District D Industri S District • THIS INFORMATION 0 Water Protection Reside ce 1 District '�1,9 pO��r�o•�,y :i Reside ce 2 District ❑Parcels G P-de ce 3 District SSACMUS�t O Hydrographic Features A de ce 4 District —Streams 1"=66 ft w4 pude ce 5 District YYY de ce 6 District �d a ssidential District The Commonwealth of Massachusetts Department oflndustrialAccidents 1 Congress Street,Suite 100 < Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Anmlicant Information Please Print Legibly Name(Business/Organization/Individual): ?M2 Address: City/State/Zip:� Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.0 lam 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, []Remodeling any capacity.[No workers'comp.insurance required.] 3�I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 10 E]Building addition 4.❑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. Plumbing repairs or additions 5.F]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 � p 6.Q We area corporation and its officers have exercised their right of'exemption per MGL c. 14.g]Other r ovy 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. 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 I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: I 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 hereby under tlr EP d penalties of peijuty that the information provided above is II-Ile and correct. Signature: �p Date: Phone#: '33�6071 7 Official use only. Do not lvrite 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 Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: