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Home My WebLink AboutBuilding Permit #945-14 - 11 EDMANDS ROAD 6/30/2014 BUILDING PERMIT of�No oTH 6 6 9 TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINATION * -� Permit No#: Date Received4 "`"0r ACHUS�� Date Issued: —9,9 — (- C/ IMPO ANT:Applicant must complete all items on this page LOCATION' ` M t9 A106 � -�' P rint PROPERTY OWNER,, Print---- 1 o0 Year structure yes Qnno.MAP = PARCEL-: ZONING DISTRICT: Historic District yesMachine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building A One family ❑Addition ❑ Two or more family ❑ Industrial WAlteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others- 0 Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain 0 Wetlands 0 Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: I� Identification- ease Type or Print Clearly OWNER: Name: T/\ME S ��®9LL-' Phone: 9 -1066-17pz Address: Contractor Name: _ Phone: 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: $ Sz FEE: $ Check No.: C>1-- Receipt No.: �� NOTE: Persons contractan with unre rstered cctors do not have access to the guaranty fund Signature of Agent/Owne, Signature of contractor Location No. Date . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ �— Building/Frame Permit Fee $� �; Foundation Permit Fee $ ��' '� Other Permit Fee $ . ' :"I,Lo TOTAL $ Check# 7721 Building Inspector 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 PLANNING & DEVELOPMENT Reviewed On Signature_ 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 3 FIRE DEPARTMENT Temp`Dumpster on site. yes n4Osgood street o Located at 124 Main Street p ig Fire Department si nature/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 4y' 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 Call Email Date Time Contact Name Doe.Building 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 ❑ 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/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 ❑ 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 ( ) p Hydraulic Calculations (If Applicable) a Copy of Contract ❑ 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 • 4,��, TOS'OF 19ORMAND 0 B OMCE OF . . gnI►DING DEPARTMENT • ' •� .'.1600 Dsgood Street Building 20,Suite 2-36 •Py eves �' . �s R140S c�5 North Andovex,Massachusetts 01845 Gerald A.Brown - Telephone(978)688-9345 InspectorofBull dmgs Fax (978)688-9542 HOMEOW:NER.•LICENSE MNkTIoN BUtD TG pERi I'�` I ICATION please�rint .' - • BATE: - JOB LO CA'ITON: ' � '. DIs �P Number StreetA.ddress Map/Lot ROMEO t�ilNER {'11 E S Z)131. L Name Home Phone PRESENT MAIC,ING ADARESS P D.M �N 5' �'OwffD2 �7 - Zip Code The current exemption for"•homeowners"was extended to to allow sftt h homed,;,- x -nchide owner-occtipled dwellings to i�vo units ox;ass�d uers,d engase an? divaaual•forEre-Who does not possess a7 cense,provided that the owner acts as supervisor). St teBuiRding (Code Section 108.3.5.1) DEFINITION OFROMEOWNER Persons)Who awns a parcel of land on which he/she resides or intends to reside,on which there is or is rote be,a one or two family structures. A person who constructs more that one ho considered a homeowner, me in a two yearperiod shall not be to The undersigned"homeowner"assumes responsibilityforcompJiances With the State Building Code and other Applicable codes,by-Jaws,rules mdzegulations. The undersigned"homeowner"cert;$es that he/she tmdarstauds the Town of Nbrth Ando•verBuildingDepamment minimum inspection procedures and requirements and that he/she will c requirements, omplY with,said procedures and HONMOVTNERS SIGNAT APPROVAL OF BIIILDIN OF CIAL Revised 7.2009 Form Homeowners Bxempfion 13DARD OF APPEALS 688-9541r r • C07�SERVATTON 688-9530 HEALTH 688-9540 PLANNING 688-9535 NORTH Town of � � :..4., Andover 0 : :. - ..�: No. h ver, Mass, coctiicHRWICK �1• x.95 RAreto) U BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System ,�,THIS CERTIFIES THAT ...........�Ni ........... .......................................... BUILDING INSPECTOR has.permission to erect .i&"4L .......... build' on ��,. a 4�1�1... Foundation ....... .. ....... .. ...�....... Rough 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 NT ELECTRICAL INSPECTOR q(00 UNLESS CONSTRUCT I ST Rough Service .............. ...L .. ... ... .............. ............ Final B SPECTOR 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. The Commonwealth of tl4'assachuseffs Department ofindustriqlAccidiks Office of.Investigafeons 600 Washington Street Boston,MA 02111 -www.mass govlclia Wo rkexs'CompenSai ion lmurmec Affil-avit:Buffders/Cont°ac FoxslElectrcxc�ians/RMin.Ibex s APPReant Wormation Please Print Le ibXv Name(BusinesstorganiizationlXndzvidud): t, �1'J S /uD, L Address: 1/ z.: 0 yV gj0 s K9P - City/S tafemp: 1,f, kD CS Tohone#: r 7 .&ice you an employer?Check the appropriate box: c d I Tyne of project(required): to an I.El I am.a exnployex with^ �� I am a general contra x g, [New c6nstntction. ees Full vithpart-time).* have hiredthe sub-contractors employ ( 7. 'Remodeling 2.[] I am a sale proprietor or partner- listed on the attached sheet;� These sub-contxactoxshave 8. [(Demolition ship and`havenaemplayees working i'oxme in any capacity. workers'comp,insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑we are a corporation and its 10.0 Electrical repairs or additions required.] officers have exercised.theix 3. I am a homeowner doing all work right of exemption per MOL 1111 1'lumbing repairs or additions c.152 §1(4),and we 12, Roofre airs myself�'o workers comp. a Q p insuxancexequixed.� employees..P oworkers' 13.0 Otliex comp.insurance required.] xAny applicant that checks box of must also fill outthe section bel6w sho-wingFheirworkers'compensationpoliv information. t73bmeownerswho submitibig affldae indlGatinjiW ke doing allworMand then hire outside contractors must submit a now affidavit ladcatifig s4ch. gContractors that chrlC e this box must attached as additional sheetshowingthenameofthesuh-contractorsandtheirworkers'comp.polieyinfomiation. am an Below isthepolicyan4johsite information. Insurance Company Name% Policy#or 8elf-ins.Lic.ff: Expiration Date: rob Site Address: City/State/Zip: Attach a copy oftiae workers'compensation-pollcy declaration page(showing the policy mmber and expiration date). failure to secure coverage as requireduuder Section 25A ofMOL o.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 WORTS ORDER and a ixne of up to$250.00 a day against the violator: Be advised that a copy ofthis statementmaybe forwarded to the Office-of- investigations finvestigations of tho AIA for insurance coverage verifcation. Z do liereb ert under the p fts a [ties r[ury t the information,provided above is true and correct. - Si afar • Date• - Phone O aeia[use oBly. .Do not write in dais area,to be competed by city or town official City or Town: Permit/Liceuse# Issuing Authority(circle one): 1.Board of Health 2.Buildingbepartment 3.City]Towaa Clerk 4.Electrical Inspector 5.Embing Inspector 6.Other - r „,f- Information and Instructions _ Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation fox their employees. Pursuaait to this statute,an ernployee is defined as"...every person iii the service of another under any contract ofhire,- express crimplied,oral orw i ten." An argloye�zs defined as"an individual,partuexship,association,corporation or other legal entity,or any two or moxe of the oxegoing engaged in a joint enterprise,and includingthe legalxepresentatives of aAaceased emplo x.or the receiver orfxustee of au individual,partnership,association or other legal entity,employing employees, Wever 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 pexsons 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 Hc-ensing agency shall wifhhold the issuance or renewal of a license or p ermit to op erate 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 chapterhave beenpresented to the contracting authority." Applicants Please fill out the workers'compensailon affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-confractor(s)nam.e(s),addresses)andphonenumbex(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,axe notregnked to carry workers'compensation insurance. If an LT C or LLP does have employees,apolicy is required. Be advhodthattbis afCxdavitmay be submitted fo fhe Deparfineat of Industrial Accidents for confirmation of insurance coverage. ,Also be sure to sign and date the affidavit. the affidavit should be retumedto the city or town that tine application forthepenmit or license is being requested,xtot the Department of Industrial Accidenfs. Should you have any questions regarding the law or if you are xequired to obtain a yTorkexs' 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 andprinted legibly. The Department has provided a space at the bottom of the aft"idavitforyouto fill out in the event the Office ofInvestigationshas to contactyouregardingthe applicant. Please be•sure to fill in the permif/liceme number whichwill be used as a reference number, In addition,an applicant thatxmst submitniultiple 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 towb).".A:copy of the affidavit that has been officially stamped or marked by the city or town maybe pxovided to the applicant as Proof that a valid affzdavit•is on file£or future permits or licenses. A new affidavit must be,filled out each year.Where a homeowner or citizen is obtaining a license ox p exmit not related to any business or commercial venture (i.e.a dog license orpermit to burn leaves etc.)said person is NOT xequired to complete this affidavit. The Office of Investigations would like to theme 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 faxnumber: TN G`4 Q -WDaft O Sac?U PIf, Depa be,ul Q£Zudu iaX ec e t Office of IRVeWWo..Ra 694 Wasting(gn xeel< BQSton,MA 02111 T01, 61M-21Z,4900 ZK4900 W 406 Qn 1-•8777- Revised 5 26-05 Fax#617-727-7749 ' w�•�pa�s.gQvfclxa. Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost S 819 `OOLO E) m $ - $ 96.00 Plumbing Fee $ 12.00 Gas Fee 100 comm. $ IGOWO) Electrical Fee $ 12.00 Total fees collected $ 220.00 11 Edmands Road 945-14 on 6/30/14 Bathroom Remodel