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HomeMy WebLinkAboutBuilding Permit #Exception - 11 ROSEDALE AVENUE 3/17/2007 ORTH BUILDING PERMIT o� rttt�o 06,0 - o? TOWN OF NORTH ANDOVER APPLICAvf R PLAN EXAMINATION e� 0� Permit NO: Date Receive*-_, 74A�AA7lD �,y�� �SSACHUS�� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION l V,oc,\x r t 6v&u Print PROPERTY OWNER V tiOCt P (7c.1tc.�tAc o Print MAP NO: '-Al PARCEL: ZONING DISTRICT: Historic District yesno Machine Shop Village yes TYPE OF IMPROVEMENT ROPOSED USE sidential Non- Residential New B ilding rne a mile dditio Two or more family Industrial terati n No. of units: Commercial R air, eplace e t Assessory Bldg Others: De olid n Other SepWell Floodplain Wetlands Watershed District Wate wer DESCRIPTION OF WORK TO BE PREFORMED: Pq10L ou I- J, WW-- 1-11; TVIV -1 ,wv%w�� Identification Please Type or Print Clearly) 10 OWNER: Name: Zvse, i)'Oacios 3 vkc ie( �\��+pec�c�S one: Ot—&'99.00aT Address: 0 201weckale nA-Ye- CONTRACTOR Name: 5-t CrCry\ 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: $ter U(J gg3FEE: Check No.: Receipt No.: NOTE: Persons contracting ith unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner - i gnature 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 - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT 10? COMMENTS AO UL,,-k-s fL DATE REJECTED p�"TE A ROV D CONSERVATION COMMENTS Ae),VW /s resFn,)Sila1' "Dv !ambo/x/h4f wifh,* Nle), 4►WAleY-1s' alef�Wo' L?446W �hw 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 FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department 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 use (6 cli� !,A ❑ Notified for pickup - Date ..............__............................_..........................._.—..................................._......................_._............................................................................__.........................................._..._...................................._......_................_...................__............................................_.........................._.._........._ Doc.Building Permit Revised 2007 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 ❑ 'Copy of Contract ❑ 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) ❑ 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 Hydraulic Calculations (If Applicable) ❑ 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 INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 l COMME NORTIf TOWN OF NORTH ANDOVER OFFICE OF ~ BUILDING DEPARTMENT *� 1600 Osgood Street Building 20 Suite 2-36 �.�.2 s�c�,C �*�� North Andover,Massachusetts 01845 �ats� Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please pri DATE: JOB LOCATION: I 1 'os-e d04 r 4 J Number Street Address Map/,o HOMEOWNER '��C t i f_ & Lc"(4 90,c i a 5 (,-) I-) '50q(0<�8 ( Name Home Phone Work Phone PRESENT MAILING ADDRESS l l Q o-� 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 (Cock Section 108.3.5.1) DEF NITION 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 helshe understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requiremermts. HOMEOWNERS SIGNATURE A APPROVAL OF BUILDING OFFICIAL xrAsa 10.2005 Form Homemvnms E=W ion BOARD OF \PPE:V.S 698-9541 CO.NSERV.YI'ION 638-9530 HEALTH 688-9530 PL.L\VIN'G 6"-9535 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, AL4 02111 www,mass.gov/dna Workers' Compensation Insurance Affidavit: Builders/Contractors/Electrid' s/Plumbers Applicant Information Name (Business/or Please Print Le 'bl ganization/Individual): U I _tr Address: o City/State/Zip: an r)GN rp r 116-0 Ia�qS Phone.#:_ r2. e fou an employer?Check the appropriate boz: I am a employer with T_ 4. Q I am a general contractor and IF7. e of project(required)employees (full and/or part-time).* have hired the stab-contractors New construction I am a;sole proprietor or partner- listed on the attached sheet ]Remodeling ship and have no employees These sub-contractors have working forme in any capacity. employees and have workers' 8' Demolition [No workers' comp.insurance comp. insurance.# 9. ❑Building-addition required.] 5. D We are a corporation and its 10.❑Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their ` m self 11.❑Plumbing repairs or additions y [No workers' comp. right of exemption per MGL insurance required.]r c. 152, §1(4), and we have no 12'0 Roof repairs employees. [No workers' 13.❑ Other comp. insurance required:] 'Any applicant that checks box#1 must also fill out the section below showing their workers compensation policy information. t Ham owners who sub—mit this davit indicating th7,are doing all wotk and fh:n hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the nam of the sub-contrEctors and state whether or not those entities hove employees. If the sub-contractors have employees,they must provide their worke t s' comp.policy number. I am.an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy.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). Failuie.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 certify under the pains-and penalties of perjury that the information provided above is true and correct Si store: GLctc� Date: Phone#: 7 FS (o IR9 co R g 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.Otlie1, Contact Person• Phone#: 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"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including 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 aparhazents and who resides therein, or the.occupant of the dwelling house of another who employs persons 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"ever state or local licensing agency shall withhold the issuance or renewal of a license or permit to,bpera'tera business or to construct buildings in the commonwealth for any', applicant who has not produced acceptable evidence of compliance with the insurance coverage required." AdditionaIly,MGL chapter 1.52, §25CO)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 chapter have been presented to the contracting authority. Applicants Please fill out the workers'compensation affidavit completely,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 ibis affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if youare required to obtain a workers'. 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 ghat the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sureio fill in the permit/hrense number which will be used as a reference number. In addition,an applicant that must submit multiple 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 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 license or permit not relatedlo any business or commercial venture (i.e. a dog license or permit to bum 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: Tlae CoinFTlonwealth of?Massachusetts Dg)artmi int of Industrial Accidents Office of Investigations 600 WaslII gton Street Boston, MA 02.111 Tel.# 617-727-4900 ext.406 or 1-877 MASSAFE Revised 11-22-06 Fax # 617-727-7749 ww ,.masLgov/dia PROPOSED PLOT PLAN LOCATED IN NORTH ANDOVER, MASS. SCALE.1"=40' DATE.AUG.24,2005 MARCH 17, 2008 Scott L. Giles R.P.L.S. Frank. S. Giles R.P.L.S. 50 Deer Meadow Road North Andover, Mass. NOTE: THE ZONING DISTRICT IS R-3. SEE PLAN#12397 AT THE N.E.R.D. �J SEE VARIANCE GRANTED 4/12194. 102.00 O N 7805 62$11 E ^' � m y 33' PROP- W Z 10, p00 6 26' .3 j 25'X - m 0 w 'AI A C) LOT N 0,200 S"' QM O O W o �o 3 25' �O z V� 1� 4 o c SPP �0 m P 0 102.00 S7 056'2819 78056,2811 W I CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE `tiH OF THE OFFSETS OF THE BUILDING INSPECTOR ONLY �o�* , SHOWN COMPLY AND SUCH USE IS FOR THE ILS s" WITH THE ZONING DETERMINATION OF ZONING 0 •93872 BYLAWS OF CONFORMITY OR NON-CONFORMITYfCIMM� �� ' NORTH ANDOVER aaR LAS® WHEN BUILT WHEN CONSTRUCTED. / Zvls{i i I I i 3 i Transaction Slip Account# (1' '} "` `-( ' 2 'f `t ,rt l Identification: Merchant Name ❑'Driver's License# ? .% ' State < °` ❑REGULAR: Finance Charges will accrue from the date of purchase and minimum monthly payments will be due each billing cycle. ❑ Other Identification ❑NO PAY:Finance Charges accrue from the date of purchase,no minimum monthly payment will be due until Date of Sale / 'r / -- * Date of Delivery the payment due date of the billing cycle following the expiration of the No Pay period of days. ❑NO INTEREST/NO PAYMENT: No minimum monthly payments will be due and no Finance Charges will Quan Description Price Each Cash Sale Price ^ accrue until the expiration of the deferred period of days. ❑SAME AS CASH (SAC):Finance Charges will accrue on the purchases from the date of purchase and mini- mum ini mum monthly payments will be due each billing cycle.If you pay the cash sales price of the purchase by the expiration date of the Same as Cash period of days, as indicated on your monthly statement, no J Finance Charges will be due on the purchase. ©=NO PAY/SAME AS CASH(SAC): Finance Charges will accrue on the purchase,but no minimum monthly payments will be due prior to the deferred due date of ( `)L, days,as indicated on your monthly state- ment,and if you a the cash sales rice of the purchase b the expiration of the Same As Cash period,no f v Sales Tax Y pay P P Y P P Salesperson Finance Charges will be due on the purchase. ❑NO INTEREST:No Finance Charges will accrue on the purchase until the day following the expiration of theCash Price No Interest"period of days,with minimum monthly payments due each billing cycle. Seller's Auth Rep ❑FREE FINANCING: No Finance Charges will accrue on the purchase for the "Free Financing" period of Auth Code Down Payment days,assuming you make the required minimum monthly payments and the account is paid as agreed. Unpaid Balance If a balance remains after the specified period expires,Finances Charges are assessed at the rate disclosed in ❑New Account EI-Existing Account of Cash Price the cardholder agreement. ❑REDUCED RATE:A reduced rate Finance Charge will be applied to the balance attributable to the purchase until I promise to pay to CitiFinancial Retail Services Division of Citicorp Trust Bank,fsb(the the expiration of the reduced rate period or payment in full of the reduced rate balance,whichever occurs first. "Bank")or its assignee the Unpaid Balance of Cash Price for the purchases shown ❑INTRODUCTORY PLAN: Finance Charges accrue from the date of purchase. Monthly Payments will be above plus Finance Charges,fees,insurance premiums and all other charges due $ for months,after which:time, minimum monthly payments will be due each billing thereon and grant and confirm a purchase money security interest in the goods shown cycle in accordance with the Cardholder-Agreement: to secure the unpaid cash price,subject to and in accordance with all terms and con- Customer Signature X __ ditions of the account agreement with the Bank which establishes the Account with which this purchase is financed,even if I am not a parry to that agreement. Customer Name(PLEASE PRINT) Telephone# FORM 25689-E TRANSACTION SLIP 10104 ORIGINAL-BANK COPY-CONFIRMATION COPY-CUSTOMER COPY-DEALER