HomeMy WebLinkAboutBuilding Permit #230-15 - 11 SPRUCE STREET 9/3/2014 L
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BUILDING PERMIT oF�t�eo bgtio
TOWN OF NORTH ANDOVER
M `l APPLICATION FOR PLAN EXAMINATION
V .•w .
Permit No Date Received �RQ�w�reo
�SSgcHuss�
Date Issued:
IMPC RTANT: Applicant must complete all items on this page
LOCATION
Print
PROPERTY OWNER R Vol
Print 100 Year Structure yes n
MAP PARCEL: f ZONING DISTRICT: Historic District yes n
Machine Shop Village yes o
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building None,family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
i
X Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
11
\ c 1 J
Mentification- Please Type or Print Clearly
(A—T OWNER: Name: _ ;[ Phone:
Address:
Contractor NamehlEg `&e Phone: 7-68'—sing --q C/b
Address: 3 �lIT `�c G fi 6L2
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 BAS DON$125.00 PER S.F.
Total Project Cost: $ FEE: $ v
/
Check No.. Receipt No.: v'
.�� �� p
NOTE: Persons contracting with u regi erect contractors do not have access to the guaranty fund
Signature of Agent/Owner Signature of contractor
J
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 Siqnature
COMMENTS
HEALT.t. Reviewed on Signature
L.
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 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)
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I
f
❑ Notified for pickup Call Email
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Date Time Contact Name
i Doc.Building Permit Revised 2014
—_ r
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
D Building Permit Application
o Workers Comp Affidavit
o Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
o 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
Li Workers Comp Affidavit
o Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
o 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)
o Building Permit Application
o Certified Proposed Plot Plan
o 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)
❑ Copy of Contract
o Mass check Energy Compliance Report
o 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
1
Location./,/
No. r Date
r
• - TOWN OF NORTH ANDOVER
Certificate of Occupancy $ ' h
Building/Frame Permit Fee"
Foundation Permit Fee
Other Permit Fee $
TOTAL $
Check#jxzoS-
Building Inspector
Enter construction cost for fee cal - North Andover Fee Calculation
Construction Cost
$ 703000.00 m
$ - $ 840.00
Plumbing Fee $ 105.00
Gas Fee 100 comm. $ 100.00
Electrical Fee $ 105.00
Total fees collected 1,150.00
11 Spruce Street
230-15 on 9/10/14
Replace Roof, Windows, Kitchen and Siding
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Constructimn Supers icor
License: CS-014197
MARK F RAE
130 MARBLERIIDGE
North Andover NCA 01845,
Expiration
04/24/2016
Comrriistioner
NORT4
t E
Town of ndover
No. 115 I
ii
ver, Mass, 412. 11d
h
op coc.a�tWICK �1'
AERATED PPP
1`S LJ BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT .........r(ar ..... ..................................................................
&oA.......%k_- . ...•.•.• Foundation
Phas permission to erect .......................... buildings on ..� ••• '•
^"""�' Rough
as .....� �.1.1► . .. ..WM.l• .....-i•�t ........ Chimney
to be occupied ••.•••••��„•Q
provided that the person accept) this permit shall in every respect conform to the terms of the app Ion Final
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and PLUMBING INSPECTOR
Construction of Buildings in the Town of North Andover.
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit. Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
® UNLESS CONSTRUCTION SWOTS Rough
Service
.. Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
Final
Display in a Conspicuous Place on the Premises — Do Not Remove FIRE DEPARTMENT
No Lathing or Dry Wall To Be Done
Burner
Until Inspected and Approved by the Building Inspector. Street No.
Smoke Det.
The CommonweaM ofHassach.asetts
• ,
Offlee o,ffnvestigafeozis
00 Wayhbigton Street
Roston,MA 02111
-wwm masy go-PId a -
Wo rkexo'Comp ensaflon Thquxance Affidavit: erp
.A.pPleasePxzntLeA
Hama(Businessj0rgan aatimnJlndz`uzduat:
Address: 136 01U"6-
City/ �atef Phone#:. �::k
Are yont an eraployer?Check the appropxzateroox: 'Type of pxaject(regmlred):
1.Q I am a employer wida.__ 4• X I ara a general cmtactor and I 6. E]New constmetioa F
employees(Mandlarpatttiwa).T havoWredthosu.b-conixactors
2.ElI am a sola pxoprietox ox paxtnez
listed ontha attached sheet: • XR-emorleling
These salt-contractorsave h8. [(Demolztion
ship anChaveno•exnployees -,
working forme in any capacity. workers'comp.insurance• S, ❑Building addition
[NO workers'comp.jusurance S. Q we axe a corporation and fis 10.t]MectTic alTop airs a additions
xeq*ad.] officers have exexcised.theit
S.[l I aan a homeowner dging all work right of exemption perMOL 11=p Plumbingrepairs or adcfflons
mys& [lowoxkers'comp. c.152,§1(4),andwahavano -t2,QE.aofxepairs
insuraz<c�xecluhed.] employees.[No workers' 18,[�Other
comp.insurance required.]
M�appiimntthaschecksbox#Zmnstaiso llontthesecfionbelbwshowingtheirvlbrkers'compensationpolicyinfoimation.
I Homeovrners vrho subniitlbis aft'idavitindicatingthey ire doing allwori£andthenRo outside contractors mustsubmit anevi
comp.po lloyIfaoimaisiuocnh.�Contracforshataheoktboxmustattachedmadditionalsheetshovingthenameo£hesue-contractors andthekworkers' .
czrfa trx2 ernptoyet'ttit isp Qvidir�g t o e s'eorngellsation bsurance fa�x�y er�zployees; Be,o�v ist/ie alicy andjob silo
Insurance CornpanyName:_
Policy#or Semr!W.Iic.#" Expiration Date
rob Site Address' City/State/Zip: '
A.tta.elt a copy oMewolkerrs'WmPensatioRTolicy declaration page(showing4ke policy PuTaTrer and expiration date).
Pailura to secure coverage as xecluirecl.uuder Section 25A ofMGL o.152 cart lead to the imposition oferiminalpenalties ofa
Mme up to$1,500.00 and/axone-Feat xmpxzsox�me tt,as well as civilpefa ales in the fom of a STOP VY ORS,ORDER.and a fmo
o£up to$250.00 a day against the violator: Be advised that a copy ofthis statem•entmaybe foxwardedto the Office flz•
Xnvestigaions oiffthe DIA.fox insurance coverage verification.
X60 Ifer`eby cer rrricr rielia' ciy� ie o��perfury treattrie in ar�ncz�zon proviriec�a�rove is due and cort�ee�,
8i afore• Data: L`
offleAd nse o.gry. Do noiwrite in tries area,to be coxawl'eted by city or taiga ofelfff
City or 'own: PermPULIcense M
f'ssuingAu.thoxity(circle one):
1.Board of wealth 2.Building)[)epartment I Ci ylTown Clerk 4.Electrical,inspector 5.Tlumbing fuspector
f.Other - r
information and o Instr ctx n y . -
Massachusetts General Laws chapter 152 requires aff employers to provide workers'compensation for tb ei employees.
Purst7azito fhts stafate,an e�r� royes is defined as L°..,evexg p exson hithe service of another under any coxifxact ohixe;
express cr�implied,oral orwxifEexz."
.An erTloy#bq defined as"an individual,paxtnexship,association,corporation or other legal entity,or any,,o oxm ore'
ofthe foregoing engaged in a,�oint enterprise,and includingthe legalxepxesenfafives ofa•deceased
Xedejveror.teej anndvduatpemlyex,.or the
p, atonoxoterlegalentity,employingemployees.
96evex-,he,
owner of a dwoEnghousehavingnatxztore thantbxee apartments and who xesides therein,or the occupant oftAa
dwelling h Ouse,of another who employs persons to do on maintenance,construction oxrepair world such dwe%g house
IDT Onthe groumds orbuilding apputtenanttlterefo shallnotbecause of such employmentbe deemedtobe an employes."
UQL chapter 152,§25C(6)also states that:"every state or local#cemsiug agency shall withhold the issuaxtce or
-renewal of a license or permit to operate a business or to construct buildings fa the commonwealIs for arty
applicant Who has notpro duced.acceptable evldene-0 of coxnpIiaxtce with the Insurance coverage regalred:'
Additionally,MGL chapter 152,§25C(7)states,Weitherthe commonwealth nor any of its political subdivisions shall
enterinto any contractfor the performance ofpublicwo*until acceptable evidence of compliance with the insurance
xeq*ementsoftbischaptexhave beertpxesante dto.thecontractzngauthoxaty."
Appltcauts
Please fill out the woxkexs'comp ensaizon affidavit completely,by checking the b ores that apply to your sitaaon and,if
iiecessaxy,supply sub-contracfor(s)name(S),addxess(es)and,phoxte number(s)along with their eergoate(s)of
insurance. LixnifedLiabihi reompanies(LLC)orLimzfedLiabilityPattnerships(LLp)W%tb no eln Ioyees otliextbats the
members orpmtners,arenotrequiredto can7workers'compensationinsurance. Xf an T�%C orLLP deeshave
employees,apolicyisrequired. Beadvisedthattbisafxdavitmaybesubmittedtothe Departmentof Industrial
Accidents for con#ation of insurance cavexag% Also be sure to sign and date the afidavi. the affidavit should
be xetaxned to the city or town thatthe application fox the peznait or license is being requested,not the Depaxhnent of
In dustral Accidents, Shouldyou have any questions regarding the law or u you are xecfuired to obtain a workers'
comp ensationpolicy,please call theDepartmentatthgn-amberlistedbeTow:
'r their
self"insuxaxtcelicense nuxnbex on the appropriate line.
City or J' 070 Officials
Pleasebesuxethatthe affidavit iscomplete andpxintedZegibly- T$eDepartmenthaspxovidedaspaceatthebotLor�z
offhe affWavitfor you to-&out igthe event the
'laasebesuxefonilinthe permif/licOffice oxlnvesfigatioxishasto contact You xegardingtheappBcant
extsenumberwbzchwillbeusedasaraftencenumber. haddition,an.applicant
fhatznust submitmultiple pezmif/Rcemo applications la any glvenyear,need only submit one affidavit 1:nd1catin Gwent
policy infomzafion(Xnecessary)and under".lob,Site Address"the applicant should-mite"all locations in g(city or
towzt)°'&.copy O the affidavit thathas been officially sfaiup ed or marled by the city ox tovvn may be provided to the
applicant as pzflof that avalid oftdavitis ortleox fufuxepexmifs orlicenses. .A nevi afdavitmustbefdled out each
Year,Where ahome owner or Citizen is obtaining a11009 oxbexmitnot related to anybusiness or comsxtexcial venture
(i.e.a Tog license orliexmit to burn leaves etc.)said person is NOT xequired to complete tb:is a£fxda,&.
The Office of luvestigations would lige to(hank you in advance for your cooperation and should you have any gtxesfsons,
Please do not hesitate to give us a call.
The l7epaxtment's address,telephone aixd fa�numbex.
The CQM-wo-aw-Gal'th ofasu'c;awns
Qfte off-qestiga.#a)0�a
6bQ Waftgtoa
TO 4 617.7-2'Z-49,00('d406 Qr Z .A -
Revised 5-26-OS �a� 617427 7749