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Home My WebLink AboutBuilding Permit #534 - 110 MARBLEHEAD STREET 3/21/2008 BUILDING PERMIT r10RTy q p tt,ao 6a ti� TOWN OF NORTH ANDOVER p i p APPLICATION FOR PLAN EXAMINATION # ,� c . +� oq Permit NO: Date Received � RAT291 P' SSACHU Date Issued.: IMPORTANT:Applicant must complete all items on this page - r`.. c '' t .^s .m rM pv •"` ¢ e LDCATI ON 1 C� `1:� ��re 0t y - A OwnPrir �nt -77 , . PROPERTY OWNER �n VIAP NO} PAROL: ZONING DISTRICTS Historic District yes no s Mach n 'Shop Vjllage yes no. t % _ 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 5ept'io dNel1 x loodplairt Wetlands Watershed istnct` �DESCR IPTION OF WORK PREFORMED: �TOBE Y�e �,J � e/ � n1C i� i►^,�_ Identification Please T � QC-wLf or Print Clearly) OWNER: Name: Q Phone: C �3` Address: cAd. CUNTRA�CTOR phone k S x 3 s s SupeTv-,Isor's i✓onstructlon L7cense Exp Da#e: Ho.rrie lm ravement L�cerse, g. , a ARCHITECT/ENGINEER N Phone: Address: Reg. No. FEE SCHEDULE:BULDING`P�ERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ V31I fAV10 Pew,()• FEE: $ Check No.: �� Receipt No.: c>(10 j NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 5�gnature ofeAgent/ caner - `t'�'� SJana ture of contractor l 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/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 Doc:INSPECTIONAL SERVICES DEPARTMENT:13PFORM07 Revised 2.2007 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 COMMENTS I DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED r HEALTH COMMENTS b Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes i Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature &Date Driveway Permit Located at 384 Osgood Street F-IRE DEPARTMENTTemp Dumpste,$onsite yes& Llocated atI 24',,Tajqreet r : j FireDepartment sign atureldatez , . i 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 2 1 A—F and G min.$100-$1000 fine NOTES and DATA— (For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 Location � �� AeAl No. 63zv Date a_ NORTH TOWN OF NORTH ANDOVER f �,y 9 Certificate of Occupancy $ �- -4 Building/Frame Permit Fee $ JgGMUs Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �_ Building Inspector STORAGE sEIEDS AND GAZEBOS New England Outdoor Wood Products JOSEPH BART LMA (978)689-4414 37'x4 Oakland'Ave. 1.800-6494549 Methuen,MA 01844 Fu:(978)681-8009 VINYL SHEDS Available in Chateau, Gambrel, Quaker and Delmar models 3 'A 4 • SPECIFICATIONS • • WALL HEIGHT: 6'3"on Chateau and Gambrel (TY optional). TY on Delmar model standard. • DOORS: 60"4 panel steel double doors,6"black decorative heavy "T" hinges,keyed "T" lock handle. • WINDOWS:Aluminum single hung window with screen. • (Larger Available) • WALLS:2"x4"kiln dried framing 16"on center. • SIDING: Walls sheathed with exterior plywood with low maintenance, durable vinyl siding. • ROOF: 2"x4" Roof Trusses 16" on center, 1/2" exterior grade plywood. 25 year self sealing shingles, (grey, black or brown) • FLOOR: 5/8" exterior plywood, 2"x4" Pressure Treated Floor Joists 16" on center(6' & 8' deep sheds). 2"x6" Pressure Treated Floor Joists on center(10', 12'& 14'deep sheds).(Larger Floor Joists Available) I TOWN OF NORTH ANDOVER-Building Demolition Affidavit NORTp Building Department ►° ti ' p 1600 Osgood Street * _ Building 20 Suite 2-36 North Andover MA 01845 s s Tel: (978)688-9545 Fax(978) 688-9542 ^cHu DATE: OWNERS NAME& ADDRESS C 2)ce Xl l k(�A CA`t1 A cO\j PROPERTY LOCATION 1 � DESCRIPTION CONTRACTORS NAME& ADDRESS DEPARTMENT SIGN-OFFS NO. ANDOVER HISTORICAL SOCIETY=DEMOLISHING 100 YRS OLD BLDG - ,30/03 - per MA- _c D.P.W./WATER SEWER GAS ELECTRIC TELEPHONE CABLE TAXES POLICE FIRE EXTERMINATOR DUMPSTER-ON/OFF STREET DIG SAFE NUMBER BULDING INPSECTOR DATE RECD %A TH '9 o" . 0 t 4Andover No. o ' dover, Mass., 2W • T Q LAKE COCHICMEWICK AERATED P`P \ �CC S BOARD OF HEALTH Food/Kitchen Septic System PERMIT .,, T D BUILDING.INSPECTOR THIS CERTIFIES THAT...... .... .. .................... .. .................................................. �..�� ..........,................�.�.�.�... ... Foundation has permission to ct........................................ buildings on ;Q........ �,.�.�. �......... ..... Ro h to be occupied as.. .. ,r!!►.f .o.to...... �..::::.::.: .. .. 41.1. . ... 1�.... N.....rmon .... d �� o. ... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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 MONTHS ELECTRICAL INSPECTOR. UNLESS CONSTRUCTIO STARTS Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. I F SEE REVERSE SIDE Smoke Det. NORTH TONM of : t itAndover No. x3 W!� o dover, Mass., • T 0 - LAKE COCKIC MEWICK y � ORATED P'Pa` 5 BOARD OF HEALTH PER IT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...... . .....to6. ...................V.......I�.�.M.�... ..... .................................................. Foundation has permission to ct........................................ buildings on lip........ �.�. . i ........�..... Ro h to be occupied as.: .. cm.014�......�. � RAIVII-1-d........... ...NOW....pA....��.t1�...f provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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 MONTHS ELECTRICAL INSPECTOR. UNLESS CONSTRUCTIO STARTS Rough ................... ..... .. ......... .........;....;.'--~:"--�................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. NEW ENGLAND DATE 5f 7-"nE� SHED# SIZE Az x IL — OUTDOOR WOOD ""�`'' x `°"°t" PRODUCTS MODEL: CHATEAU 13GAMBREL LlQUAKER 0 DELMAR 0 GAZEBO 37%Oakland Ave.,Methuen,MA 01844 SIDING: 0 PINE O CEDAR I1 VINYL (978)6894414 Shed Price s-4227.- 021d6- -4227. -02146-4 pC"79, Total Cost of options from below $ �� C_UMMER 1 FORMATION Sub Total $JAME Sales Tax $ 0 . ,TREET 110 1��.-gLf?i' }�Sr 30 pi Sub Total $ ;ITY , Aolpovtk-QMoving Charge $ *TATE A- ZIP Carrying Charge $ •TOME PHONE (976 ) p 37V -Z- Delivery Charge $ NORK PHONE (7U �) �d _�2.2-�0 Sub Total $ 30 3EMARKS Deposit $ Total Amount Due Upon Delivery $ OPTIONS SALES PERSON 2UANTITY j I VINYL SHED INFO ONLY: Door Exchange $ Siding Color: Louvres ($36 pair) $ Shutter Color: Ramp $ ROOF COLOR: O BLACK GREY O BROWW, Add 1'wail height(7'3°) $ PLACEMENT OF DOORS AND WINDOWS Window Exchange $ Pressure Treated Plywood $ l .� ��CLuP U ✓L $ 3�9 SIDE �Jd EI FRONT $ (Length) $ SPECIAL INSTRUCTIONS $ TOTAL COST OF OPTIONS $ sRAGE SEUM cAMMOS New,England Outdoor Wood Products JOSEPH BARTOL07TA ' .. (978)689.4414 37%Oa d=&Ave. 14800.649-4549 Methuen,MA 01844 Fiki:(978)68148009 VINYL SHEDS Available In Chateau, Gambrel and Delmar models gfgA SUP WOO2C-tRa90e ;L"y-4`l c }R tit I�t� u GT L I E i PAW vtNY� OUM a/W ---- G -_ fts�tF �` 6 t u � u�/tc9C,kiuEi NAw1Dt.E Ifo ms's;S a Cr2. TOWN OF NORTH`ANDOVER-Budmg Demolition Affidavit � '•ao � '` Building Department 1604.Osgood Strcet Building 20Suite 2=36 North Andover MA 01845 ►,��'b+,n, Tel: (178).688-9543: Fax(978)6889542 SwcNu� DATE N ,D SS PROPERTYLOCATION DESCRIPTION CONTRACTORS NAME a ADDRESS DEPARTMENT SIGN-gm NO.ANDOVER HISTORICAL SOCIETY-DEMpLISHING 100 YRS QLD BLDG Off,, 4� C8 D;�,WlWATER SEWER GAS _ ELECTRIC CABLE. TAXES POLICE. EXTERMINATOR DUMPSTER-ON/OFF STREET' DIG SAFE Nj j ER BULDnn IaSECTOR DATE RECD' MORTGAGE PLOT PLAN EK SURVEY INC. MORTGAGOR DEED REF. PG. 2�1— ADDRESS OF PRINCIPLE BUILDING PLAN REF. 40- i/t_ 1" 44kiw&p 54- DATE OF INSPECl10N jot6 ZZ IWq ��Zs roc- n ' pose- q �p^R W,0 Stko : n Z t2 �aY Mj4C.%Cu`AO -5 &-r I NOTE: This mortgage Inspectlon was prepared �v\� I FURTHER SATE THAT IN NY PRa-ESSIONAL Iy far mortgage purposes and b not too� T . CP'l410N the princl Ie structure/s and occossory be relied iled upon az a surveys EK SURVEY occ&pti RUDEL outbuilding,. $b,-r no respoculbitty for domages Ro 36W � with the eatbadc ►egnlroments of trio tocd nik�ncd by anyone other than the sod mortgog" F,. zoning ordinonoes, and that no endwoachm.nla and It3 assigns In connection w" Its proposed �� FCI RE a� of ma}or irn kecnonts ettt tra mortgaq• ftnonnlnq to said mortgagor. Jf�OM�S xOSJt property 11nes except on thoun. Y oorosti CERMCATION TO: Ill. Property Is hot to a Flood Hazard Moa, Tho cot Moation Is bovA on the IoccWon of sorwy maricera [32. Property Is In a Flood tta"d Area, of others, Wd d"3 not rc4xca.nt d property auricy, thorofaro 03. Itlfarmatlon Ia-huutQdent to �iatscmine Flood Hazard. Flood H=ard datetmined *Dm ttm kttost Fedord Flood off3atz shown aro not 16 bu tiaod for the %ximbliihment of The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 r' www.mass.gov/dia ' Workers'. Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print�eeibly Name(Business/Organization/Individual) t rt�n Address: .l\ a City/State/Zip: Cit Jn0( ( -I �3t(S Phone.#: 2)<i - 4 �- Are.you an employer?Check the appropriate box: 4. I am a general contractor and I Type of project(required): 1.❑ I am a employer with � ❑ g , employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a'sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling . ship and have no employees These sub-contractors have 8. ❑Demolition working forme in any capacity. employees and have workers' [No workers' comp.insurance comP• insurance$ 9• ❑Buildingaddition , required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3 I am a homeowner doingall work officers have exercised,their 11-[1 Plumbing repairs or additions myself. [No workers' comp, right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 11. 4Other?'e.O1f.�C( �let4(14 0 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 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 forof 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 coveraee verification I do hereby certify under the pains-and ofperjury that the information provided above is true and correct Sisnatur`e: Date k, �(' Phone#: -1-4 FOther se only. Do not write in this area, to be completed by city or town official own: Permit/License# uthority(circle one): of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector P erson: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provideworkers'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 apartments 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,bperae?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, §25CO)states"'Neither the commonwealth nor any of its political subdivisions shall enter into any contract fm 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-contractors)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 this 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 you are 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 that 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 sure to fill in the permit/license 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 peiinits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture i.e. a do license or permit to burn leaves etc. said person is NOT required to complete this affidavit. ( g P ) P q mP 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: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel.#617-727-4900 ext.406 or 1-877-MASSAFE ` Fax# 617-727-7749 Revised 11-.22-06 - www.mass_govldia + KoeTp TOWN OF NORTH ANDOVER ° 4"•" "� OFFICE OF 0. AAMMWA BUILDING DEPARTMENT + r : 1600 Osgood Street Building 20, Suite 2-36 North Andover,Massachusetts 01845 �SACMUS� Gerald A Brawn Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please P1 DATE: 0- JOB LOCATION: N, 0 C", r JP a Number Street Address Map/Lot HOMEOWNER q- a Name Home Phone Work Phone PRESENT MAILING ADDRESS I \ () M ar bl e_6-A S A- 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 s%mrvisor). State Building (Code gection 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which helshe 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,niles and regulations. The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department mininwm inspection procedures and requirements and that helshe will comply with said procedures and requirements. , HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAI. xavised 10.2005 Form Homaowmm EzwWdon BOARD OF \PPEALS 648-9541 CO.NSERVArION 638-9530 1IE.\LTH 698-9540 PLANNING 688-9535