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Home My WebLink AboutBuilding Permit #621-13 - 115 JOHNNY CAKE STREET 3/25/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: a 1 Date Received Date Issued: �IP-ORTAANT: A plicant must complete all items on this page LOCATION, 5 0 , <3� n -e Prit PROPERTY OWNER Print loo Year Old Structure yes no MAP NO' �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 El Two or more family El Industrial El Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District o Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Cs - Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: Phone: E ss: visor's Construction License: Exp. Date: 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: $�,c ,'— FEE: '�.-- Receipt � Check No.: t No.: p NOTE: Persons contracting wiJkwnregistered contractors do not have access to the guaranty fund Signature of Agent/Owne Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ 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 CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS c I 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 Tow2 Engineer: Signature: Located 384 Osgood Street TIRE`DEPARTMfVT - Temp Dumpster on site yes no Located at 124 Main Street Fire Departmer't 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— (Foto department use El Notified for pickup - Date i Doc.Building Permit Revised 2010 Building Department The foliowing 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 a 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 o 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) o 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) ❑ Building Permit Application o Certified Proposed Plot Plan Li 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 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 app;-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Bui?ding Permit Revised 2012 Locationkt— rOh q�m r /�- No. Date FL ' TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee i Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check 26226, Building Inspector Enter construction cost for fee*cal - North Andover Fee Cakulation Construction Cost $ 129000.00 m $ - $ 144.00 Plumbing Fee $ 18.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 18.00 Total fees collected $ 280.00 115 Johnny Cake Street 621-13 on 3/25/13. Remodel Master Bath 3� �'aRr atio TOWN OF NNORTH ANDOVER o uo D bbd �r ° OFFICE OF BUILDING DEPARTMENT ` Re Osgood Street Building 20, -Suite 2-36 North Andover,Massachusetts 01845 A�Htls - Gerald A.Brown Telephone(978}688-9545 Inspector of Buildings Fax (978)688-9542 tf HOMEOWNER-LICENSE EXEMPTION - BUMING PERMIT APPLICATION Please print DATE: 3L/t JOB LOCATION: Number S e't ddress ` • - Map/Lot 1JOMEOWNER Name Home Phon WorkPhone PRESENT MAILING ADDRESS . C City Tod*m ` S4'a�w' Zip Code The current exemption for"homeowners"was extended to hnclude owner-occupied dwellings to two units or less and to allow su;h homeovi.mers to engage an individual•for hire who cioes not possess a license,provided That the owner acts as supervisor). State Building (Code Section I08.3.5.1) DEFINITION OF HOMEOWNER Person(s)who Qwns 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 farm- ly structures. A person who constructs more that one home in a two-yeazperi 'd 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 Wrequirend that he/she will comply with,said procedures and requirements, HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption • 4 BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 The Commonwealth of Massachusetts - Department of IndustrialAccidints Office of Investigations IF 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers lease Print ibl Applicant Information Name(Business/organization/fndividual): Address: City/State/Zip: rV, 4� 4— 4, 01 1 Phone#: ��`� � �� Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6_ E]Nc nstruction employees(full and/or part-time).* have hired the sub-contractors7. emodeling t the attached sheet on . 2.❑ I am a sole proprietor or partner- listedDemolition ship and'have no employees These sub-contractors have 8• ❑ working for me in any capacity. workers'comp.insurance. g• 0Building addition [No workers' comp.insurance 5• ❑ We are a corporation and its 10.El Electrical repairs or additions required.] officers have exercised their 1LE]Plumbing repairs or additions 3. right of exemptioner MGL §I am a homeowner doing all work g myself. [No workers'comp. C. 152, 1(4),and we have no 12•[]Roof repairs insurance required.]t employees.[No workers' 13.0 Other 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 their workers'comp.policy information. 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 requiredunder 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=yearimprisonment,dvised that a copy of this statement may be forwarded the form of a STOP. Otothe �oe of d a fine of up to$250.00 a day against the violator. a Investigations of the DIA for insurance coverage verification. I do hereby certi h ins and penalties of perjury that the information provided above is true and correct. Date: L Si ature. Phone t7 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.Other Contact Person: Phone#: Ir 1 NORTH . ver O No. * - �I '� Z h i ver, Mass, COCHICNl.;.CM AERATED S u BOARD OF HEALTH Food/Kitchen PERMIT T L D Septic System THIS CERTIFIES THAT ................ ..�? ......:..�n...2.1 .1..sr4.. :.<n.S: .................................. BUILDING INSPECTOR ^ 1 Foundation has permission to erect .......................... buildings on ....�.1..�........ N:�..�: .K-� �• .......................... Rough to be occupied as ......� ...../�-�Y..KQv`..:`.:.:�.-�:. .: ..ti�Anl:1�.,. ..................................... chimney provided that the person accepting this permit shall in eve res conform to the terms of thea lication p p p g p every p pp 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ATS Rough Service ......... .. ....................................... Final BUILDING INSPECTOR 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. SEE REVERSE SIDE