The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #177 - 117 NUTMEG LANE 9/2/2009 BUILDING PERMITo� "o oTH 'qti TOWN OF NORTH ANDOVER - - - APPLICATION FOR PLAN EXAMINATIONoo 2 Permit NO: I�T Date Received 34"�A7eo•� c5 rr�� SSACHU5�� Date Issued: I//PORTANT:Applicant must complete all items on this page � LOCATION / f /V C� �,� '✓ /UO'� l '`� J�/0 ,/ �� PROPERTY OWNER P int C----- Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yesno d 0 -- 4 Machine Shop Village yes <Cno TYPE OF IMPROVEMENT PROPOSED USE Reside Non- Residential New Building One famil Addition I wo or more family Industrial! Alteratio No. of units: Commercial epair, replacement Assessory Bldg Others: Demolition Other Se ell Floodplain Wetlands Watershed District ater/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Identification P e se Type or Print Clearly) OWNER: Name: 4� ( Phone: Address: CONTRACTOR Name: ! � ' Phone: Address: ' P 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: $ !/-6)00 d CJ FEE: $ Check No.: (D 2 �S Receipt o.: 69 d-3 NOTE: Persons contracting with unregi tered contractors do not have access to the guaranty fund Signature of Agerit/Owner -Signature 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 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 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 ❑ Notified for pickup - Date Doc.Building Permit Revised 2009 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 PP 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:Building Permit Revised 2008 Location No. Date " 2 o �aRTM TOWN OF NORTH ANDOVER O L « Certificate of Occupancy $ s i � Building/Frame Permit Fee $ Foundation Permit Fee $ 1 Other Permit Fee $ TOTAL $ Check # 2 2" 6 4za--� Building Inspector NORTH 0 0 4Andover No. . I w ._ A o dover, Mass., ` d I� COC MICHEW ICK y1, 7�ADRATED P'P�� S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT.............. ... ............,....� ..v..ol....................................................................... Foundation has permission to ere ..................................... buildings on .J /';L.....�or� ..... ...................... Rough to be occupied as...... Chimney p ,C...... .....5.�i ............erim ,�r�.,, ............................I.... provided that the person accepting this permit shall in every respect cono a 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 SELECTRICAL INSPECTOR UNLESS CONSTRU TARS Rough ...... ... ......................................................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Omtpy 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 j Smoke Det. t _ 1Yte tbmrnon}, waft taf h!=achusetta' �`' J� DeP�merzt of industrial Accidents• J E ��e o„f Inro esiz,afions . tis 6 B Wasfiingti n Street Boston, MA 02111 r� Workers' Compensation Iasiu-ance nzdssgatrldia . A p o3icant Informationcivit~ Builders!Contractors/Eiectricians/Piambers Please Print Legibly Name (9usiness/org .d'on/Individual): ~ Address: �l /Lk' City/Staff/T.,iF; A14 Phone F. [NIo s employers Cheek.the appropriate-box: a employer with 4. ❑ I am a Type°f projex ( u gametal contr.wtor and I . yees(fun and/or pari time.* have- 6. ❑'Now construction . .sole ) I r-ed thesub-contractorsPraPn�cr Pager- on the attached sheet f 7. ❑Remodeiigg nd have no employtet;ng for me in st -eontractors have8. [j Demolition�3'capacity. work-== comp.insurance. orkers' come• iasiaattceS. ] We an-e a co oration and its 9• ❑Budding additionecd ofn"c= have exercised their 1 Q.E.Electrical homeowner doing all workri raPa�or additions myself[No•worki s'comp, �of exemption Per MOIL 1 I.[]plumbing insurance. e t 52, §1(41,and-we have no repairs or additions ted-].t. ,.employews:[No workaW 12.[]Raof repairs �P• insurance required_] 13.0.06= t may�piirsnt runt cheoiu;boa'#l meat dso IM out the rection below alto t fiomeoumras wbo aabtnit this ffwdavit indicating they an iQg rworkac'aompensatior,Poiny infnnnetioa 4Caaoactort that cheek this box reusr doing wos$'and the hiM outside conuactort most submit t Df a as atltL�tioas]ahecishowi:9.t�tmrrea ordm mb-cont�turs affidavit indim*such.' I�.iait a and ffgswyer tlta7 a'•oro�utg:worters• ter;-�e<zc�R »,..�.:,. irtfarfn = % �iisuraaceforfny�nA10ve� Below-ir gze Foamy and ysb sate . Insurance Cotnpany Name: Policy#or Sell`'-ins. Lie.#: Job Site I Address: Attach a copy of the workers''eom CttylS�te1Z�' peesation Policy declaration page(showiQg the POrIcy number and expitstioa date}. Failure to sema*e coverage as required undsr Section 25A of fine up to$'1,.50U 00 and/or one-year imprisonm C, c. 152 can lead to the imposition of criminal p-nai4es of a of up to 5250.00 a o as weal :}s eivtl penalties in the form of a STOP WORK OPD anal a fine EnvestSi _violator. Be advised tire[ a copy of this statement may be forwarded to the ptfi of gallons of the DIA,for insurance coverage vwffiza ice_ I do hereby cmafyfy < <.o tYim the lnfnrfnQ(aon yrnnided above is tree Si .. aonecL Date: (J Phone#: r OffCi&USe of ly. Do not.write in thea area to be C'nviete, hy aio or town ofidal City or Town: Permit/Licance Issuing Authority(circle one): I. Board of Seaith 2 Snifrling Departanent 3.Cih/Town Clerk E Other 4. Eiectrica[Inspector :S Pfnm6inQ firs pector Confect Person: Phone#: Information a gad Instructions Massachusetts General Laws chapter t S2 requires all emp 3 dyers to provide workers' compensation for their employees. Pursuant to this statrife,an eatplayee is defined as"..:every person in the s-tutee of another under any contract of hire, express or implied,oral or written:" ' f An em player is defined as"an individual partnership,amc:idiation, corporation or other Ito entity,or any two or more, of the'fomping engaged in a joint enterprise,and ii clud'r"g the saga!representatives of a deceased amployer,arthe receiver ortrinim•of an individual,partnership,essociatiain or other legal wtity,employing employees. 'Iiowevrathe ownc•of a dwelling house having not more than thrx opa_rtments and who resides thm min,or the,ocxupant of the dwelling house of another who employs persons to do m Limtm ace,constr<sction orresab wcirk ou such dweilinghouse or on the grounds or building appurtenant thereto shalt not b=ar=of such muployment be damned to be an employer." MGL chapter 152,§25C(6)also states that"every state o.ar kcal 6eensing agency shall withhold the ismanwor renewal of a license or permit to operate a business or im construct Milo n p in the commonwealth for any applicant who has riot prodoc ed acceptable evidence.oircompiSaom with the.iosaraoce coverage required." Additionally, MOL chapter 152,925C(7)status-Neither the commonwealth nor any of its political subdivisions shall enter into arty contract for the perfiorrrce of public woriie urm'1 acceptsiile evidencx of compliance with the ins�aancx requirements.of this chapter have been pro=ftd to the careering authority." Applicaota Please fill out the workers',compensation-affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-cosnractor(s)nme(s),address(es):azrid phony numbers)along with their=n ific (s)of insurance. Limited'Liability Companies (LLC)or Limited Liability Pwtnmsliips(LLP)with no employers otherthan the members or partners,are not rzqubnd1to carry workem cr rnpmsnfim insurance. !fan LLC or LLP does.have =ploy=,a policy is regi&e& Be advised first oris a.flide vit nsay be submitted to the Departaecrt of Industrial Accidzri s for couf mation of msur ice caversge. Also Efe sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the peirnit or license is being requestc notthe Department of Industrial Accidents. Should you have any questionsregarding the law or if you are required to obtain a workers' oon}pensation policy,pleat-can the Department atthe-nuMber.listed below. Self-insured companies should or=their ssifirrsrzaancc license aurrrii-r an t6c"Mrophift ii= City or Town Officials Piease be sure that the affidavit is complete and printed bglbly. The Department hes provided a space at the bouarn of the affidavit for yon 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/licanse number which w-ill be used as a reference number. In addition,an applicant that must submit multiple PermWhc'ense applications in any given year,need only submit one affidavit indicating-current policy'inf xmsfion(if necmssary)and under"Job Site Address"th-_applicant shouldwrsta"all locations in (city or town)."A copy of-the affidavit that has bean_officially stmmped or marked by the city or town may be provided to the applicant as prrjof that a valid aifidavrt is on file for futmz permits or licenses. A new affidavit must be taped out each ere year. Wha home owner or citizen is obtaining a li=nse: or permit not elated to any business or commercial wittier (i.e. a dog license or permit to bum leaves etc.)said Person is NOT_rrqufred to compieto this affidavit. The Office of Investi.0ons would lice to thank you in advance for your cooperation and should you have any questions, please do not.hesitate to give us a call 'Ile.Departrnmrt's address,telephane and fax number: The Commonwealth of Massachusetts IDcpartrnant of Tmdustiial Accidents Mee of Lnvesti;shoos 600 Washington Street Bosfon, MA 02111 TeL 4 617-727-4900 i=406 or 1-9.77-MASSAF£ Fax?&r61 7-727-7744 Revised 5-2b-45 www.m2&S.gov{tea p NORTH TOWN OF NORTH ANDOVER 9 ots"co °�ati°� OFFICE OF ° p BUILDING DEPARTMENT ,4* 1600 Osgood Street Building 20, Suite 2-36 °..",r.o 11A North Andover,Massachusetts 01845 SSS 9CHUSE� Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please print DATE: JOB LOCATION: 112 Number Street Address Map/Lot 6 �116HOMEOWNER � /� �� l ��l�O 3 'OtY67 � Name Home Phone Work Phone PRESENT MAILING ADDRESS 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 (Code Section 108.3.5.1) DEFINITION 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 he/she understands the Town of North Andover Building Department minimum inspection procedures and requirementsZat /she wil o ly with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535