HomeMy WebLinkAboutBuilding Permit #068-16 - 12 ELLIS STREET 7/15/2015 NORTH 1
BUILDING PERMIT �a°.<r`',°.;6•�oG
L TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMIN IP8 1—
ermit NO: Date Received °,,��Kp�. '
Date Issued: ��
�Rss•�c►+us
IMPORTANT: Applicant must complete all items on this page
LOCATION
Print
PROPERTY OWNER 1�3, cg-t N W t l_SoKl
Print
MAP NO: �PARCELb)2-5 ZONING DISTRICT: C, Historic District yes no
Machine Shop Village yes o
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building ❑ One family
0 Addition ❑ Two or more family : Industrial
D Alteration No. of units: C Commercial
:1 Repair, replacement ❑Assessory Bldg Li Others:
0 Demolition Other CG.Ra7.l Z ooL
0 Septic 0 Well ❑ Floodplain 0 Wetlands 0 Watershed District
❑Water/Sewer
1�sTA�t.taT�otJ of vjaw 2A' 2,A met re-r2 54" N s6 N A-E>ovE,
CLou too �oo�
Identi cation Please Type or Print Clearly)
lt ,J
OWNER: Name: ��¢-R-`� � Phone: �i�( 8 - 8'S"T ► I�3
Address: 2 e t,t-1 S S'Tt2ee-l'
CONTRACTOR Name: 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 qOST Bg ON$125.00 PER S.F.
Total Project Cost: $ � d C� FEE: $ `
Check No.: Receipt No.: t1
NOTE: Persons contrctin with unregistere ntractors do not have access to the guaranty fund j
of Ag
xig1natureent/O Oture of contractor
i
Location Z 1 is ST
No. Date
. - TOWN OF NORTH ANDOVER
r . Certificate of Occupancy $
- Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check# �
Building Inspector
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Taming/Massage/Body Art ❑ Swunming 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 m U FORM
PLANNING & DEVELOPME Reviewed On Signature_
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
Wafter& Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIREDEPARaMENiT{ TempDumpster on suer ,yesY>
} LocatQ jdt�124 Main Street
,F +r +�
Fi :
re�Department. ignature/date z �.
COMIVIEIVTS; T r �
�I
Dimension
I
Number of Stories: Total square feet of floor area, based on Exterior dimensions. i
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.$10041000 fine
I
NOTES and DATA— (For department use)
�
i
® Notified for pickup Call Email
Date Time Contact Name
Doc.Building Permit Revised 2014
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
i
Roofing, Siding, Interior Rehabilitation Permits
Building Permit Application
Workers Comp Affidavit
Photo Copy Of H.I.C. And/Or C.S.L. Licenses
4, Copy of Contract
Floor Plan Or Proposed Interior Work
Engineering Affidavits for Engineered products
OTE: 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
16 Photo Copy of H.I.C. And C.S.L. Licenses
4, Copy Of Contract
Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
4, Mass check Energy Compliance Report (If Applicable)
Engineering Affidavits for Engineered products
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
4, Building Permit Application
a 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
2012 IECC Energy code
Engineering Affidavits for Engineered products
OTE: 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
° No RTN a TOWN OF NORTH ANDOVER
OFFICE OF
A BUILDING DEPARTMENT
1600 Osgood Street Building 20, Suite 2-36
North Andover,Massachusetts 01845
SS4CNUSti
Gerald A.Brown Telephone(978)688-9545
Inspector of Buildings Fax (978)688-9542
HOMEOWNER LICENSE EXEMPTION
Please print
DATE: -717 I 1 S
JOB LOCATION: S-T 2C'E'T
Number Street Address Map/Lot
HOMEOWNER �gj u W,�SnO ci7$- -19
Nam6 Home Phone Work Phone
j
PRESENT MAILING ADDRESS 12 C-LA� 5 STS—(
a1R-'(l�t N SO L f\A I't 0( 9 '4!S
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.
j 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 require ents and that he/she will comply with said procedures and
requirements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Revised 10.2005
Form Homeowners Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
I
MORTGAGE INSPECTION PIAN
BOSTON
SURVEY, INC. 08-06125
P.O.Box 290220 Charlestown,MA 02129
(617) 242-1313 MAIN (617) 242-1616 FAX
APPLICANT: WILSON DEED/CERT: 4056-214
LOCATION: 12 ELLIS STREET PLAN REF: 10816
SCALE: finch=30 feet
CITY, STATE: NORTH ANDOVER,MA PREPARED: 09-17-2008
CERTIFIED TO: MORTGAGE SERVICE CENTER
6' WOOD
4' CHAIN FENCE
LI K FENCE
0'-0"
6'WOOD IN.
OT B 500+1-SF
FENCE
LOCATION OF NEW 21'
DIA. X 54" HIGH POOL
DECK n
ri
X12 6'WOOD
FENCE
6'WOOD FENCE GARAGE 1.5 STORY 1
W/LOCKABLE t UP
GATE t
. 42" PVC F;
ELLIS STREET RAILING AND
ACCESS EASEMENT GATE
ABOVE GROUND POOL LOCATION PLAN
1994(c)Boston Survey Software
'tX UF R4
The permanent structures are approximately located on the �r�-t _ yC According to Federal Emergency%4anagement Agency
ground as shown.They either conformed to the setback �G $ [.he ma or improvements on this o all in an
iZ) requirements of the local zoning ordinances in effect at .� GEORGE BPS, 1 property
WOO R the time of construction,or are exempt from violation cis C• N ' o designated as Zone. C,
FC enforcement action under M.G.L.Title VII,Chapter 40A, COLLWS �, mmunity Panel No. Z;500�r �- loco C
Section 7,and that there are no encroachments of major ,Q No.41784 1
z —1 Effective Date: r
o �P� c<p X improvements either way across property lines except as l9 9 -StOr O� ,
< o D shown and noted hereon. tf TE:Zone C is areas o! .inimal flooding(no shading).
0 r oI SU RV This designation is not based on an elevation certificate.
m n z NOTE:This is not a boundary or title insurance survey This Ria +ras prepared�*n accordance to procedural and technical standards for Mortgage Loan Inspections as adopted
5 n by the Massachusetts Board of Registration of protessionaf a 3;nee:s and land surveyors.250 CMR 6.05,and use for any other purpose is prohibited.This plan is not to be
up 0 O �� used for recording,preparing deed descriptions,or tonsir,, iron,
0,5,GS F T y0
L J
l^J T MO. O O . I �CzDp�zo 7 Z r0
G) Z uC " I -mX
O y .20 = %o
3 tO D0u0 6 Z r
IT1 z Z M Z
O m _
D t� 3 ��mc>1m� r 0 �O
—� C y = °mA5c,g -� = N TJ :t7 �' r-- n
O Z 0 + Z��ooZD z D m —� M z M z_ -+
I m-imi�tm0 -� Z r go = N =D N
�Z I<
TI `.` A='0mo; cn O r 0 Z rm- � go Z 11
V I �mmmm�-{ Fn 0
D O 3 m�Zrznmt7 —� ZP055;011) M CA Z p tb M m l
U)(n Z xl
Zr MCI)
A� - m m oM 4y�
' DO
mCOOr-`G M cn O
I O > r Do
00OO�D
o0 EDA� m o O D O
t� Fa r— o id0z
I Z r
cn 0 A �
r , NORTH
_ E 1c . . ve" .
O ..
: -
No. � a * T � Tu'J _
y �5 2d 5
o�h ver, Mass,
CO[HIC"IWICH y1'
��AERATED I'Pa,`�5
S ll
BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
'!)� 6 '� �')
BUILDING INSPECTOR
THISCERTIFIES THAT ........ g,.... .......................................11..................................................
fkhas permission to erect buildings on .. � l`i`� ems+ Foundation
p ...... Rough
to be occupied as ....... ............ .�!"^
. - ..... ?................................................................. Chimney
provided that the person accepting thisermit shall in every respect conform to the terms of the application 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 CONSTRU 10 STAR Rough
Service
........................ ................................................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building 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.
The Commonwealth of Massachusetts
Department of Industrial Accidents
0 1 Congress Street, Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): r lE�' t1gp�
Address: (Z_ eA k.A S S'f
City/State/Zip: PoV TLA ANkUVEK MA OIMSPhone#: 91 $- RS-7 -11 y�
Are you an employer?Check the appropriate box: Type of project(required):
1.❑I am a employer with employees(full and/or part-time).* 7. ❑New construction
2.❑I am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling
any capacity.[No workers'comp.insurance required.]
9. ❑Demolition
3.F1 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
10❑Building addition
4I am a homeowner and-will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole It. Electrical repairs or additions
proprietors with no employees.
12.Q Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs
These sub-contractors have employees and have workers'comp.insurance.t
6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[ Othez' i!-g� (Lq,LO.lb
152,§1(4),and we have no employees.[No workers'comp.insurance required.] (�00�►
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
I 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.
Iain 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.Lie.#: 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 MGL c. 1.52,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage ve ' cation.
I do her y cer y under the pains and per altie. perjury that the information provided above is true and correct.
Si nature: Date: 77 110115
Phone#: 1 — ( L
Official use only. Do not write in this area,to be completed by city or tows:official.
City or Town: Permit/License#
Issuing Authority(circle one): ;
1.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#: