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Home My WebLink AboutBuilding Permit #787-2017 - 120 CANDLESTICK ROAD 2/21/2017 r� ATOWN OF NORTH ANDOVER "'I APPLICA TION FOR PLAN EXAMINATION permit NO: '7 ? Date Received �' pate Issued: IlYIPORTANT:Applicant must complete all items Or this page o� 1 t ° LOCATION �, f �r .�. - PROPERTY OWNER Zr � i 'Z� Nr1�7 A a ��C� StfUCtLlfe �, 4 esu no ` '� PARCEL�� ONING DISTRICT- ZH�storic ®istnct �Y�� , � •..w3,�' .�..�aa«+ry�'•ne4'e**"'!�">v y..n�•-nr��a71+R�' ??S+��ye�1:r�, _� <_ �t.�...�. .;iT sash i^a.'»'yhw P. P TYPE OF IMPROVEMENT PROPOSEDUSE Non- Residential Reside tial ElNew Building ne family ❑Two or more family ❑ Industrial ❑Addition ❑ Commercial Others: Iteration No. of units: [i Repair, replacement ❑Assessory Bldg ❑ ❑ Demolttron ❑ Other . ❑Wetland_ ,s Q W t Septic Well ; .. Floodplain �_r , atershed.Distrtc ��.: --- - . .-..... ..... DESCRIPTION OF WORK TO BE PERFORMED: min le�AS�E Identification Please yp or Print Clearly) Phone: froom �yb� I OWNER: Name: Address: . . ... - _ .'CONTRACT R Name: �� .m °' - - 17 7 Supennsor's Construction License. �r. � t,, ,� ti ,.,g` f ._.' yr f F Ck r t }:T �f e2 orne.lmp_rovement License: . _ , - — ARCHITECT/ENGINEER Phone: Reg. No. Address: FEE SCHEDULE:BULDING PERMIT $12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER SF- FEE ,Total Project Cost: _FEE: $ /4- Receipt No.: 3 /S Check No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund :Signature of.Q eAt/.OW. a=.'. .. Sig aatu,re,.of:.contractor. :.. _ g _. _... Plan- Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ s v 'own of North Andover )ayment Date Tuesday,February 21,2017 )eposit Number 1702211 )perator Counter pc 1 ACR(BUILDING INSPECTION) $300.00 'otal Paid $300.00 a ;ash $300.00 { ;hange $0.00 i teceipt Number gov00005366 j :121/2017 9:23:09 AM Jame 120 CANDLESTICK RD-NO#787-2017 ;ashier Id. treasco11-17 v Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE:OF.SEWERAGE DISPOSAL Public Sewer ❑ Tannin Swimming Elg/Massage/Sody Art Pools❑... g 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—'D-)D\ 1) Si nature ` COMMENTS HEALTH Reviewed,on Sianature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments R Cq\ servation Decision: Comments Mtater & Sewer Connection/Signafiure Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE-DEPARTMENT -Temp Dumpster on site yes no Located at-124 Mair:Street Fire Deparfinerif signature/Mate i 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 El Notified for pickup - Date f Doc.Suilding Permit Revised 2010 1 Building Department Tine 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 V-1"IV:orkers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract 0/-If'10or Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit 1 Xddition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan E2 Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o 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 TOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit i 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 o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products IC�TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cas�:s if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apw,al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be- subm:tted with the building application Doc: Doc.Bui!ding Permit Revised 2012 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 253000.00 m $ - $ 300.00 Plumbing Fee $ 37.50 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 37.50 Total fees collected $ 475.00 120 Candelstick 787-2017 on 2/21/2017 partial basement finish NORTH Town of �. 6 ndover, �o h ver, Mass, J • ,2 / • ao 1 7 �/- COCNICNlWKK y1. S U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System _ THIS CERTIFIES THAT .......09.04!....... .............................................f�A /� �► /Yil . BUILDING INSPECTOR .... ..... . � Foundation has permission to erect .......................... buildings on .......�. .0..... �! ��.... ..�C>�.... Rough to be occupied as ........ 4,416 Jai /, ,,,,,.. ..d • ,,,, 1�!!i Chimney provided that the person accepting this permit 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 CONST..R. GN ST TS Rough #411 . 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. + T-- __�-_ - � -I- - � — { ...--i--._ ._a. _ .I_ _ `.. {_ ! ._ ;�. �.._ 1. _ _i_ _.. .�._ I. . - ---- -� .— � --- ii .......... T----------- ........... I i I 1--.-J I------ ---------- ---- ----------- .......... J va) i .,the Commonwealth o,f Massachusetts . '.F Department of IndustfialAccidents 1 Congress Sheet,Suite 100 _. Boston,HA 02114 2017 i q�< www mass.go P1dza WQ kers'Compensatioz�bsuraned A.ffidavzt:Buildexs/CGAU�HOR�Jy- czaxzsl Immbers. TO BE FUE D WUH'�PMM Please PrIIzt L I A l%cant formation afionJJndividual): C4 Go �l Name(Businesslozga= s'lco Address: e-r X Phone, u do City/State/Zip: �� Type.of project(xeq*eC Are you an employer?Check the appropriate box: . 'employees fulland/or parttime).` '1. El I�e�F co7�sf�'iictioll 1,Q I am a employer with. 2.❑1amasolepropzietororpa'f"hipandhayenoemployeesWorkingfoxmein 8. �Re717odeXiiig any capacity.[Novvorkers'comp.insurance required] 9. ❑Demolition e rkers'comp.insur'aucerequu:e10 CII El Building addition 3.Q I am ahomeownez doing all workmys lf.jNowo 4.f mahomeownerand will.behiring contractorstoconduct all work onmyproperty. IWill l 1.❑Electrical repair's or additions ensue that all contractm either have workers'compensation insurance or are sole 12 j 7.Plutrrb3lrg repairs o7:additions proprietors withno employees. L._t 5-1-1 I am a general eontmctor and Ihavo htredthe sub-contactors listed onthe attached sheet 13,.[]Roofrepairs These sub-contractorshave enrp].oyees andhaveworkers'comp.insorance. 14.M Other 6.F]W.are a corporation and ifs,officdm have exercisedtheirright of exemption per MGL c. 152,§1(4).ar4Y ehava no empldyees.[No workere comp.inswance required-I theirworkers'rompensationpoRoYiofounatia7m _ *.may apphcarrtthat checks box#1 must also fa out the sectionbelow showing contactors_ i Homeowners who strbmi., I a 'ha- indicatingthey are doing all work e name of tiie soba contractors and sfatewhtether or notthoseme�rc esh saeb tConiractom that check this boX must attached an additional shee-Vidt t ng cam policy number. employees. Ifthesub-conisactorshaveemployees,theymustprovidetheir workers' F P Y X am an employer that is p:+'oviding-tvork-'?S'compensation insurancefo�my employees. 8elo7v is tliepolicy crud job site info mation. Insurance CompauyNazne: Expiration.Date' Policy#or Self-ins.Lic.#:. Yttach a copy of the yvoxTrexs' cb Site Address: a On Pe�iC aZ _City/Mate/Zip: Nprk PTX 22= /AAI�yb omipensation policy declaration page(Showing the policy number and expiration date). Failure to secure coverage as required under MGL c.152,§25A is a criminal violation punishable by a foie up to$x,500.00 and/or one-year imprisonment,as well as civil penalties in the formto STOP TOP a O of Thu OR�.DEE ns of the DIA forfine oful� oinsuran 0 a day against the violator.A copy oftbis statement may be forward coverage verification. X do liere7�y certify uncle tliepains andpenal ofperjuly Mat the inforvneonp�ovzdedabove is txUe and corTec Date: Si ature: Phone#: official rise only. Do not Write in this area,to he completed by city or town official Permit/License# City or Town- issuing A-athoxdty(circle one): 1.Board ofealth. 2.Buildingpepartment 3.CitylTownl( Clerk d.Electrical Inspector 5.Plumbingxnspectox 6.Other Phone#- Contact Person• Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'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 d'efnibd 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 xeceivetbr,ttustee 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 employee, MGL chapter 152, §25C(6)also states that"every state or Iocal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the comm onwealtb for any applica)ttwho has not pre duced-acceptable evidence of compliance with the iasuxance coverage req&ed." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for 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 Pleasb fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),addresses)and phone number(s)along with their cerucate(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 may be 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-corkers' compensatioji policy,please call the Dopa-itmort at the number listed below. Self-fi=edcompaniesslamildenter their self-insurance license numb onthe appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legbly. The Department has provided a space at the bottom of the affidavit for you to£ill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the p ermit/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 stamp ed or marked by the city or town may be proved to idthe applicant as proof that a valid affidavit is on file for future permits 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 dog license or permit to burnt leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number_ The Commonwealth of Massachusetts Department of IndustrialAcoidents I Congress Street, Suite 1.00 Boston,MA 02114-2017 Tel_#617-727-4900 ext.7406 or 1-877-MASSAFE Fax# 617•-727.7749 Revised 02-23-15 wwwmags.gov/dna I, of NORry . TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT Main Street North Andover,Massachusetts 01845 CHus� Donald Belanger Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Building Permit Application Please print DATE: -a ( - �,-v i -7 JOB LOCATION: Number Street Address Map/Lot HOMEOWNER__q&_ I 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 of one or two family dwellings and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. 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 dwelling,attached or detached structures accessory to such use and/or farm structures.A ; person who constructs more than one home in a two-year period shall not be considered a homeowner. (780 CMR Section 110.R5.1.2) The undersigned"homeowner"assumes responsibility for compliance with 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 requirements and that he/she will comply with said procedures'and requirements. I <C::��, HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL G Revised 9/16 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535