The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #718 - 123 BRENTWOOD CIRCLE 6/23/2009 BUILDING PERMITa� V1oRTry qti TOWN OF NORTH ANDOVER 3 4....� 0 APPLICATION FOR PLAN EXAMINATION �o e« Permit N0: Date Received 01 Date Issued: �� SSACHU`S�t�h IMPORTANT: Applicant must complete all items on this page - s �frwu„ LOCATION I I a Jr . F � � ff PROPERTY OWNER '�?rlin/x' y r _ zz ti r ., � PARCEL � ;Print �. } .� ter f - MAP NO ZONING DISTRICT Historic Distract �' x :-7c 17fi� dyes .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 Septic V11ell } ' Floodplain ' Wetl'andseJ Watershed District 3 "Water/Sewer . DESCRIPTION OF WORK TO BE PREFORMED: �� `1 Q l/�� `1—��`.�� /•,J��t,�1_�3i/.,sew/� r Identification Please Type or Print Clearly) OWNER: Name: 1(6c_L�1-,A_ Phone:?710 Address: 17 7 / 341. ..YC �"`�� N, 'Ye �, ..r •' �' f � � �^ �,� �f-` a��:Ar e s T4s n z -t �'r� J �'rtq"c. 'L �# CONTRACTOR Name � � � a' Phone -. n ,.. > �+ ! d _ 4 W Supervisor's*Construe idh License u xp - Home ImprovemenblAdense � � y - :Date y,h ARCHITECT/ENGINEER Phone: Address; N 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: $ � FEE: $ A �— Check No.: ? Receipt No.: l NOTE: Persons contra 'ng w'h unregistered contractors do not have access to the guaranty fund $w9nat _reof A.g . : �. n__.'dw o rac Location -� Date No. MORTM TOWN OF NORTH ANDOVER F • .d�� Certificate of Occupancy $ --- } Per Foundation Fee $ 0— b�•..o Building/Frame Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2 i Building Inspector 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 Siqnature COMMENTS Q HEALTH Reviewed on Signature COMMENTS i 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 DPW Town Engineer: Signature: Located 384 Osgood Street FIRE aDEfPARTMEIVT,F p Ternp4Durnster on situ yes ,W no 'Y' Fsatedat,��4"MdinStreet�„ ,ate c � - ire Department signatyx ure/datek , .. � :r.,Jy.-µ .;+.:.¢ x- ..�.�� ,,:..�'�*r_ «��',-�5�fi+�..� er -,� .�,m.�-i.—,-,€re � ...x,�c.a,., Y:�..Y .� .✓s +t� Dimension ' -Number of Stories: Total square feet of floor area, 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 2008 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 U 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 o 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 Dor.INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 NORT#q ® of 4Andover . 0 No. 7/1 * - =_ y z dover, mass., % • T Q = LAKE COCMICKEWICK V 7� 0RATED PPS\ �C:) BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT..... ......................... .................................... ................................ Foundation has permission to erect........... ........ buildings on 123..........06 .•7A.j.I.d.OCKS................. Rough to be occupied as. .� ..... ......../ 1 I..! +.iN..Z�..J.. .......................... himn y C e provided that the person accepting this permit shall in every respnform 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 CONSTRU N TARTS 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. The Commanwea&k of Mwachuse&s ' Department of Industrial Accidents j i rJ Dice of Investigations it 600 TT ashington Street Boston, MA 02111 r , WwI<4-mus-govIdia Workers' Campeneation Insiuranee Affidavit: BuildeorsiectriciaQslPiamb A p licant Information. rslContracf /Eers Please Print LeQibi Nagle(Business/DWirdlion/individual): J�J --------------- Address: C Lf,,T,1;y. City/State/ ' � . Phone#: . 70 ------------- j Are you sn employer?Citeck.the appropriate boz: 1.❑ I am a employer with 4. ❑ 1 am a general contractor and I Type of Prelim(required): 2.Qemployees(full and/or part-time).* have hired the sttb-contractors 6.. ❑.New construction . I am-a-sole proprietor.or partner- listed on the attached sheet.I 7. ❑Remodeling ship and have no employees These sul�-eontractors have working for me in any opacity. workers' comp.insurance. 8. Q Demolition [No workers'comp.insurarsce.. 5• ❑ We are a corporation and its 9• Q Building addition tluired.] officers have exercised their 10.0 Electrical repairs or additions 3 a homeowner doing all work right of eXem 'on M self 'a P e n 11.�] Plumbing repairs or additions my [No-workers' comp. rw 152, §1(4),and we have no . insurance required.].t emplayees.[No workers' 12.Q Roof repairs comp• insurance required_] 13.❑.Oth Tiny applicant Bret Necks bozo#I must also fill out the Section below showing their workers''oom T Iiomeown=who scbmtt this affiUavit irulim n theyam doingan pensetion policy infonnation. $Contractors that cheek this box must woig end than hire outside contractors must submit anew affidavit indi ectecbed an add.�tioas]sheat showi-eg•the name of the sub-contmctm and their workers•ccr••_ rim••eat such !ass an ew oyer teat is n? po ;in&MWan. �► ,vufurg:workers compensatfor7 baunwee or iRformaf�nrt .� m}'employees: E,elow is thePolJey midjob site _ Insurance Company Name: Policy#or Self-ins Lie.#: Expiration Bate: Job Site Address: City/state/Zip. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration dasge Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal fine up to$1.50UO and/or one-year imprisonment;as well tis civil Penalties of a penalties Of to in the fo $250.0 P rm of a up 0 a STO day against the violator. Be advised that a copy.of this statement may be forwarded t�QRDER and a fine Investigations of the DIA for insurance coverage verification. Office of I do hereby c u r the p pen /Parju y that the information provided above is tree and cornet Si ttge. Phone#: 79 6A00"'112y Date: Ea only, Do not write in this area,m be completed by rsiy or town official wer. Permit/License# thority(circle one): Health 2- Building Department 3.City/Town•Clerk 4. Electrical Inspector 5. Pluinbin Insg pector son• Phone#: Information a nd Instructions Massachusetts General Laws chapter 1 S2 requires all emp f oyers 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 defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of thelbre in engaged in a joint en rise and includi go g gag } terp s-ig the legal representatives of a deceased employer,6r the receiver or trustee of an individual,partnership,associatioin 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 maimtmumce,construction or repair work m such dwelling house or on the grounds or building appurtenant thereto shaU not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local ficensiug agency shall withhold the issuance or renewal of license or permit to operate a business or tte construct buildingsin the commonwealth for any y applicant who has not produced acceptable evidence•oir compliance with the insurance'coverage requirred" Additionally, MOL chapter I S2,§25C(7)states"Neither tie commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until-acceptable evidence of compliancx with the insurance. requirements of this chapter have been presented to the corttrac mg authority." Applicants Please fill out the workers'.compensation.affidavit compl4mtely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es):a.1nd 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 orpertners,an not requiredito carr workers'ccirnpensation 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 'Che affidavit should be returned w the city or town that the.application for.the permit or license is being requested,notth Department of Industrial Accidents. Should you have any.questions regasding the law or if you are required to obtain a workers' compensation policy,please call the Department at the nurarber listed below, Self-insured companies sherrle enter their self-insurance•license number on the•appropiiate 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 thea-event the.Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/Iiceme number which%%-ill 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 be=Pfficiaily stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for fdure permits or licenses. A new affidavit must be filled out each year. When a home owner or citizen is obtaining a license or permitnot related to any business or commercial venture (Le, a dog license or permit to bum leaves etc.)said parson is NOT.required to complete this affidavit The Office of lnvekimations would Ince 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 Lnvestti -tions 600 Washington Street Bosfvn, IIIA 02111 TeL#617-7274900 ext 406 or 1-8.77-MASSAFE Fax#617-727-7744 Revised 5-2645 www.mem.gov/dia NORTH TOWN OF NORTH AND or •:'- �� OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 North Andover,Massachusetts 01845 SSACMUs�t Gerald A Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE: JOB LOCATION: Number Street Addrew HOMEOWNER 7e rG J1,r., 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 Persons)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 be considered a homeowner. home in a two-year period shall not The undersigned homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. ne undersigned"homeowner"certifies that Wshe understands the Town of North Andover Building Department mrnrmum inspection procedures and requirements and thatrequirments. she will c0mP1y with said procedures and HOMEOWNERS SIGNATURE 4 -------------- APPROVAL OF BUILDING OFFICIAL Revises 10.2005 Form Homww wn Eum m f O. RD OF 1PPE.\[.S FVK 9541 Cc)�CER�.1'Iin\♦.,RR-9530 [ iE.1L'Tfi 688-954()954Q PI_,�\,N[NG 0!8-9535