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Home My WebLink AboutBuilding Permit #268 - 1248 SALEM STREET 10/11/2007 yORTh BUILDING PERMIT °�tt``° TOWN OF NORTH ANDOVER ? APPLICATION FOR PLAN EXAMINATION 0 'Ile Permit NO: Date Received ��SSACHUS Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION liqy . - Print , PROPERTY OWNER "'scVi, Print MAP N0. PARCEL: ZONING DISTRICT: Historic District yes 0 Machine Shop Village yes ' TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One fame Addition Two or more family industrial Alteration No. of units: Commercial epair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: S:A%�� c,.J w� I f Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: i t`t CONTRACTOR Name: 3} �� +�� t 4�- Phone: �o W 3 3 Lt i t Address: S ��^ ; iy� ta Superviso,r's Construction License: ° S. T q 3 Exp.. Date: Horne Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BAS D ON$125.00 PER S.F. Total Project Cost: $ i 2-r ooz _ FEE: $ Check No.: Idgr' Receipt No.: 'qa(3S-- NOTE: Persons contracting with unregistered contractors do.not have access t the gu ty nd -m — - -- -- - - ' - f+ Signature of Agent/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 DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature 8, Date Driveway Permit Located at 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster-on site yes no Located at 124i Main Street fire Department signature/dater 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 2007 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 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Location No. Date NaRTM TOWN OF NORTH ANDOVER 3?0�,(`•o •,�oL i 7 • Certificate of Occupancy $ JwCMUs<� Building/Frame Permit Fee $ Foundation Permit Fee $. Other Permit Fee $ TOTAL $ Check #rr wilding Inspector �oRT„ TOWN OF NORTH ANDOVER :°,�;`'" ;•.'foo OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 North Andover,Massachusetts 01845 1sswc►�us�� Telephone(978)688-9545 Gerald A.Brown Fax (978)688-9542 Inspector of Buildings HOMEOWNER LICENSE EXEMPTION Please DATE: C 1 t •v� JOB LOCATION: 11-`1 I' Number Street Address Map/lxt HOMEOWNER i�r�. C 0,81 �; °tI< (-E'S. 93 Name Home Phone Work Phone PRESENT MAILING ADDRESS 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 SeWon 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 requirements and that helshe will comply with said procedures and requirements. HOMEOWNERS SIGNATURE n APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homeowners Exemption iROARD OF 1PPE:\I.S(M-95=11 CONSERVArt l\648-9530 ITEALTH 688-9540 PL.LVVI`G 688-9535 NORT1, _ -Town of over 0 No. $, o dover Mass. o _ �A p/b �— I� COCNICMEWICK ADRATE D `r BOARD OF HEALTH Food/Kitchen PERMITI- T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...... . ..... .................Z-4..... . ...q .. ................................................................ Foundation has permission to erect....,.. . .......................... buildings on ..(.� Rough Chimney provided that the personaccept! Final be occupied as......wswn .... x......00.� i ..... is permit shall in eve ryres ect cnfor to �tes he 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 ONTHS ELECTRICAL INSPECTOR UNLESS CONSTR TS Rough ..... ..... Service BUILDING INSP OR Final Occupancy Permit Required to Ocaipy Building GAS INSPECTOR Rough Display in a Conspicuous Place o^n the Premises — Do Not Remove Final No Lathing or D' 7 Wall To Be Dobe FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. t';, � ✓/ie �o�.ninzo�uUea/�L a�✓�ac�ivantt BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 005743 i Birthdate: 03/26/1954 Expires: 03/26/2008 Tr.no: 19521 Restricted: 00 DAVID J DEVELLIS 198 MAINST SANDOWN, NH 03873 commissioner I i i 'i DEmius chmpamy 198 Mail) 'St"mat Sanu'cswn, Nrit PROPOSAL 7—7�=_-�77 PROZPOSA� U?,,,VED AT- WORK F0 BF.' pEr-IF TEe- UF PLA-Nc M1 HITF07., ............. p"opOsp!(I%1'r1ish t1le ,.ii; I ------�___A DFOorrn, thc-fabor necer,-,- a7y -C'(F—LA-144- L —--------- ---------- imaleria! isgus4, ....... aritee'd to M,,jnr,,jr fc, WOrk and c lrn;3�eted i�, a ;5Ubsiantial ar-,Cordance 'Ni fh��, dOove worst to Le per-f(I r the Surr, Vvilh jo 0 Ye U�S frAII)VVS 70 Ptnpecrwy suhmirip-j ____-_..�_-.—_..__-._._ Thi-,ProPrj:ahre',,be Vvi'I'dawnby Ug if rot above ACCBF'_VANCF OF PROPOSAL We W3taptory an7 . r`?!,e1B1) RccP1e , Y, are 0cka"101"e m4 t � 4twG( as$PecffiW. Payvj,.et)15 CIA ------- The Commonwealth of Massachusetts --- Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): DAP .4 S( 4 Address: t of V M 01;A i City/State/Zip: SC-^Jl z,w,A A/ lk U 3k}3phone #: .,3 Cit, l L Are you an employer? Check the appropriate box: Type of project(required): L❑ I a employer with 4. El am a general contractor and I pi ye es(full and/or part-time).* have hired the sub-contractors 6. E] New construction 2. 1 am a sole proprietor or partner- listed on the attached sheet. 1 7. ® Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. 9. (� Building addition ❑ We are a corporation and its required.] officers have exercised their 10.E] Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §](4),and we have no 12.0 Roof repairs insurance required.] f employees. [No workers' comp. insurance required.] l3.❑ Other *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 required under 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-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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cceertt fy under t pas an enald s of pe at the information provided above is true, d correct Signature Phone#: 0 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#: