Loading...
HomeMy WebLinkAboutBuilding Permit #757 - 125 BOSTON STREET 5/26/2010 i "°pT" BUILDING PERMIT °< qti TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: /S 7 Date Received '� � e ed 3 �q,T.o 9SSACHUS�� Date Issued: F IMPORTANT:Applicant must complete all items on this page gg LOCATION r k - ! PROPERTY©INNER //" �°' ng x �-r a ga MAPa21 PARCEL ON1NG DIS`RICT xH storac IS rice des Q - _ IVlach�rie Slap V�lla�eu es ne 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 + Septac ry� Weil �Icaod;plan 1/1etlands Watershed District \N�terlewer r DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name:�i�f�/�� Phone: Address: CONTRACTOR Ia-Mr71 h Pl�onev a - Address Y Sup rv�sors Cnnsttuction ddense" ` Exp.4.Da#e� Home,m,p bverraent)_icense: Exp Oahe.. t ..: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PE ITko-Z) $12. I //00 PER$10,00.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: � / Q 7 4 1 �� 2 Receipt �r2 NOTE: Persons contracting with unregistered c0r tractors do not have access to the guaranty fund Signature'of A ent/Owrer - 9 _ _ _ gnat We of contractor Location No. Date NORTH TOWN OF NORTH ANDOVER � 9 ` Certificate of Occupancy $ _ �'�s',••°'t<� Building/Frame Permit Fee $ G` ncMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �✓ L��� F � f i'0 232 Building Inspector t 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 f COMMENTS I CONSERVATION Reviewed on Signature COMMENTS i 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 F1RE'DEPART,MENT��=Temp Dempster on siie:y yes no „. Located at 124M nrfStreet - Frre Departme-.ntnsi"gnature/slate . .., , COMME.NTS i 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) 1 ❑ Notified for pickup - Date Doc.Building Permit Revised 2010 I 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 ❑ 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) E ❑ 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 I ❑ 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 orspecial 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 NORTH TOWN OF NORTH ANDOVER 0. OFFICE OF BUILDING DEPARTMENT =o504 e�* 1600 Osgood Street Building 20, Suite 2-36 �4`°q,.�o•4°"cy North Andover,Massachusetts 01845 �SSACHUS�i .. Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978) 688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please print DATE: 5' JOB LOCATION: Number Street Address Map/Lot IJOMEOWNER��// 94,e 0 Tf 05�rj5;5'�ZcFC Name Home Phone Work Phone PRESENT MAILING ADDRESS 1��" / Xttr - 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 requirements and that he/she will comply with said procedures and requirements. _/"! e :� 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 The Commonwe¢ Ith of Massachusetts Department o f£radustrial Accidents Office of I-nvestigations 600 Washington Street Bostorz, M4 02111 Workers' Compensation Insurance Affidavit: Build rs/Contr Anolicant Information actors/Electricians/plumbers Please Print Legibly Name (Business/Organization/Indivi dual): Address: City/State/Zip: IV, --Phone#: �"��j 11.2 Are yo:10, n employer?Check the appropriate box: 1.❑ I employer with 4. ❑ I am a o 77. �[] f project(required):eneral contractorand I 2.❑ empyees(full and/or part-time) * have hired the sub-contractors New construction I am a sole proprietor or partner- listed on the attached sheet x emodeling ship and have no employees These subcontractors have working for me in any capacity, workers' comp.insurance. 8. ❑Demolition [No workers' comp, insurance 5. ElWe are a corporation and its 9 ❑Building addition 3•E] required.] officers have exercised their 10 0 Electrical r I am a homeowner doing all work right of ex additions emption per MGL myself: [No workers'comp. c. 152,§1(4);and we have no 11.❑Plumbing repairs or additions insurance required.] t employees_ [No workers' 12•❑Roof repairs Pomp-insurance required.] 13.0 Other `'-nY aTMThcant that che--ks tib-ox#i must a?s"{til ouc the secti . ^^beal sock-.^IIe+�wr wort^s'cos.a ��. t: .• � � Homeowners who submit this affidavit indicating the;,are de»• �... ..E h work and then hire outside contractors s/iust submit a new affidavit indicating such. +Contractors that cheek this box must attached an additional sheat showing the name of the sub contractors and their workers'comp.poiicy information. am information.an employer that is providing workers'compensation infoinsurance for my employees. Below is thepoficy andjob site 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 age(showing olicy Failure to secure coverage as required under Section 25A of MGL . 152canlto ththe e imposition number of c andexpiration �pdate). fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the fowl of a STOP WORK ORDER and a fine penalties of a 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 cern,fy und54he pains and pe ' s perjury th¢t the information provided above is true and correct Signature: �c .� Date. Phone#: ��'J!' -P)& Official use only. Do not write in this area, to be completed by city or town official 1 City or Town- Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.pleb R 6. Other in Inspector b Contact Person: Phone#: XAORTly Town of . No. ° �'oAKE =o dover, Mass., C MICMEWICK DRATED i'? cb U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System ryc ...................................................................................... BUILDING INSPECTOR THIS CERTIFIES THAT..........l...C'��. . ' ........ .........��. Foundation has permission to erect.................:...................... buildings on ..... '�..--�? ........ .......................................... Rough to be occupied as Chimney provided that the person accepting this permit shall in every respect conform 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 CONSTRUCTION ARTS Rough ........ ............ ... Service . ....... . .... .......... BUILDING INS 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.