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Home My WebLink AboutBuilding Permit #327-2017 - 133 GREENE STREET 9/27/2016 44yw ' V Vl �1AwJS l�W AJF D NORTH BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION a�_ A Permit No#: N Y'�li Date Received q- 01040 �Ssgc►+us�c Date Issued: PORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER-- -t /?-'v Print p 100 Year Structure yes MAP PARCEL: e2OO V ZONING DISTRICT: Historic District ye no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building F One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement .5;Assessory Bldg ❑ Others: 0 Demolition ❑ Other ❑ Septic ❑Well 0 Floodplain ❑Wetlands ❑ Watershed District 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name:Iygw ut.k06,0`2-Phone: T'2? b 4,65, yq t - Email: Address: 3 7 014 k. 4-n,c-) � 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 COST BASED ON$125.00 PER S.F. Total Project Cost: $ y. cc.. FEE: $ Check No.: 7 � `tom Receipt No.: �01\ NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund V1 s ignature of Agerdbwner� 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 0 Private(septic tank,etc. ❑ Pennanent Dumpster on Site ElTHE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On 1 6 Si nature COMMENTS (- A"41 7 /l0 ✓JSP /((Q S()�tJr!V "CONSERVATION Reviewed on b Si nature , COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes r Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date 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 Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 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/Cross Section/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:Building Permit Revised 2014 Location i� _t _ - ffi�:�„•H No. 2 2 1 2 U, Date 2 . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ t Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# t ' i r" Building Inspector r r , V NORTH ver 0 No. s 3 1 � . Z b �h ver, Mass 2� > > [OC HIC HlWKH V S U BOARD OF HEALTH Food/Kitchen P- ERM IT _ T L D Septic System THIS CERTIFIES THAT .......... 1, p4..:. ,,,,,,,,,,,,,,,,,,,,,„ ,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,, BUILDING INSPECTOR . ............................... �'. �eP4` t ,,... Foundation has permission to erect .......................... buildings on ...... .. .... .................... ............. ....... 8. � Rough tobe occupied as ....:.......... ... .. .. .. . ........................................................................... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST TION R Rough Service ”" Final BUILDING INSP OR 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. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPj Public Sewer Tanning/lblassage/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 PLANNING & DEVELOPMENT Reviewed On Signature COMMENTS /fid t� CONSERVATION Reviewed onb 'Signature '` 14 COMMENTS HEALTH Reviewed on Signature COMMENTS (Ili } ` 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: �- �- -ART; _ .- Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes r e no. Located at 124 Main Street. -- Fire Department signature/date _. COMMENTS °F t►ORTM 1 TOWN OF NORTH ANDOVER ss�ac �a N OFFICE OF F0* BUILDING DEPARTMENT �o 1600 Osgood Street, Building 20, Suite 2035 North Andover Massachusetts 01845 �SSACHUSEt Donald Belanger Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please print DATE: `I f o22 JOB LOCATION: J 3 3 o nju w !5-z S4- Number Street Address Map/Lot HOMEOWNER ` t itta_ , _ J43,,�;� T? 6,6 J7 5 / (oo3 9,53 19 7<3 Name Home Phone Work Phone PRESENT MAILING ADDRESS 3Cor4,4 ^j L � /00 4Kr�pw gra-- O/ C-Y r 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 I IO.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. HOMEOWNERS SIGNATURE t APPROVAL OF BUILDING OFFICIAL Revised 8.2015 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 The Commonwealth of Massachusetts X Department ofIndustrialAccidents X Congress Sheet,Suite 100 d a }` _ Boston,MA 021X4 2017 ��M 5V4 www.mass.gov/dia Workers,Compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PFP2&TbNG AUTHORITY' please Print Le 'bl A lieant Information Name(Business/Orgabizationllndividual): i •'�'''s' ( u-/h"�7 �y Address: / 3 3 K� w Phone#: Q 2 2) 3 60 /� City/State/Zip: ZVO 4,tD , :. .. . .. : x... - Type of project(required); Are you an employer?Check thea pP p ro nate box: em to ees full andlorparttime). 7. E]Nd V donstr6dion 101 am a employer with p y 2.F11 am a sole proprietor or partnership and have no employees�rorking for mein 8. liemodeliiig any capacity.[No workers'comp.insurance required.] 9. ElDemolition 3.Fj 1 am a homeowner doing all work myself(No workers'comp.insurance required.]t 10 Q Building addition 4.®1 am a homeowner and will be hiring contractors to conduct all work on my property. 1 will 11.❑Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 12.L]Plumbing repairs or additions 5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 110 Rbof rep airs These sub-contractors have employees and have workers'comp.insurance.t 14.[l Other 6.F1 We are a corporation and its,officers have exercised their right of exemption per MGL c. 152,§1(4),and we Have no employees.[No workers'comp.insurance required.] *Arty applicant that checks bbic#1,must also fill out the section below showing their workers'compensation policy information. davit t Homeowners who submit this affil{tt h d an additional sheet showing the all work name of the sub-contractors and state wen hire outside contractors must heth t a r or naot fhoseen ti have h tContractors that checkthrsox employees. If the sub-contractors have employees,they must provide theft workers'comp.policy number. workers'compensation insurance X am an employer that is providingfor my employees. Below is the policy and job site information. Insurance Company Name: Expiration Date: Policy#or Self-ins.Lic.#:. , City/State/Zip: IL) /4- �i✓1 G YS XTob Site Address: ttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). al-violation 0-00 Failure to secure coverage as required under MGL enalties?in the form of25A is a aSpunishable OP WORK ORDER and fine f p to $2050.00 a and/or one-year imprisonment,as well as civilp day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Xdo hereby cert, thepains an pen Zttes ofperjuty Haat the information provided above is true correct _ Date: ? Si ature: Phone#: Official use only. Do not write in this area,to he completed by city or town officiaL Permit/License# City or Town: Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#: Contact Person: Sales: 800.448.3636 Phone: 804.271.2363 NEXT GENERATION Fax: 804.743.7779 LET'S GET IT DONE STORMWATER MANAGEMENT SOLUTIONS acfenvironmental.com Site Development and Retrofit • Low Impact Development . Green Infrastructure FOCALPOINT(high flow biofiltration) - R-TANK(modular subsurface storage) - PAVE DRAIN(paving,drainage,storage) - FABCO(decentralized treatment) i I I I — I +— } 4 I I NORTHERN ASSOCIATES, INC. 68 PARK ST. 2ND FLOOR ANDOVER, MA 01810 TEL:(978) 837-3335 FAX:(978) 837-3336 MASSACHUSETTS OWNER. TERRY HOLLAND DEED REF. . LOCATION. 133 GREENE STREET PLAN REF. #1780 CITY,STATE.• NORTH ANDOVER, MA SCALE. 1"=20' DATE: 7/06/16 JOB #, 63.00'- -H 3.00'- LOT 2 j 11,900± s f 1 I i t PROPOSED L GARAGE 16' X 30' 1 STY ADD. t J TO BE W REMOVED o i .. EXISTING DWELLING # 133 L=1'o'0o> T STP