Loading...
HomeMy WebLinkAboutBuilding Permit #144-15 - 14 ANNIS STREET 8/11/2014 i NORTH BUILDING PERMIT Q�STIED ,bqq� TOWN OF NORTH ANDOVER 02 APPLICATION FOR PLAN EXAMINATION * n ew Permit No#: y- Date Received7R'�RArED gSSACHUs�� Date Issued: // /� IMPORTANT: Applicant must complete all items on this page LOCATION 1"1 !-1 t'1t'1 �� d �SCoPrint PROPERTY OWNERPeb2CC6 4 9-0010-Ci-E5 MAP 1 h' Print 100 Year Structure yesnn PARCEL: �'i ZONING DISTRICT: Historic District yesMachine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building V One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: We 6-ragol nG AD con Ve r-� ui n G ro©m ('n�Z? bed-roonn Identification- Please Type or Print Clearly OWNER: Name: P�,�2[C.CL��6 S'r© ICc�1)la Phone: Address: 1'1hls ss . C� 0 vQ-'' M0 01 9y Contractor Name: HUnM(')f, )ftPfhone: 1 Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER r 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: $ 1000 — FEE: $ y Check No.: {{�1 11 Receipt No.: 2-1 ell NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner J?� . - i nature of contractor _. Location 14 No. S Date 11 . - TOWN OF NORTH ANDOVER Certificate of Occupancy �$ Building/Frame Permit Fee $ -30 — Foundation 3yFoundation Permit Fee $ Other Permit Fee $ TOTAL $ i Check# LJ f �' �r � ` 136kling Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSA 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS 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: Z 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) I ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 I 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 o Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work o 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) La 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 t%ORTH own of s E ndover 0 - � No. I qq , ver, Mass, CO[NICMEW.CM �1• x,95 R�TEO 11 BOARD OF HEALTH Food/Kitchen PERMIT T LD- Septic System THIS CERTIFIES THAT .....�!:� Z.Z...F...(!4rk....�.✓... ?. iS.. .. ............................................................. BUILDING INSPECTOR has permission to erect buildings on .���.�.., S `S� Foundation .......................... ................................................................... Rough tobe occupied as ........................... ...... t�/.. .................................................................. Chimney provided that the person accepting this p mit 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 CONSTRUCTION ST RTS Rough Service , ..................... .... �,�... "a,' ................ 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. e Y) o . PfndoUer wf� oim POO 7-1"�"' m.� t .w..t •i •. Y M�o rl Ml 8iitt Borg Roan fl Tile Commonwalth ofMassachusetts Dep���nento,�'�nc��cs�rc�l.Acczc�en�s • - Office OfInvestigatlons 600 Wasl'iingion Street Boston.,MA 42111 -wimmassgovld a Worekex$'CompensationfusuranceAffidavit:Builders1Co).tractors)Electrexclan:s]Piuinbexa .A,. plicant Worrzrlat�ion PleasePrcxntLeObk Name(BusinessfOrgani'zation/Tvdz`vzdud): �dbeeca To disco Kov I aU3 Address: I LI Pn ni 3 cx y�s�a��l p: no.)4r over rYt ►�- Phone#: Are your an employer?Check the appropriate box: Type of project(required): 1,[( I am a employer with 4• ❑I am a general contractor and I 6. New construction F employees(fall andlox part time)* have hixedthe sub-contractors 2.El I ani a sole proprietor or p aztn.er listed on the attached sheet.T 7• ❑Remodeling ship and`liavena.employees These sub-contractors have 8. [[Demolition working forme in any capacity. workerscomp.insurance, g• ❑Building addition [No workers'comp.insurance 5. ❑We axe a corporation audits 10[(Electrical repairs or additions cixed.� officers have exercised.their 3.[ S a�n a homeowner doing all work right of exemption per MOL 11.,[]Plumbing.repairs or additions myself�1'owgrkexs'comp. c.152,§1(4),andwehaveno 12.PRoofxepairs imsuranceretluixed.]� employees.[No workers' 13.El Othex • comp.insurance required.] vAny applicant that checks box#I must also O outthe se,tion bBidw showingtheir workers'compensationpolicy infounation. f Homeowners who submimis affiidavit indicatingthey ae doing allwork and then hire outside contractors must submit a new afddavit indicating such. xContractors that cheAtbis box must attached art additional sheet showingthe name ofthe sub-contractors and their workers'comp.policy information. Iarnane�nployeNt�iati�p�aviciing�oxkers'eo�npens�ationins�cmeefo�•rye7nployee� Botot� c�he�aZieyancijoyrsi�'e infoxxmadon. Insurance Company Name;. policy#or Selz ins.Lic.#: E�piratiortDate: T'ob Site.Address: CitylState/Zip: Attaeht a cope o tXieworltexs'coxntpensatioxrpolicycleclaxation page(slhowing•tha policy number and expkationt trate). Failure to secure coverage as raT=Wfunder Section 25A.of MOL o.152 can lead to the imposition of criminalpenalties of a fine up to$1,500.00 and/or one-year imprisonment,as wallas civilponalties in the form of a STOP WORD ORDFR and a fm e ofup to$250.00 a day against the violator. Be advised that a copy ofthis statementmay be fozwardedto the Office of Investigations ofthe DIA for ibsurance coverage WARcation. X do liereby cert uridet•tilepains and penalties o f perjury that tree information provided above is true and correct, - Si Date: ©ne# Q�8-aOg--qua Offic'eial use ortly, DO not Write in iflis"ea,to be eompleted by city or town 0 'clal. City or Town: Pezmit/License i# fwaing Authority(circle tine): 1.Board of Health.?.Building)Depaxtmend 3.Cityffown Clerk .Electrical inspector 5.PZunahzngJCuspectoz• f.Other - Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for them employees. Pursuant to this statute,m employee is defined as"...every person iii the service of another under any contract ofhho, express or•implied,oral orwritten!' An erxrplaye:is defined as"art individual,partnership,association,corporation or otherlegal entity,or anytwo Or More ofthe Foregoing engaged in a joint enterprise,and including the legalrepresentatives ofwdeceased emplyex,.ox the receiver orfrdstee of an individual,partnership,as§ociatlon or other legal entity,employing employees. IoWeverthe owner of a dwelling house having notmore than three apartments and who resides therein,or the occupant ofthe dwelling house of another who employs persons to do maintenance,construction orrepair Work on such dwelling house or Who grounds or building appurtenant thereto shallnot because of such employment be deemed to be an employer:" MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a Reense or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have b con presented to the coptracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checld g the boxes that apply to your situation and,if ziecessaty,supply sub-confractor(s)name(s),addresses)andphonenumber(s)alongwiththeircertificates)of insurance. Limited Li ability Companies(LLC)orLimitedLiabilityPartnerships(M)withno employees otherthan,the members orpartners,arenotrequiredto caxryworkers'compensationinsurame. If anLLC orLLP does have, employees,apolicy isrequired. Be,advised thattbisaffidavit maybe submitted tothe Department of Industrial Accidents for conftrination of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should 'be retumedto the city or town that the application for the permit or license is being requested,nod the Dep'atbment of Industrial Aceidenfs. Should you have any questions regarding the law or if you ate required to obtain,a workers' compensaffcnpolicy,please call the Department at the number listed below. Self insured companies should enter their sel- insurance license number on the appropriate line. ' City or Town Offtcials Pleasebe sure thatthe affidavit is complete andpxinted legibly. TheDepartmenthas provided a space atthe bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be-sure to fll in the potmit/Neense number Whichwill be used as a reference number. In addition,m applicant thatmust submitmzultiple,pexmit/izeeme applications in any given year,deed only submit one afdavit indicating cutrent PORGY,information(ifnecessaty)and under"Ab Site Address"the applicant shouldwrite"all locations im (city or towlr).".A.copy oftlie affidavit that has been officially stamped or marked by the cify or town may bo provided to the applicant asProof that avalid affidavit•is on file foxfutuxepermits orlicenses. Anew affidavitmistbefilled out each year.Where a home owner or citizen is obtaining a.license ox permit not related to any business or commercial venture (i.e.a dog license orpermit to burn leaves etc.)saidperson is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any.questions, please do not hesitate to give us a call. The Depaxf rent's address,telephone a-nd fax number: T.d Ca 9x-Wealth of I!mma dkvt fotta DITaxtMoUt d1lidu Wal Acciden.•ta MROe 6b0 WaWngtm S xe t Bogen,ATA 02111 TO, 61M-2'�,4900 ext 406 ox 1-877-WSAFE _ Revised 5-26-OS Fax 4 V a rya TOWN OF NORTH AND ovEp _ OFFICE OF _ • R by ..7600 OsgoodStreetBuil&g20,•Shite 2 36 ��s'ACfii15 �� ' North Andover Massachusetts 411845 Gerald A,Brown Telephone(978}588 945 Inspeeforof$uildings - Fay (978)688-9542 HQMEOWNER.•Z,ICENSE XBE ,k TION BUMING PE7.M- T APPLICA•T.ION . pleaseprint - •' .. ATE. —] PB LOCATION. I n 4- Number StreetAddress 1VIap/Zot I MEOWNER e bec ca'i s c.oS Q Name. QU _ •, Horne I',hone Work Phone �'18-aa� *91 )a (C ) -PRESENT NIAMING ADDRESS f S• ��— . �Or�h )9h do U2 r ' $u 5-. . U�.;�`re,m Stafw 9H p Cod; The current exemption for"homeowners"was extended to inolude owner occupied 'i0 c�IIO~iY SAEh hoMe-() g dwelhugS to r4Y0 7ImtS QX i�SS and Tti ers to en 1��•e an divadual-forhire w:lo does aotpossess a license,provided Chats-D the owner acts as supervisor). State Do, (Code Section DEFINITION OFHOMEOVMR Persons)who awns aparcel of land on which Tie/she resides or intends to reside,on which there is,or as amended to a homeowner, be,a one or two family strictures. A person who constricts more that.one home an.a t hick V rperiod shall not o considered The undersigned"homedwner"assumesresponsibilityforcompliances with the State Building Code and other Applicable codes,by laws,rules andzegalations, The undersigned"homeowner"certi,$es that helshe understands the Town of North AadoverBuilding lie attment �nurspection procedures and requirements and that he/she will comply withtsaid procedures and requh ema eminspection 11OAMDWI.7ERS SICrI*tATURE APPROVAL OF BUILDING OFFICIAZ. Revised 7.2009 Form Homeowners 8x8mpfion _ 'HOARD OFAPPBALS 68B-954ICO7�SER4r r AT(ON68b-9530 HEALTH 688-9540 PLANNMG689-9535 i LO ole We � , . 6� a { sE i ry,