HomeMy WebLinkAboutBuilding Permit #774-14 - 14 PRESCOTT STREET 4/29/2014 COMPLAINT NUMBER DATE:
#8 MAY 8, 1995
COMPLAINTANT:FRANK FICOCELLO CLOSE DATE:
ADDRESS: PHONE: 777-2157
OWNER:ENAIRE PHONE #:
ADDRESS:PRESCOTT STREET �<,�
INSPECTION DATE: ORDER L DATE:
COMPLAINT:MR. FICOCELLO CALLED FOR HIS ELDERLY MOTHER-IN-LAW, JOSEPHINE
RUSSO, 12 UPLAND STREET. THE ENAIRE FAMILY THAT ABBUTS HIS
MOTHER-IN-LAW STARTED TO BUILD A SHED TYPE BUILDING AND NEVER
ACTION: FINISHED THE PROJECT. NOW THEY ARE STORING RUBBISH, PAPERS AND ALL
KINDS OF JUNK IN THE UNFINISHED SHED. THE PROBLEM IS THAT THE RUBBISH
IS BLOWING OVER ONTO HIS MOTHER-IN-LAW'S YARD. HE BELIEVES THIS IS A
HEALTH HAZARD.
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TOWN OF NORTH ANDOVER
qLICATION FOR PLAN EXAMINATION
Permit NO. � p— 1 Date Received
Date Issued: L
P RTANT: A plic nt must complete all items on this page
LOCATION -
A _ Paint
PROPERTY OWNER. . _ -
Print loo Year Old;'Sftucfure yes no:
MAP NO: _PARCEL: T ZONING DISTRICT:. - _- --- Historic District yes no
Machine Shop Village .. yes no
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 ❑Well -p-Floodplain, 0 Wetlands., El Watershed District
0 Water/Sewer _
DESCRIPTION OF WORK TO BE PERFORMED:
L4
Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address:
CONTRACTOR Name - _ - t
Address:
Supervisor's Construction License:_ _ _ _Exp. Date: m -
Home Improve hent:License:____ _ _ . Exp. Date:_
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ 2FEE: $(-9
Check No.: Receipt No.r<:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signaturekof Agenture,�&contractor
Plans Submitted L `Pla s Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
1 Building Department
The following iss'allist of:the requked.forms to be filled outfor.:the appropriate:permit to be obtained.
R.00fh,g, Siding, Interior Rehabilitation Permits
L) Building Permit Application
❑ Workers Comp Affidavit
LiPhoto Copy Of H.I.C. And/Or C:S:L: Licenses
❑ Copy of Contract
Li Floor Plan Or Proposed Interior Work
o Engineering Affidavits for Engineered products
NOTE: All dumpster,permits require sign off from Fire"De.partment prior to issuance of Bldg Permit
Addition Or Decks
o Building Permit Application
o Certified Surveyed Plot Plan
o Workers Comp Affidavit
o 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)
o Mass check Energy Compliance Report (If Applicable)
o 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)
Li Building Application
Permit A lication
o Certified Proposed Plot Plan
o Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Copy of Contract
o 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 apw�al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be subm.+.ted with the building application
l
Doc: Doc.BuiHing Permit Revised 2012
- Plans Submitted ❑ .Plans-Waived-❑ '._Certified Plot Plan ❑ Stamped Plans ❑
.TYPE OF:;SEWER:AGEDISPOSAL
Public Sewer ❑ Tanning/MassageBodyArt ❑. . .Swimming Pools ❑
Well ❑. Tobacco.Sales ElFood Packaging/Sales ❑
Private_(septic tank,etc:_ ❑. permanent Dempster on:Site ❑
THE-FOLLOWING SECTIONS FOR-OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
- DATE .REJECTED DATE.APPR=OVED
PLANNING& DEVELOPMENT' ❑ ❑
COMMENTS
CONSERVATION Reviewed on 13-9 1q, Siglnature�, ij)
COMMENTS- �J-o w ,A �„�\ �ti t p � '
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes .
Planning Board Decision: Comments
1„
Conservation Decision: Comments
Water & Sewer Connection/Signature& Date Driveway Permit
DPW'I ow o Engineer: Signature:
-- 84
Located 3 Osgood Street
FIRE DEPARTM,.L-"Nt .,Temp"Dumpster onsite ..yes no
Located-6t.1M Main Street
-Fire Departme►]t 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--.Chapter166.Section 21A=F and G min.$100=$1000 fine
NOTES and DATA— For department use
® Notified for pickup - Date
s �
Doc.Building Permit Revised 2010
Location
No. Dateif i
. - TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Frame Permit Fee .+►F/�
- Foundation Permit Fee $
� ^ Other Permit Fee $
TOTAL $
r_
Check#tz--1
5 _ Building Inspector
NORTINI
nuoverTO% wn ot2
O
No. jil
h ver, Mass, 1391,
,!- COCNIC ftl WICK
S U BOARD OF HEALTH
PER IT T LD
Food/Kitchen
Septic System
THIS CERTIFIES THAT .................................... BUILDING INSPECTOR
111,11 mono •, Foundation
............... buildings on .
'r: 01q4has permission to erect ........... • • ••• •• •..................••
.; Rough
to be occupied as ................I�♦ ...x...�. ...............s
.................................................. 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 66THS ELECTRICAL INSPECTOR
UNLESS CONSTRUCT Rough
Service
............................. 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.
TO"OF NORM
ANDOVER
_6 ° OFZCE OF
BUMDING DEPARTMENT `
7 600 Osgood Street Building 20,-Suite 2-3 6
'ssA�+�us�c�5 North Andover,Massachusetts 01845
Gerald A.Brown Telephone(978)688-9545
Inspector of Buildings
HOMEQN-NER-LICENSE EXEWTION - Fax (978)688-9542
13DIIDING PERNN.CIT.APPLICATION
Please print
DATE:
JOB LOCATION:
1
Number Street Address
Map/Lot
T1OMEOWNER
Name. Home Phone
Work Phone
PRESENT MAILING.ADDRESS
Citsi Tn m �fYt•�.
-
Zip Code
The current exemption for"homeowners"was extended to include owner-occ
I
to allow such homeot,,ners fo engage an ildividual•for hire who does not possea 7 c`3Zse provided fhattthe o�wnear 1
acts as supervisor). State 3uilding (Code Section 108.3.5.7)
DEFINITION OF HOMBOWNER
Persons)who Awns a parcel of land on which he/she resides or intends to reside,on which(here is,or is intended to
be,a one cr two family structures. A person who constructs more that Ane home in a which
there
O shall not be
considered a homeowner.
The undersigned"homedwner"assumes responsibility for compliances with the State Building Code and other
Applicable codes,by-laws,rules andregulations.
The undersigned"homeowner"cert aes that he/she understands the Town of North Andover Building Department
mmimurn inspection procedures and requirements and that he/she will comply with,said procedures and
requirements, -
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING O FICIAL
Revised 7.2009
Foran Homeowners Exemption
''BOARD OFAPPEATS 688-9341r r
CONSERV AVON 688-9530 HEALTH 688-9540
PLANNING 6$8-9535
North Andover MIMAP April 29, 2014
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Interstates -
-I
SR Horizontal Datum:MA Stateplane Coordinate System,Datum NAO83,
-Roads - - Meters Data Sources:The data for this map was produced by Merrimack
gORTN Valley Planning Commission(MVPC)using data provided by the Town of
[r Easements O� f l{o {9ti North Andover.Additional data provided by the Executive Office of
0 MVPC Boundary ? s{' �{�O Environmental Affairs/MassGIS.The information depicted on this map is
O Parcels for planning purposes only.It may not be adequate for legal boundary
F- 9 definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER
MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING
It '4AF'WW*F ; THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY
OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT
ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
THIS INFORMATION
SSAtNUSB -
1"=70 ft ^�°
The Commonwealth ofMassachuse'Us -
Department oflndlicstrial Accielents
Office ofInvestigations
600 Washington Street
Boston,MA 02111
www.mass govIdla
Workers'Compensation Ynsurance Affidavit:Builders/Cont°actors)ElectricxansfPlYunbers
AppReant Information Please Print Le 'bl
Name(Business/Organi'zation&dividual):
Address: -
City/State/Zip: Phone#:
Are you an employer?Check the appropriate box: Type of project(required):
1.[( I am a employer with. 4. El am a general contractor and I 6. El Now construction
employees(full andlor part time)* have hired the sub-contractors
2.El am a sole proprietor or partner listed on the attached sheet. 7• E]Remodeling
ship and•have no.employees These sub-contractors have 8. ❑Demolition
working forme in any capacity. workers'comp.insurance, g. EJ Building addition
[No workers'comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
xequked.] officers have exercised.their
3, .am a homeowner doing all work right of exemption per MGL 11.El Plumbing repairs or additions
myself.[No workers'comp. c.152,§1(4),and we have no 12.❑Roofrepairs
insurancere ed. i employees.[No workers'
l 13.0 Other
comp.insurance required.]
NAny applicantthat checks box#1 must also fill outthe section below showingtheir workers'compensationpolicy information.
T Homeowners who submit this affidavit indlcatingthey ate doing all work and then hire outside contractors must submit anew affidavit indicating such.
tContractors 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 isproviding workers'compensation insurance for my employees Below is thepoliey andioh site
information.
Insurance Company Name:
Policy#or Self ias.Lic.#: Expiration.Date:
Job Site Address: City%State/Zip:
Attach a copy oldie workers'compensation-policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as requiredunder Section 25A ofMGL o.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 statementmay be forwarded to the Office of
Investigations of the DIA.for insurance coverage verification.
X do lie�hy ertify under the pains anrd penalties ofperjury that the information provided above is true and correct.21
Si afo • Date:
Phone .
Of acial use only. Do not write in this area,to be completed by city or town official.
City or Town: PermitiLicense#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.C41Town Cleric 4.Electrical Inspector 5.Plumbing Inspector
6 Other - - -
Contact Person: Phone N.
Information. and Instrnctions
Massachusetts General Laws chapter 152 requires all employers 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 ofhire,-
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 the ioregging engaged in a j oint enteiprise,and including the legal representatives of a•deceased employe/,or the
receiver or trustee of individual,partnership,association 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 maintenance,construction orrepair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to bean employes."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license 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 suhdivisions shall
enter into any contract fbr the performance ofpublic work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill.out the workers'compensation affidavit completely,by checking the boxes that apply to your situation,and,if
necessary,supply sub-contractors)name(s),address(es)and phonenumber(s)alongwiththeir certiffcate(s)of ,
insurance. Limited Liability Companies(LLC}or Limited Liability Partnerships(LLP)with no employees other than the
members orpartners,are notrequked to carry workers'compensation insurance. If an LLC orLLP does have
employees,a policy is required. Be advised thatthisaffidavit maybe submitted tothe Department of Industrial
Accidents for confnmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the.permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation.policy,please call the Department at the number listed below. Self-insured companies should enter their
self insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete andprinted legibly. The Department has provided a space at the 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 fill in the permit/license number which will be used as a reference number. In addition,an applicant
thatmust submitmultiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(ifnecessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy ofthe affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit•is on file.for future permits or li.censes. .A.new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license orpermit to burn leaves etc)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance fox your cooperation and should you have any.iuestions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The GQ onwoalthofMossac,,husPtts -
DITaftent Qf Industrial AA coldenta
Office dIAvestigatiom
6,00 WasgtQ�. txeet
Boston,MA.02111
Td.#617-7.2'x,4900 W 406 Qx 1-877-:MASSAFF,
Revised 5-26-05 Fax#617"727'7749
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