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Home My WebLink AboutBuilding Permit #877-14 - 141 MAIN STREET 6/4/2014 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: 7-7-lq Date Received _t Date Issued: I i IMPORTANT: Applicant must complete all items on this page LOCATION Print. PROPERTY OWNER Print lob Year Old Structure yesno MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no i TYPE OF IMPROVEMENT_ PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: W�1815mercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identifi ion Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: Phone: Address: _ Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: ` f Address: Reg. No. - FEE SCHEDULE:BOLDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON 00 PER S.F. 04 Total Project Cost: $ � � FEE: $ / �' Check No.: Receipt No.: NOTE: Persons contract g with u egistered contractors do not have access to the guaranty fund ��_ .. .- - ... .. a .. .. .. ... -. .. -_. . .� Signature�of Agent/Owner ig%_ ture of contractor Plans Submitted LJ )Pla s '❑ Waive Certified Plot Plan ❑ Stamped Plans ❑ i -: Plans Submitted ❑ Plans Waived ❑: ..:.Certified Plot Plan ❑ Stamped Plans ❑ :TI'PE-OF;SEWERAGEDiSPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ .. Swimming Pools ❑ Well ❑ _ Tobacco Sales 0 Food Packaging/Sales ❑ Priv ate:(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 CONSERVATION Reviewed on Signature COMMENTS -HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Manning Board Decision: Comments Conservation Decision: :Comments Water.& Sewer Connection/Signature&.Date Driveway Permit DPW To` o Engineer: Signature: Located 384 Osgood Street FIRE DEP 4RTI!!! NT - Tem.p Dumpster on site yes no -Located-at 124 Mair, Street Fire Departine►d 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 LI Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The fol-awing is-a=list of the required,forms to be filled outfor:the appropriate.permit to be obtained. R.00fh,g, Siding, Interior Rehabilitation Permits o Building Permit Application u Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or-C`.&L Licenses o Copy of Contract o 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 o Building Permit Application Li Certified Surveyed Plot Plan u Workers Comp Affidavit u Photo Copy of H.I.C. And C.S.L. Licenses u Copy Of Contract u Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) u Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products g 9 9 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application Li Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit u 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 u Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all casts if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apv,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.tted with the building application Doc: Doc.Building Permit Revised 2012 . Location No. —�� Date rG • - TOWN OF NORTH ANDOVER ' • Certificate of Occupancy $ Building/Frame Permit Fee $ ?r) ori Foundation Permit Fee $ Other Permit Fee $ TOTAL $ / 00 Check# l.� uilding Inspector 4 OE HORTN 1H - �,s AC Nl15Ei40 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 877-14 on 6/4/2014 Date: August 28, 2014 THIS CERTIFIES THAT THE BUILDING LOCATED ON 141 Main Street MAY BE OCCUPIED AS Tenant Fit Up — Salon Jen Z IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Olympia Realty Trust 141 Main Street North Andover,MA 01845 Building Inspector Fee: Pre Paid $100.00 Receipt: 27643 Check :150 Z F ]f ♦ 'Y 'tib°+,..°..••519 SS"CHO CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 877-14 on 6/4/2014 Date: August 28, 2014 THIS CERTIFIES THAT THE BUILDING LOCATED ON 141 Main Street MAY BE OCCUPIED AS Tenant Fit Up — Salon Jen Z IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Olympia Realty Trust 141 Main Street North Andover, MA 01845 Building Inspector Fee: Pre Paid$100.00 Receipt: 27643 Check :150 NORTH own of _ Andover O �.. No. '91 ,t h ver, Massit /� o % > > cocN,cNewrcw �1' 7�A�4ATEG S V BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT ........0 ...Y....1 ... .... 5BUILDING INSPECTOR Foundation has permission to erect buildings on ................... ........... / v C�� Rough to be occupied as ..................... � .T.�..�... ....... ... chimney provided that the person accepting this permit shall in every respect conform to the terms of the application na 0 on file in this office and to therovisions of the Codes and By-Laws relating to the Inspection,Alteration and p Y Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT! STARTS Rough Service BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove . Fina' No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. a ��d AC NSE4,9 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 877-14 on 6/4/2014 Date: August 28, 2014 THIS CERTIFIES THAT THE BUILDING LOCATED ON 141 Main Street MAY BE OCCUPIED AS Tenant Fit Up — Salon Jen Z IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Olympia Realty Trust 141 Main Street North Andover, MA 01845 Building Inspector Fee: Pre Paid $100.00 Receipt: 27643 Check :150 F NORTH Town of 2 = Andover 0 No. - 1 � ti h ver, Mass, tArJE 2.4 A_ COCHICµt WICK[ 7,e A�R�{7ED ►'Pa,�'�y S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .......0�X ... ..!. t .... SUS BUILDING INSPECTOR .... ................. ��...� ..................................................... ev� lli �✓ Foundation has permission to erect .......................... buildings on ...... .:Y....... .............. �.......... L �- / ' / .. Rough to be occupied as ....................�!i/��!�.....�:.�.. ...(.�.. /4N,l/En/ ................ ... Chimney provided that the person accepting this permit shall in every respec conform to the terms of the application na dZ �� jy 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR • UNLESS CONSTRUCTI STARTS Rough eel rService ....... .... . .......... ...... ..... .......................... LV* ��yyyy .. Fin ! 'Ll.,—� BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove . Fina' No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. ` ' O O A I IAORYN '3/�•^4no rr��9 �SSACNUSE� CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 877-14 on 6/4/2014 Date: August 28, 2014 THIS CERTIFIES THAT I THE BUILDING LOCATED ON 141 Main Street i MAY BE OCCUPIED AS Tenant Fit Up— Salon Jen Z IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Olympia Realty Trust 141 Main Street North Andover, MA 01845 Building Inspector Fee: Pre Paid $100.00 Receipt: 27643 Check :150 ' I I NORTH own Of ndover O - to No. * 'i t - 1 y o 2.6 h ver, Mass, �/� COCMIC"t WICK �1• �,9 p°R•�reo �P�,��S S U BOARD OF HEALTH Food/Kitchen PERMIT Tj //�� Septic System THIS CERTIFIES THAT .......0�:X �Y°14..�..?.6a1??`. ....717C15� BUILDING INSPECTOR ................. �/ ..................................................... Foundation has permission to erect .......... buildings on ��. - ' / Rough to be occupied as .................... .T.�.. ... ...,.:` ... �� .vC� Chimney provided that the person accepting this permit shall in every respectconform to the terms of the application on. 0dZ7e�l��11y 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 in t i 4-iY PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI STARTS Rough Service ....... .... . .......... ...... ....... .......................... BUILDING INSPECTOR in 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. Mo oTH'N ♦ ^M AcHU— r r e19 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 877-14 on 6/4/2014 Date: August 28, 2014 THIS CERTIFIES THAT THE BUILDING LOCATED ON 141 Main Street MAY BE OCCUPIED AS Tenant Fit Up— Salon Jen Z IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Olympia Realty Trust 141 Main Street North Andover, MA 01845 Building Inspector Fee: Pre Paid$100.00 Receipt: 27643 Check :150 a NORTF1 Town of EAndover No. � ver, Mass� h , •Sl coc"Ic Mtwli K y1. �1,9 pORwTEO ►PP�.(5 S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System 1_ 7 BUILDING INSPECTOR THIS CERTIFIES THAT .......4 . . r ��` / lc `�� ................................... ................................................. �, .... Foundation has permission to erect buildings on ..................... .!^l..`. •••••• .............. •• ............ Rough to be occupied as ............. . . ... � :.X. ..J.....:...4..... ........................... `\C�l• �� V C� Chimney provided that the person accepting this permit shall in every respec conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI STARTS Rough ........................ Service ....... ..... . Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises — Do Not Remove No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Salon en ty le for Life 04 eorH°Sy To YY.Lq OFi`!10R'Jl'.LL ANDovj R OFFICE OF ]BUILDING DEPARTNT cR .� -_-Z600Osgood StreetBuifding20, 6 ` ��s�ACHus��y NorthAndover,JMassachn.setts 01845 , Gerald A.Brown Telephone(978)68$-9545 InspectorofBuildings . Fax (978)688-9542 ' HOIUIEOW:N,ER•LICENSE EXEMPTION 13MING-PEWIT APPLICATION I'lease�iinf DATE: T JOB LOCATION; - Number SizeetAddress Map/Lot • ,IXOMEO�IL-�R • - .. Name. . Home Phone Work one -PRESENT MAMING ADDRESS . ----------------- Ciii Tn�=m L ffw zip Code The eurrenf exemption fbr"-homeow_n_ers"was extended to iarM6 owner-occupied dwellings to Uvo units"or;ass 2nd to alloy su;h hornea;ruers i4 engage andividual•forbire who c?oes notpassess a license,provided that the.owner acts as supervisor). State 3uizding (Code Section IDS-3.5,7) DEFINITION OFHOMEOVMP, Persons)who Qwns aparcel 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- there erio d shall not be considered ahomeowner. The undersigned"homedwner"assumes resp onsibility for c omplianc as with the State Building Code and outer Applicable codes,by-laws,rules and-regulations. The undersigned"homeowner"cerE'Res that belshe understands the Town of North AndoverBuilding De arfinent zuinirnum inspection procedures and requirements and that he/she will comply with,said procedures and xequirements, ' HOAMOWMERS SIGNATURE AVPROVAL OF BUILDMG OFFICIAL Revised 7.2009 Foran$omeowners Exemption 'BOARD OF APPEALS 688-9541 CONSERVAMN 688-9530 HEALTH 688-9540 PLMNTNG 688-9535 The Commonwealth ofMassachuselts - - .Department o,f'I.ndust ial Acelknis Office of fnvestigations ' 604 Washington Street .Boston,MA 02111 -www.mass gov/ciia Workers'Compensation Ynsuran.ce Affidavit:Builders/C'ontr.actorsfElectxicianst�lumber.a A.ppReant 7nfor ation Please Print Le�ibiy Name(Business/Organizationitndz`viduan: .A.ddress• City/State/Zip: Phone#• Are you 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. []Now construction employees(Eula.and/or part time).! have aiiredthe sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet: 7• El li emodeling ship and'liaveno.employees These sub-contractors have 8. ❑Demolition working forme in any capacity. workers'comp.insurance, g• El Building addition [No workers' comp.insurance 5, ❑We area corporation and.its 10. Electrical repairs or additions required.] officers have exercised.their 3.[l I am.a homeowner doing all work right of exemption perMGL 1I.[(Plumbing repairs or additions myself[No workers'oomp. c.152,§1(4),andwehaveno 12.❑Roofrepairs insurancere ed.�•' employees.(No workers'� 13.[]Other comp.insurance required.] !Any applicant that checks box#1 must also fill out the section below showingtheir workers'compensationpolloy information. T Homeowners who submitibis affidavit iadicatingthey go doing all work and then hire outside contractors must submit anew affidavit indicating such. xContractors that cha kthis box must attached as additional sheet showing the name ofthe sub-contractors and their workers'comp.policy information. I am an employer that isproviding workers'compensation insurance for my employees Bellow is the policy randiab site information. Iusuxance Company Name: Policy#or Self ins.Lic.#: ExpiratioaDate: rob 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 requiredunder Section 25A.ofMGL o.152 can lead to the imposition of criminal penalties of a fine up to$1,50 0.00 and/or one"year imprisonment,as wallas civil penalties in the form of a STOP WORK ORDER and a fine ofup 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. Ido hereby cergS under tree pains andpenaldes ofperpu that the in,formation provided above is true and correct. - Si ature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official: City or Town: PermitlMicense# 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#: Information and Instructions , 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 ofhiw,• express crimplied,oral orwxitten.." An ern2ployei is defined as"an individual,partnership,association.,corporation or other legal entity,or any two ox more of the foregoing engaged in a joint enterprise,and including the legal representatives of a•deceased employer,or the reeelver ortrustee of anindividual,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 or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to bean employer." 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 pro duced.acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states `Neither the comm aalthnor 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 eon presented ta the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supplysub-coniractor(s)nam.e(s),addresses)andphonenumber(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are notrequired to carry workers'compensation.insurance. If au LLC or LLP does have employees,apolicyls required. De advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation 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*orkers' compensationpolrcy,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 fox 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 submit multiple permit/license applications in any given year,treed only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A-copy of the affidavit that has been officially stamp ed or marked by the city or town may b e provided to the applicant aspzoofthat a valid affidavit•is on file for future permits or licenses. .A,new affidavit must be filled 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 eta.)said person 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 Department's address,telephone aird fax number: Thi CQ ORW-Oalt�Ol,X1i1:?sqOWA, 5ettl Depaxmeut ofluduatxialAccidents Of Ree offweStigat[oja.,% 60 WUWU&tCn sb=t S0Ston,: 02111 TO,#61M-2-7-4900 W 406 QX-1-877,MAKSAFF, _ Revised 5-26-05 `ay, 617"727'7749 WWW-Maagovfclia