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HomeMy WebLinkAboutBuilding Permit #388-2011 - 1440 SALEM STREET 11/5/2010 BUILDING MIT � � 0 o� "O D , �ti "•6? 1� Plans Submitted Plans Waived "'',Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL _1W Og i Public Sewer Tanning/Massage/Body Swimming Pools Well Tobacco Sales Food Packaging/Sales Privateeptic to ,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPRO ED (I T PLANNING & DEVELOPMENT C9 COMMENTS ONSERVATION Reviewed on Signature �roVr� COMMENTS 1,124 HE LTH Reviewed on Z- � ?� Si nature COMMENTS i Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: V Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Os ood Street PARTME�IT 4k D'E -Terop Du ipster. on si#e} Yes nno Pi�bcated,at 124:Main-Street Free Departrraent:signature/elate . �.MMENTS W Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. I - i Total land area, sq. ft.: , ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No j DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine I 4 NOTES and DATA– For department use) It 7 I� I i ❑ Notified for pickup - Date ..............------._....._........................_........._........__..._........................_..........._..__..........._._.__. _........................................._—_._.._.................._._.__....--....._.................._......_.................................. -........_ Doc.Building Permit Revised 2008 1 i � J 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 I ❑ 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 i Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers. Comp Affidavit L3 'Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract l o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Pian And j Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (if Applicable) ' 1 ❑ 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 o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract ❑ Mass check Energy Compliance Report 1 s c3 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 Appeat is j 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 +` f r f i Revseci 2?008 —r Location No._zf-f o�1D// / Date NORTIy - '�`3 TOWN OF NORTH ANDOVER Certificate of Occupancy $ . i 'T + , IT '< Building/Frame Permit Fee $ X68 r Y a^cMusE Foundation Permit Fee $ ti Other Permit Fee TOTAL $ Check # M 23663 PgIding Inspector ORTFI A 0VM AndovF _ LAKE O dover,�A Mass., CE COC MIMWICK 1 7� DRATED pl? SS BOARD OF HEALTH IT T 4 r Food/Kitchen sh Septic System �j / BUILDING INSPECTOR THIS CERTIFIES THAT .. �' .... ' '� '�/G ..... .......�r............................................................................................................ Foundation haspermission to erect........................................ buildings on ........./..................................................................................... Rough to be occu ied as . </ t�-4/` t � r / Chimney ........... .. . . . .. .. . . . provided that the person accepting this permit shall in every respect conform to therms oft a 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 UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough Service `��' / BUILDING INSPECTOR 1 Final Occupancy Permit Required to Ocatpy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry !Nall To Be Done FIRE DEPARTMENT Until Inspected' and Approved-by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. F NORTH TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT o ep 1600 Osgood Street Building 20 Suite 2-36 North Andover,Massachusetts 01845 SACHUSE Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings J Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please print DATE: Nov, � JOB LOCATION: Number //Street Address Map/Lot HOMEOWNER r 4J -6,53-=29—ANe, 1/, - �0,20, 3 Name me rngy Work Phone PRESENT MAILING ADDRESS D //7-7 CfWe/ Cif X45 City Town Srw. Zip Gude 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 require' nts and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDIN FEICIAL Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 689-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA. 0211.1 www.rnass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Flectricians/Pliumbers Applicant Information Please Print iLe�-,ibly Name(Business/Organization/Individual): �� /IId Address: City/State/Zip:j&T 4cA��n�QIX415 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 1 6. ❑New construction employees(full and/or part-time).' have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.1 7. ❑Remodeling . ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. [�Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its ' officers have exercised their 10.❑Electrical repairs or additions required.] o 3.71.1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c.152,§1(4),and we have no 12.❑Roof repairs insurance -required.] employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box 41 must also fdl out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors 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 is providing workers'compensation insurance for my employees. Below is the policy and job site information. 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 page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 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. De advised that a copy ofthis statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby rti�fy nder pains "nd enaldes of perjury that the information provided above is true and correct. Si ature: � Date: v Phone#: — %�f FOfficialuseonbi. Do not write in this area,to be completed by city or town official wn: Permit/license# thority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 150,0' LOT 1 43,908.16 SQ. FT. 1.0080 ACRES J Shed to be raised 6r�9' 24 � °' CD - o Deck to ,_ Proposed 24' � be Raised I6' Addition cU 32.21 �xi5�ing� 5e Existing Shed 74.7' d- co FRONTAGE= 150 ' L E M TREET PROPOSED ADDITION CL/ENT. DAGHLIAN V- \A0FA 1440 SALEM STREET NO.A1dD4VER,MA. o� I CHAELSS9Clfl J U) o _ DATE. 11/04/0 . SCAGE:1"=4®' SERC No.s �. f Cf RI AN,SE ! SE GI PROFESSIONAL ENGINEERS .h LAND suRVEYORs - 160 SUMMER ST. HAVERHILL,MA. 01830 M. 978-373-0310 @2008 8Y CHRISTIANSEN & SERGI INC. OwG.NO.:08029.002 i i I ILL CASE LICENSED BUILDER REGISTERED PROFESSIONAL ENGINEER E t �(�(' rr�,� p�+I Al BY �" ------•DATF_15_�S.J!. �Ci SlJBJECT_____p►-�1Zfl uk'`------------------ SHED NO.---t-----�- : p p� (gyp u CHK®. 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