HomeMy WebLinkAboutBuilding Permit #388-2011 - 1440 SALEM STREET 11/5/2010 BUILDING MIT � � 0 o� "O D , �ti
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Plans Submitted Plans Waived "'',Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL _1W
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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
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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
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4
NOTES and DATA– For department use)
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❑ Notified for pickup - Date
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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 +`
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Revseci 2?008
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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
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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
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DATE. 11/04/0 . SCAGE:1"=4®' SERC
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160 SUMMER ST. HAVERHILL,MA. 01830 M. 978-373-0310
@2008 8Y CHRISTIANSEN & SERGI INC.
OwG.NO.:08029.002
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