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Home My WebLink AboutBuilding Permit #727 - 145 JOHNSON STREET 5/20/2010 BUILDING PERMIT p►ORTH QfttLEp z �� ,. •, o TOWN OF NORTH ANDOVER 0� APPLICATION FOR PLAN EXAMINATION10 e« Permit N0: Date Received 4 ' qOq TeD SPP (h Date Issued: -10 "SSACHU`�� IMPORTANT: Applicant must complete all items on this page LOCATION : ,.. .._f 3 00 1\4 so I\,) S 1 Print PROPERTY OWNER [.J[L_I /j--No :�xU#,i e. c,co C: x F,.,._ �� Print MAP 210 PARCEL: ZONING DISTRICT: Historic District yes 9050) !Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family( Addition Two or more family Industrial AlterationX No. of units: Commercial Repair, replacementK Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: G4uo o SK IK 7_5 7M crL-E F N o_s (�I moi?W4 C,i= 5 0i%lam 1 1 Identification Please Type or Print Clearly) 3077 OWNER: Name: [.✓! L [ "1 ! ckoci4 Phone:13 761c137 138 , Address: IS [� CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED CO BASED ON$125.00 PER S.F. Total Project Cost: $ Aa FEE: $ �— Check No.: Receipt No.: 3 NOTE: Persons con tYacting '1 h e i eyed contractors do not have access to the guaranty fund Signature of Agent/Owner ,Signature of contractor Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales . r Private(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 Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: 4 Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no s 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 ❑ Notified for pickup - Date _._......_................................................................................................................................................_._..._.._....._......................................__........................................................................................................................_.._........_................................................_................................................................................... Doc.Building Permit Revised 2010 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 ❑ 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 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 o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ 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 o Certified Proposed Plot Plan ❑ Photo of H.I.C. And G.S.L. Licenses ❑ Workers Com Affidavit davit ❑ 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 i Doc:Building Permit Revised 2008 Location � � ��r1S06 No. Date ` U NORTh TOWN OF NORTH ANDOVER Certificate of Occupancy $ , �' b'••'°''tom Building/Frame Permit Fee $ ..-- ,SJAGNUSE Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 231 '/ ;, Building Inspector i The Commonwealth of Al assachusetts Department o f Industrial Accidents Office of Investia ations 600 Wasizing ton Street Boston, MA 02111 www-Mas eaWorkers' Compensation Insurance Affidavit Baers /CoractorsElectiAu licant Information cians/Plumbers PIease Print Legibly Name(Business/Organization/Individual):-[I�/ Address: S� City/State/Zip: N100 V� h X17 6 Phone#: )g 1 `13 7 138-1 _ FeMploYe;es you an eloyer?Check the appropriate boa: I am a eloyer with 4. ❑ I am a beracontractor Type of project(required): (full and/or part-time) * have hir d the sub-ontrac orands6• ❑New construction I am a sole proprietor or partner- listed on the attached sheet t 7• ❑Remodeling ship and have no employees These subcontractors have working for me in any capacity. workers comp. g• ❑Demolition [No workers' comp. insurance 5 P insurance. ❑ We are a corporation and its 9' ❑Builder edition required.] officers have exercised their 10 ❑Electrical r 3 I am a homeowner doing all work right of ex repairs or additions Myself P 4),an n Per MGL 11.❑Plumbing repairs or additions Y [No workers'comp.. c. 152,§I(4),and we have no insurance required.] t employees. (No workers, 12.7 Roof repairs comp.insurance required] 13.❑ Other a^�hcant that ch�—_k.;box id? muss also nu c;:t the section'clow s:^.ow=g. Homeowners who submit tais affidavit indicating the a.d n.. — "�"R errrers' Y a doing h �at'ri and Theo hire outside coatractors m/av,,submit a new affidavit indicating such. +Coatractors that check this box moat attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. am information.an employer that is providing workers'compensaiion in.foinsurance for my employees. Below is the policy and job site Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declarationao p be (showing,,he 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 fine up o$1,500.00 and/or one-year imprisonment, as well as civil penalties in the foam of a STOP WORK ORD of up o $250.00 a da a Penalties of a y against the violator. Be advised that a co ER and a fine Investigations of the DIA for ins ce co PY°f of may be forwarded to the Office of ge verification. I gnature:her 'under SigP pcru th'"the information provided above is j e? enalties o.fP l ry true and correct Phone#: � �j�� , 3 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3. City/Town Clerk 4. Eiectrical In5.PIumbinR 6. Other a Inspector Contact Person: Phone#: ORT1y To 0Andover : . , r. .......... .... -" MO., o `' dover, Mass., S O COCMIC LAKIZHE 7�p A ..RA7E D F' y `s BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System G �—� BUILDING INSPECTOR THIS CERTIFIES THAT........... .1.` . .. .................. ................................................................. ................... Foundation 40 Z has permission to erect .... buildings on ... ..................... ..... Rough to be occupied as....... ,A,,r .�i�. ..... ......./ .......5.... /.. ... ...... '...v.�! ► Chimney Ch' e provided that the person acce ting this permit hall in every re.0*4spect conform to arms of the 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 ELECTRICAL INSPECTOR UNLESS CONSTRU T TS Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. F NORTH TOWN OF NORTH ANDOVER �2o`4tte° ; OFFICE OF BUILDING DEPARTMENT * RL4 1600 Osgood Street Building 20 Suite 2-36 North Andover Massachusetts 01845 �SSACHUSE� _ Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please print DATE:- 02 0 " M�`Y 041 JOB LOCATION: Number Street Address Map/Lot HOMEOWNER f Vl I��I 19 M 1- G" O C f=� 7S- 6 U 3 0 7 / �7�( l'3 z1_3 $Name Home Phone Work Phone PRESENT MAILING ADDRESS V t j ty 5c u\7 S 00 LF �(� City Town State Zip Code 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 requirements and that he/she wi comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVALOF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 ve /--NN ON � rl vi G S .. 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