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HomeMy WebLinkAboutBuilding Permit #369-15 - 15 CAMDEN STREET 10/17/2014 L tkORTH BUILDING PERMIT 01 (LED 16 TOWN OF NORTH ANDOVER 02 hf. • ,`_^.,'6 0� APPLICATION FOR PLAN EXAMINATION T b T C O y I,, �• OQ Permit No#: 1- Date Received TEo 00 (� , ACUS Date Issued: l dl IMPORTANT: Applicant must complete all items on this page PROPERTY OWNERtic. 2e` �-�z�r # s` Pnnt -100,Yeas Structure' yes r IMAP" PARCEL 0 -I4� ZONINGiDISTRICT _-iHistorie�Dist ict yes 3 r• _ ;Machine Shop Village TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building G5LQne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial $Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Floodplain � yWetlandsT � Ffa � k1lVatershed:Distnct ❑ Septic _ � -�[]_"�_1Nater/,Sew_er`� • � r � � =,�d :x �._^� DESCRIPTION OF WORK TO BE PERFORMED: z �1, P(C U ^ Z- 2 QAQ W 01 A- o.,";w z�s, —►tj4 ar, r�G V�Q.N '�y v�61 h ��,1 d V' ?�^� C,iI�v�2�✓^ �t''� Identification- Please Type or Print Clearly OWNER: Name: �t cA-\ �-A 4- L2uv� R 0ytJ.i Phone: -a3 7� Address: s r si3 rye e Contractorin 7 Name iPhone � ryfia � -:t�� `titin ♦ s `�- a '�� .:k !* �' �L• � •w •p 6 T 3 � , = ,�Supervisorjs'Construction License y'f a` tiExp ®ate .� F, Nil o."meImprovement License 3*4 3Exp� #Date E ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ v DO FEE: $ I U � Check No.: I " Receipt No.: — NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner. Signature of contractor Location ��it. Y✓l 1 -- I `� ,-�` Date No. f i aaJJ / J . - TOWN OF NORTH ANDOVER • s�C PL'�bI6y� . Certificate of Occupancy $ Building/Frame Permit Fee $I QA -, Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# "-�uilding Inspector { x, Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE'OF SEWERAGE DISPOSA Public Sewer Tanning/Massage/BodySwiumning Pools ❑ Art ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes PlanningBoard Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIREDEPARTMENI'sr TempDumpster'onisite ayes ' - ° no X z tLocatedat,124�Main Street r Er �_ �` ,� FreDepart men t;signature//date ' u _ _'v r� COMMENTS:.. -;2',�. _°a _ r •, �p£� 6 nrK ayo T€1 OF NOBSTU AND O EP, a OBFICE OF _ BUMDNGDEPARTAWNT • ' Q44 .1600Dsgood5`treetBuil& 20,•Snzto236 7 S�ACHU5��5 North A•a.dover,Massachnsetts 01845 , Gerald A.Brown � Telephone(978)58$9545 Inspector of Buildings - Fax (978)688-9542 ROM b WNER LICENSE EUNIPTION • 131ease print , DATE: [A OCT jc)'A )3 LOCATION: is- ' ' -CA �j ��� Number S:treetA.ddIess OMOER i-c VN 2 l L z v v-eN f21�N 31 s1-3- �`t6 3 Name. . Home Phone 7o/ Work Aona PRESENT MAziNG ADDRYISS .a O 1 a 2 v-\, t't or,) s� a MA aa � 7� C�1111-m�r_. lip Cod_ The current exemption for"homeowners"was extended to i to allow su:h 3,omPo;,- - _ nchide ownez occupied divallings to two units-0x less and ueas�o engage an?hdividual'forliire wllo does notpossess a licerrse,provided that the owner acts as supervisor). ,8=,ate3ulding (Code Section lt)8.3.5.1) DEFMJ-1'.I0N OF HOMEOWNER Persons)who Awns aparcel of land on whirl;he/she resides or intends to reside,on or is infended to which there is, h&,a one or two faiaily structures. A.p erson who constructs more that.one home i .a two_y rperio d shall not b a considered ahorneowner, The undersigned"homedwner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by laws,rules and-regulations. The undersigned"homeowner"cortifies that helshe understauds the Town of 14orth„AndoverBuilding Depaffinent Minimum inspection procedures and requirements and that he(she will comply with,said procedures and requirements, HOMEOWNERS SIGN-AT APPROVAL OF BUMDMG OF'.l-r'.ICIAL Revised 7.2009 FormHomeowners Exemption ')3OARI]OFAPPFALS 688-9541r 00115ERVAITON 688-9530 I3EALTH 688-954Q PL.k,NNWG 6889x35 Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: `���� S 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 Call Email 3 Date Time Contact Name Doc.Building Permit Revised 2014 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 ❑ Floor/Cross Section/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 ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ 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 Doc:Building Permit Revised 2014 NORTF{ Town of s _ Andover No. * - �h ver, Mass, A_oA 1041 114 COCHICHEWICH y� U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ..............!..'..'..Y................................ .Y�..�............................, Foundation has permission to ere ........................4. uildings on ...11C........ . .!!�..e{. ...... . ................. Rough to be occupied as ... &I!! & 9 '0 4 .......t'.6*�� 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 6 MONT ELECTRICAL INSPECTOR UNLESS CONSTRU ST S 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. ne CommonweaM o,�'ffaff,�achuseMy ~ Depart iea • , Office offAvesfigaflons ' 600 WashingtonSimet Poton.,.ltd 02111 mmmassgov1dia �'��c�e��'tCampex���io�.J�n�n���.c�1xc���rX.�:Sai�c�erce�Co�.�ac�orc�l.�ce�r��c�a�,sl�'�iiu�c�re�•,� App gapt ox�vatzox� 'Xase 'rx+ abXy Name(Buswoss(OrgadzagonJly&Idizal.- i_1 � C���c �j\ �RUQ 1 ' Address: ! 5 C 2 vK (I eN S 4- Wb3' 6 C�-�r���at�I����av`� A-� �w•2 .axe you an employer?Oeektbi)approprzatebox. Type,of project(r�erZuirecZ�: �, d x am.a genud conttox and racF 1.[� Z am a exnplopex with_______� €. ��'ew c6nstruc�ort y have DAadtha sub-contractors empZopee�(�an�(oxpar�time�T lis�edontfteatcachedsheef� 7• �I�emadeling -h2� ��-� 2.E] 1amasolepxopxietoxoxpaz aex~ These sul7-eontraetoxshave 8. DemoZitzon Cou ' BMP and`haveno.employees working forme in any capacity. workers"comp.insurance. 9, }�Buizding adciition PTO worI<ers'comp.fiance ox Q�1e axe a coxpoxatlon and its 10.�EZectricaZxepairs ox additions- xeciuixed, officershave exercised.their 3 am a he mooW]ler doing allwork light ofexemptionpexlt/lGl� 11.�pXumbingzepairs or additions mpselF. yowoxkexs'comp. o.152,§1(4),andwehaveno 12.0Pwofxe�rais insuxartc�xe ed. employees. Nowoxkers' 13.[1©thex comp.l uxanooroq ted.] applimtthat checksbOXIAMnStArofill. nitheseetionbelovrshovaingtheirvrorkers'aompensationpolicvinfozrnation. i I�omeov,�nersv,Tha suhmifttaisaf�tdavitmdicafingiiley2'redpingalZt�orkandtbeuhireoufsideconixaeforsmus�snbmi�anew'af�Zdagi�indicaiuigs'ucb. Un-dractomthateb.CckINbOM UStatta�hed'sadditionalsbeeEshowingthenameofthesuh-coj&actorsandthekworkers'comp.poHcyinforraaiion. atrz ax2 exn �oy�Y that i p avicXir�gYra e 'eampe isafzan znsr�r ar�e6f0? Aye?groyeey. .Below b9epoliey anclJoh site era,fpa�rnatio�2. . Lnsuxauce CoYnpanyName;_ Z'olicp#ox�e�ins.�c.#: Expzx�tzonDate: ' Sab;Site Aftesg: Czty�State/dip; Aff aeb,a Copy OXfke woAerS'comp ensationliolxcy cleclaxa-Um page(showing.the policy number and expkatzoa date,. aiiure to secux coverage as xecZuixed under;3ection 25 of 1ViG�,o.x 52 can Zeadto tb e imposition of eximinaZ lienaXties of a i~ttte to 1,500, 0 and(ox one-peax impxisornnent�as well as rhAVen:aRles xn the foam of a STOP-WOR T ORDER and a fn e ofupto$25Q.Qoaday againstthaviojator. Eeadvisedthatacopyoftbi statementTnaybafozwardcdtotheOfficeoz• 3'nvestigations ofthe I)U for ii'lmance.coverage variftcation. i�0 IieXeby Cer fcf 11[�iL el't�2e_tairts anct penattieg oJ.,veP.iy ttiat tfto iT2, orriizatio7Z vroa 0 rs`t7 rFe an[ Co d`BeE`, Si afore• Data: CG, 0 �'iZone#: QffrciaZ use mly. .Do riot-Write in triiq area,to be conOked by city or town offtciaf +City or Town: �'ermztl�iceztse DsufngATAurity(circle ORO 1.Board of)aealth.2.Z3uilt ugPepartmed I CAYMoym Clem 4.Electrical fnspeetor S.Numbiugfttspectox 6.Outer - - - information and Instruction Massach�zsetts GenexalLaws chaptex152xequixes atlemployexstopxovidewoxkexs'com�pensationfoxthei�employees. Puxsuaat to this statrxte,an e r� roye9 is defined as",.,evexgpexsort lithe service of another index any contract ebixe,, express or nOoci,oxal ox wxltteae, Alter pray is defined as"an individual,paxinexship,association,coxpoxagon ox otbex legal exfi€y,ox aoy ro oxxnoxe' . offheioxego�tgengagedina�ointenfex-prise,andzucZudingtheXegalxepxesentati.�eso�a•cieceasede�n. i e�°.oxthe receiver oxtnisfee of an WividualI partnership,associaflou or other legal entity,employing employees, l�owevexihe owxter of a dwellinglzousehaving�.otxetoxe-th.anflitee aparknents and-s�lzaxeszdes'�hexein,oxtbe occupaotot'tlte dwelling l ouse of another who employs persons to do maintenance,construction oxxepaix woxl on su6R dweltin-g house or?Atha grounds oxbui&g appuxLenantthereto shallnot because of such employmentba deemedta be an exaployer:" MGL chapter 152,§25C(6)also states that"every sfate or local licensing agency shall withhold the issuance or renewal of a RUM ox permit to operate a business or to consfxuct haUdfngs in the commonwealth for any applicant who has iter produced•aceeptable evidence of compliance with the insurance coverage required." Additionally;MOL chapter 152,§25C(7)stafea'Weither the commonwealth nor any of its political subd ml low shall enter into any confractfor flea pexform=6 ofpublxc workuntzl acceptable evidence of compliance with tho insurance xequirements oftbis chapter have beertpresentedto,the cgutractingauthority;" Applicants Please fal out the woxkexs'camp Bus4on affidavit completely,by checking the boxes that apply to your situation ani if necessary,supply Mb-eonfractox(s).Ua�ne(sj,addresses and phone, s aloe 7nsux=0. 'e . . . � � (� gwzth.theix certificate s of Ltm�.t dLtabtltty Companies(LLC)oxL7mxtedLiaWPar1nerships(LLl?)withno employees othexthan,the members oxpartners,aren.otxegairedto canyworkers'carnpeMgoniasuranGo. 1fanLLC or UP doeshaot employees,apolicy is required. Be advisedthat-&ie afdavitmay be mbmitcedfo theDepar[rnent of Industrial Acoidents fox confirmation ofiusmance coverage, .Also be sure to sign and date the aftzdavii the affidavit should hexeturn.edto the city or town fhatthe applicaf'tonfoxthepomlit orlicenseis bekgxeque9ed,stottheI)4artm.ent of fadusfrialAcoldents. Shouldyo-a have any cpasacusxegardingthe law oxifyouarexecpkedtaobfaka*oAms' eampensatzon olio lease calltheDq a P Yip p xbnent atth rnzmber listed 7ielow. Se7&msirxerl companies sh VId enter their • self insurance license number on tha a xo riate line. pp P City ox'l:`owxt Oncials Pleasebesurethatthea��izdavztzscompleteandpxintedlegibly. TheDepax,�n.entbas�pxovldedaspaceattliebotiom ofthe of &-vitfoxyoutofilt o-utiuthe eventthe Office offavestigatlonshasta confactyouxegardingtbeap jzcant Please be-sure to z"i1l inthe pem�t/ficense number wliicb.will be used as a xezexence number, Tn.additiort,art applicant thatxnustsubmit.multiplepexmitllicense ap licafions io,an lucre e e p ar n ed onls y g y sub y mit one az�davrt go utxenG PORGY allfOM2afion(jfnecessaxy)and under"Yob Site Address-the applicant shouldwxife"all locationsin (city or towtt�"A co yoftTieafCtdavltthathasbeonofaciallystainpedoxmarkodbythecityoxfow-amaybepxov.6dtotho applicantaspxaofthat avalid afz"davit•isonftle�or'MUI epermitsorlicenses. ,AnevTazfidavitmustbe edouzeaclt year.where altorae owner or citizen is obtawng alicense oxpenn tnotxelated to anybminess or commercial venture (i.e.a clog license oxpexmR to bWM leaves etc)saidp exson is KOT xegi&ed to complete this affida ft The Office of l vesdgafions`would Rko to thalk you in advance for your•cooperation and should you have any questions, " please do uothesifate to give us a call. The.Depa itnenf s address,telephone atd fa-Knumbar. na Coiroil. .Mpaxben Woe QfjNVuffgAVoA4 6Q �silxe Revised 5-26-05 FRI 7-7749