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Home My WebLink AboutBuilding Permit #238 - 15 COPLEY CIRCLE 9/27/2007 NORTH BUILDING PERMIT ,�' TOWN OF NORTH ANDOVER ~? "` op APPLICATION FOR PLAN EXAMINATION o Permit NO: Date Received 7 �9s q,TED SACHU`' Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Pant PROPERTYF:OWNER t MAP N0 0$1 PARCEL:Q 60UZONNINGriDISTRICT. �Htstoric District = yes . K. Machine'Shop'6Ilage yes no , TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family V/Addition ❑ Two or more family ❑ Industrial N Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic; ❑Welt 4k- I7 Floc dplain -Wetlands Watershed District P z r 3 'Udater/Sewer DESCRIPTION OF WORK TO BE PREFORMED: -A-CLO (Dn a'F dentifica ion Please Type or Print Clearly) OWNER: Name: -� j'l�'A°�r� Phone:(9,1,3 Address: i I G.1` IBJ CONTRACTOR Name: Phorie: , Andress 8upervisor'sConstruction1icense,: ," Exp. Dater � Horne Impravernent License:. Exp. 'Date: ARCHITECT/ENGINEER C!r "i Nass► Phone:��7 Address: 1 4-�6 PQP'R s' pur i'A' N. 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: $ 4 D f DOD FEE: $ /Z Check No.: � �— Receipt No.: @0(o 3�-- NOTE: Persons contract' wi unregi t red contractors do not have access to the guaranty fund Signature of.Agent%Owner Signature of contractor Location I �S C o o C' No. , Date 'P V ORT#j TOWN OF NORTH ANDOVER O, M"'O , ,h•C 3: • O JL 0 9 + ; : Certificate of Occupancy $ Building/Frame Permit Fee $ hay J4CMUSk Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # Building Inspector Plans Submitted LI Plans Waived ❑ Certified Plot Plan d Stamped Plans ❑ TYPE OF SEWERAGE DISPOSSArL Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools ❑ 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 DATE REJECTED DATE APPROVED PLANNING &-DEVELOPMENT ❑ ❑ COMMENTS D EJECTED DATE APPROVED X CONSERVATIO ( \ COMMENTS I Y� DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Y' 4 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/S9nature & nate Located at 384 Osgood Street Driveway Permit FIRE DE:PARTAIIENT - Temp Dempster on site yes no Located at 124 Main;Street F re 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 Pen-nit Revised 2007 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 o 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/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) o 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) o Copy of Contract o 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-64 A H""0 North;N-ndover, Massachusetts 01345 Gerald A. Brown Telephone(9?g)hg8-9545 Inspector of Buildings Fax (978) 688-9542 H0�IEOWNER LICENSE EXEMPTION Please print DATE:_ JOB LOCATION: ej e, Number Street Address - �„ Nlap/Lot HOMEOWNER CANES' � U.1`c�- 91� M - 11 L I 9 7$ I Name Home Phone WeeA Phone PRESENT MAILING ADDRESS SCUY*-L W1 ani NA C)1 a 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 Andovcr Building Department minimum inspection procedures req irements and that lie e will comply th said procedures and requirements. HOXlEOWNERS SIGNATURE APPROVAL OF BUILDIN OFFICIAL Rcvised io._1ous -- I;n'nt HuniLwancrs 1=,�cntplinn -OARDGF;1PFi=,;f.Sr,r,_q;.yl 1��'1I±V,� I�)Nn.ty-•sj31) I- °,;5 iF.\i._TH:::,,_;,.}i� f'L,��+NI�C: ;,` l� PA C, , s a� I rte. L(- e�,J�. �s coni P n ry °fo�:�.p Icy- po,1-oJ 1J t-o MUA,.- S Y CER71'FIED PLOT PLAN PREPARED FOR. JAMES SHEPPARD AT 18 COPLEY CIRCLE NORTH ANDOVER, MA. NORTH ESSEX REGISTRY OF DEEDS: BK. 5078 PG. 219 ASSESSOR'S MAP: 59, LOT 86 ZONING. R-3 (PRD) SCALE. 17-30' DATE.• SEPTEMBER 06, 2007 NOTEMEASUREMENTS ARE TO CORNERBOARD. o C'o 1? V� N Y 1 N�� i x/22.2' ' \ 15.0''u N /21.0' �cn EXISTING 2 STORY •�� 059' �WOOD FRAME. ELLING 20.7' U)N0. 18 12.7 _ w _ cri EXIST. rn p WOOD w 31.1'/ p 6.5' DECK, 10 7 40.5' 00 � fTl PROP. ADD'N. � 36.8' NOV LOT 12AAA 5262 S 14,828 SF. �tH°FSsgcy p0,'30• A� 7g Gfi 0� .Oh B O� N0. 35773 �SS7A1wL LAIDS.S� PREPARED BY JOHN ABAGIS & ASSOCIA TES, PROFESSIONAL LAND SURVEYORS 9 BARTLETT STREET, NO. 252, ANDOVER, MA. (978)-688-4899 JOB NO. 3533A NORTH Town of And 10 No. 07 "odover, Mass., COCMICMEWICK �1 7�ADRATED `s BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.............. !r!! ......... .. ...�P.................6.......................... ............................... """""' oundation has permission to erect........................................ buildings on .....l&......�.dp..�........C.�4............................... Rough Chimne to be occupied as.....l.O..x....6.t.$........�rtr ►.��!�..T....4#0.. W......................................................... y provided that the person accepting this permit shall in every respect conform to the terms 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 Z+� PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUC 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 BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information c I Please Print Legibly Name (Business/Organization/Individual): 1�'�-�' w � po t— � Address: I 'h �'T I �'l C_�,� City/State/Zip: N flf-c� t__� of'W'M'hone #: `�� (1i I- I7(I.,1 Are you an employer? Check the appropriate box: Type of project(required): l.❑ 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. 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 ,Cqured.]iofficers have exercised their ]0.❑ Electrical repairs or additions 3. am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions yseIf. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer �fy under the pains andpenalties ofperjury that the information provided above is true and correct. Signature: I WYE D.I� o,7 ry �� .ate: r o Phone#: 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.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: