HomeMy WebLinkAboutBuilding Permit #702-14 - 15 WOOD LANE 4/10/2014 r�1 CI NORrh
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BUILDING PERMIT
Za— l TOWN OF NORTH ANDOVER0400
APPLICATION FOR PLAN EXAMINATION
Permit N Date Received
Date Issued: o 114
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IM ORTANT:Applicant must complete all items on this page
LOCATION i5- V1 WQa� AVenroe. Q,ANDvv0R ; M�4 01 (14 Li;
pt
PROPERTY WNER PA c� e `I�ri rint
Print
MAP NO: PARCEL„ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building 0 One family
❑Addition R*rwo or more family ❑ Industrial
CKAlteration No. of units: a ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
0 Demolition 0 Other
0 Septic ❑Well 0 Floodplain 0 Wetlands ❑ Watershed District
0 Water/Sewer
vko dA`t: n! K: C\nQA- 1iAJ'2 � ) inn �+ Cov.. er
1 i � 1 re�lAc;tiS
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Identification Please Type or Print Clearly)
OWNER: Name: M C'VxA e.. I�oC 1A Phone: '-i 101,
Address:
CONTRACTOR Name: Phone:
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT.•$1200 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ 911,000 FEE: $ ��
Check No.: UM Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/OwnerPJAC-,Signature of contractor
Plans Submitted ❑ .. Plans Waived❑ -Certified Plot Plan ❑ Stamped Plans ❑
.'TI'BE OF SEWERAGE.DiSi?OSAL
Public Sewer ❑ Tanning/Massage/Body
Art ❑_ Swimming Pools ❑
Well ❑ Tobacco Sales ❑
Food Packaging/
Sales ❑
Private:(septic tank,etc._
Permanent D4npster ori-Site ❑
THE.FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF U FORM
_ DATE REJECTED: DATE:A_PPROVED
PLANNING'& DEVELOPMENT ❑ ❑
I
COMMENTS 1
CONSERVATION Reviewed on Si nature
COMMENTS
HEALTH Reviewed on
Signature
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
i
Conservation Decision: Comments 1
Water&Sewer Connection/Signature Daae
Driveway Permit
DPW'Tom;: Engineer: Signature:
FIRE DEPARTM► Nj�: _Temp Du sten on site Located 384 Osgood street
Located at 124;Mair;Street: p y@5.... _ no
Fire Depaitme►iflOg-mature/date ,.• ,
COMMENTS
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.Z®NE LITERATURE: Yes No
MGL-Chapter 166.Section 21A--F and G niin.$10041000,fin.e
NOTES and DATA—(For department use
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IIS
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® Notified for pickup - Date
Doc.Building Permit Revised 2010
r
Building Department f
The foh`owing is of list ofAhe required farms to be filled out for.the appropriate permit to.be obtained.
Roofii•acg. , Siding, Interior Rehabilitation Permits
e
o B,ailding Permit Application
o Workers Comp Affidavit
L3 Photo Copy Of H.I.C. And/Or G.S.L.- Licenses
o Copy of Contract
o Floor Plan Or Proposed Interior Work
o 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
o Workers Comp Affidavit
E3 Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Mass check Energy Compliance Report (If Applicable)
o 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
o Certified Proposed Plot Plan
o Photo of H.I.C. And C.S.L. Licenses
o 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
o Mass check Energy Compliance Report
o 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 apn;gal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be subm.tted with the building application
i
Doc: Doe.Building Permit Revised 2012
Location
No. _ Date
r
r p - TOWN OF NORTH ANDOVER
0
o
Certificate of Occupancy $
Y� Building/Frame Permit Fee $ 61
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#
2 7 t, J 7 ilding Inspector
North Andover Board of Assessors Public Access Page 1 of I
NORTH NorthAndover Board ofAssessors
sAckus� U44property Record Card
Click Seal To Return Parcel ID :210/073.0-0038-0000.0 FY:2014 Community:North Andover
SKETCH PHOTO
Click on Sketch to Enlarge Click on Photo to Enlarge
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Summary _- - �'
Residence
Detached Structure
Condo 15 WOOD AVENUE
Commercial
Location: 15-17 WOOD AVENUE
Owner Name: VENTRILLO,JOHN
C/O VENTRILLO LIVING TRUST
Owner Address: 15 WOOD AVENUE
City: NORTH ANDOVER State: MA Zip: 01845
Neighborhood:5-5 Land Area: 0.32 acres
Use Code: 104-TWO-FAM-RES Total Finished Area: 2242 sqft
ASSESSMENTS CURRENT YEAR PREVIOUS YEAR
Total Value: 337,100 350,1.00
Building Value: 168,200 181,200
Land Value: 168,900 168,900
Market Land Value: 168,900
Chapter Land Value:
LATEST SALE
Salc Price: 0 Sale Date: 12/31/2046
Arms Length Sale Code: N-NO-OTHER Grantor:
Cert Doc: Book: 00702 Page: 0294
http://esc-ma.us/PROPAPP/display.do?linkld=2436870&town=NandoverPubAcc 4/11/2014
Enter construction cost for fee cal- North Andover Fee Cakulat%on
Construction Cost
$ 81000.00 m
$ - $ 96.00
Plumbing Fee $ 12.00
Gas Fee 100 comm. $ 100.00
Electrical Fee $ 12.00
Total fees collected $ 220.00
15-17 Wood Avenue
702-14 on 4/10/2014
2 Kitchen Remodels
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Town of E :_.,,
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16
No.
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COCNICM�- ��•
X11,45 q�reo 'kPp��S
Ll BOARD OF HEALTH
P.ERMIT T LD Food/Kitchen
Septic System
THIS CERTIFIES THAT ........ � G BUILDING INSPECTOR
.............. ..... .........................
���j Foundation
has permission to erect .......................... buildings on ...I.Ir...... ......YYDa...................
.. Rough
Pa-
to be occupied as ..... . .. .......... '.. ....... ........ .............:............. chimney
provided that the erso c� tin this ermit shall in eve respect conform to the terms of the application
p p p g p rY p 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
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 M NT ELECTRICAL INSPECTOR
UNLESS CONSTRUCTIO S Rough
Service '
................... ....................................................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Reguired 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.
i
I
The Commonwealth of Massachusetts Print Form
Department of Industrial Accidents
Office of Investigations
I Congress Street,Suite 100
Boston,MA 02114-2017 li
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): C U C p
Address: 1-5 Ave
City/State/Zip: No r AN) A ti A oo e 0rgu5 Phone#: 6 1 3 6 y I o2
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 I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. §R<emodeling
ship and have no employees These sub-contractors have g. ❑Demolition
working for me in any capacity. employees and have workers'
[No workers' comp.insurance comp.insurance# 9. Building addition
�
equirefl 5. ❑ We are a corporation and its ME]Electrical repairs or additions
3. I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. ' right of exemption MGL
y �o workerscomp. on per 12.❑Roof repairs
insurance required.]t c. 152,§1(4),and we have no
employees. [No workers' 13.❑ Other
comp.insurance required.]
*Any applicant that checks box 41 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 state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp,policy number.
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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby cern under the airs and enalties o e 'u that the in ormation provided above is true and correct
- bo - —-— -
Si afore: Date
Phone#:
i
Oficial use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
f µORTH TOWN OF NORTH ANDOVER
0 OFFICE OF
A BUILDING DEPARTMENT
s x 1600 Osgood Street Building 20, Suite 2-36
6''"""'"' North Andover,Massachusetts 01845
twito
�SS�1tHU$F4
Gerald A.Brown Telephone(978)688-9545
Inspector of Buildings Fax (978)688-9542
HOMEOWNER LICENSE EXEMPTION
Please print
DATE:
JOB LOCATION: 15- 1-1 WOOD AV E
Number Street Address Map/Lot
HOMEOWNER 1'�%C\A A e-.) a C`n f q-1 B-6 9-9-L`3 3�{ co n -:3 05- 6 y 13L
Name Home Phone Work Phone
PRESENT MAILING ADDRESS 1`S W o ot5 A4 e.
1\j v t'��n ,y � c v e r AAA o t o L-og
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 will comply with said procedures and
requirements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Revised 10.2005
Form Homeowners Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535