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Home My WebLink AboutBuilding Permit #250-2017 - 154 DUNCAN DRIVE 9/8/2016 iz BUILDING PERMIT o* NORTy q ,fit LES "6 TOWN OF NORTH ANDOVER •6 0 0 APPLICATION FOR PLAN EXAMINATION * _ � 1 c Permit No#: Date Received �SSHcHus Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION /2 r Iyt `� Print PROPERTY OWNER 5i-t ' (- Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building i6ne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial KARepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands p Watershed District ❑Water/Sewer r DESCRIPTION OF WORK TO BE PERFORMED: trY ov a-f a II 41V00m - f lol�t Q 2:6 4 , Va 11 Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email: Address: ""N Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$9200 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ , O FEE: $ Check No.: I Receipt No.: ?�� ql NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 1 Location No.�L� >�` '" �j�'f � Date jJ • - TOWN OF NORTH ANDOVE � x y Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ '" Other Permit Fee $ TOTAL $ Check# e Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ SwilMing 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature :OMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes t. Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIREtDEPARIMENT TempDumpst n;s r� ite .;yeses ino 7 `y Locatedlaf°,12,41MainrSteet - - -- - Fire�Departinentsi'gnature/date _ COMMENTS i 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) I i ❑ Notified for pickup Call Email 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4 Building Permit Application 4, 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) � Building Permit Application 4 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 NORT1i Town of 6 ndover O - to No. jWJ017 * , a, �o h ver, Mass, v -blipcocNicHewrcw �1' s U BOARD OF HEALTH Food/Kitchen PERMIT11 LD Septic System THIS CERTIFIES THAT .............. :l�1. .. ... .... . �!' ,,,, ,,, ,,, ,,,. BUILDING INSPECTOR ..... .... ..... ... ..... .. Foundation has permission to erect .......................... buildings on .. .. .. ..... .. .� .......low ...... Rough to be occupied as ...........rIca .... .................................................... 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO T T Rough Service ...... ... ...... ..... �G�i ............ Final B ILSPECTOR 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. o TOWN OF NORTH ANDOVER � s OFFICE OF } BUILDING DEPARTMENT - 1600 Osgood Street Building 20, Suite 2035 North Andover,Massachusetts 01845 Gerald A. Brown Telephone(978)688-9545 Inspector of Buildings, Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION ROIDINO PERMIT APPUCATtON Please print DATE:q(z J � & JOB LOCATION: U n 64.4,1 oue Number Street Address Map/Lot (t HOMEOWNER Ju-i r t p kDuvS;' G'78 c7 -7 L/ a- Name Home Phone Work Phone PRESENT MAILING ADDRESS SSI�V LGr' l� y1 N. Uyor,,— M A C) el-IS City Town State Zip Code The current exemption for"homeowners"was extended to include owner occupied dwellings of one or two family dwellings and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. 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 dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner.(780 CMR Section 110.R5.1.2) The undersigned"homeowner"assumes responsibility for compliance with 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 Deparhnent minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. - HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL i Revised 8.2015 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 6S8-9530 HEALTH 688-9510 PLANNING 688-9535 �+ TM8 Commonwealth of Mass chusetts ..Department offr dustrialAceldents - = 1 Congress Street,Suite 100 .Boston,HA 02. 14-2017 7vwv mass govlaza Wovkers,CoxnpensationlnsnxanceA-Mdavit:Builders/Contiractors)Elgq#icims/Pluonbers. TO BE X+`ILED WfM TEE PI Rte" G AUTHORITY. A licant�oxnration Please PriD.t Le�ibl Name (Business/Organizaiionllndividna7): u I _ �Ce. ►kD w S Address: I Sv La r city/state/zip:- V)o jI , o 'hone Areyou an employer? CheckfIie appropriate box: Type of project(Tqd-[&td): 1.n I am a employez�vith s employees(full andlor part time).* 7,• F] ew Co on 2.�I am a sole proprietoror Pmtaersbip and have no employees-working forme in $. Remodeling any capacity.[No woikers'comp.insurance required_] 9, ❑Demolition 3FJ I am ahomemmD.Tdoiagall workmyself_[No workers'eomp.ansuranee required.]i 10 Building addition 4.[ Iamahomeownwandv,, bebiringcoafraeLorstoconductaliworkonmypropaty Iwill ��''"ensure fha.all contactors either Dave workers'compensation insurance or are sole 11.E]Electrical repairs or.additzon s propietnrs wf,no employees. 12 []Plumbing repairs or additions 5.n I am ageneral contactor and lhavehiredthe sub-contractorslisted oatbe attar- d sheet Roafrep airs Thesesub-omtactorsha employees andhaveworkws'comp.mstuaace. ' 14.[]Other • 6.Q Weareacorporation:andzEso�ceshaveegercisedthesrightof'exempiionperl�(iGLc. _ 152,§1(4),andvTehaveno.einployees.[No workers'comp.insurance required.] •:Any applicantthat checksb6M must alsozfrII outthe secton below showiugthe rworkam'compensaionpoHcyinformauen. T Homeowners who subbi±-kT s affidavits adicafingthey are doing allwork a adthenhire outside contractors mast s4bmit anew affidavit mdicatiag such. Contractors;hat check-&is box.must-Waclled an additional sheet showing flip name of the sob-contractors a_nd state whether ornof f ose entities have employees.Ifhe sub-cariiracfors have employees,tliey musE pravidetheir workeis'comp.policy number. I ct;`re an eYriployer tfz at ispiDl ad g-workers'coYnpensataon insuYance forYny eTJT16yee.s'BeZoit7 is the policy aYid job sate inforvazation. Insurance Company Name: Policy.#or Self ins.Zic.#: ExpirationDate: lob Site Address: City/State/Zip: Attach,a on copy of the workers' coxapeWatipolicy declaration page(show-tagthepolicynumber and expiration date). c 52 25A is a criminal violation punishable by a fine up to$1,500.00 c ecovsr easre iiiredunderMGL . 1 , § Failure to se ur � q X0.00 a and/or one-year impa-isonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$2 day against the violator_A copy of this statement maybe forwarded to'the Offica of Investigations of the DIA for insurance coverage verification. X do hereby certify under the pains and penalties ofpetJzzry tlza-tthe infonnedion provided above is Prue and correct Siature: Date: Phone#: Official use only. .po not-write in this area,to he comuleted by city or town offaciaL. City or Town: Permit(License# Issuing Autb.ori:ty-(circle one): i 1.Board ofLtealtTa 2.73uiXdiugDepartment 3.City/Town Clerk 4.Electrical Inspector 5_Plumbingluspectox 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Puxsuantto this statute,an employee is defined as"...every person in the service of another under any contract Mhtre, express or implied,oral or written-" An employer is defined as"an individual,partnership,asso ciation,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver-or trustee of-au individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the 1 dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house f or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or to cal licensing agency shall withhold the issuaxace or renewal of a license or permit to operate a business or to construct buildings in the commonwealth;Lor any applicant-v who lias not produced acceptable evidence of compliance-vvith the ixasux•anee coverage required." � Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall- enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please filI-out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub=contractoi(s)name(s),addresses)and-phone m nber(s)along with their cezti6.cate(s)of insurance. limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees'other than the members orpartners,are uotrequiredto canyworkers' compensationinsurance. If an=or LLP doeshave employees,a policy is required. Be advised that this affidavitmay be submitted to the Department of-Industrial Accidents for con-f ation of insurance coverage. Also be suxe to sign and date the affidavit. Tlie affidavit should be retumed to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law 0-T if yoiu'are xega'#ed to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insure_d.companies should'enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill inthe permit/license number which will be used as areference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessaty)and under"lob Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year.where a home owner or citizen is obtaining a license or p emit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 TeX.# 617.727-4900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/d7a