HomeMy WebLinkAboutBuilding Permit #989-2016 - 156 CHESTNUT STREET 3/22/2016 L
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�I II n I BUILDING PERMIT o�<t�eD "�0
TOWN OF NORTH ANDOVER 0 p
APPLICATION FOR PLAN EXAMINATION
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Permit No#: I Date Received °RATE°
Date Issued: Z
I ORTANT: Applicant must complete all items on thisa e
P g -
LOCATION / C ( i,tes: -
int
PROPERTY OWNER !,1
int 100 Year Structure es
MAP PARCEL: _ .� ZONING DISTRICT: Historic District yes no.
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
ElAddition ElTwo or more family ❑ Industrial
Iteration No. of units: 3 ❑ Commercial
C epair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
El Septic ❑Well ❑ Floodplain ❑Wetlands ! ❑ Watershed;District.
[dater/Sewer _
DESCRIPTION OF WORK TO BE-PERFORMED:
J o mom- wa
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4T h1 e e ft/1��l �'�T"�1.� i GA�l P 7� t 1 efl L
MA T
Identification- Please Typr or Print Clearly ���J���
OWNER: Name: and Phone:
Address:
[EEmail,:.
ntractor Name:_ _ __-Phone:
d'ress:
pervisor's Construction License: _ - Exp. Dateme Improvement License: _ _ Exp. Date:-
ARCH ITECT/ENGINEER
ate:.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.
0 000 FEE: $
Total Project Cost: $
Check No.: I Receipt No.:
NOTE: Persons contracting with unregistered contractors do not ave access to the guaranty fund
ignature of Agent/Owner ._ Signature of ntractor _
C'4
Location
No. � i " d�� Date
t t1
• - TOWN OF NORTH ANDOVER
Sf Pa��'S` aceta ��
ax Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check# w
,� ; Building Inspector
J �
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ I
TYPE OF SEWERAGE DISPOSAL
Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools ❑
Well ❑ ❑
Tobacco Sales Food Packaging/Sales ❑
Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑
II
I
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
I
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
I
Planning Board Decision: Comments
Conservation Decision: Comments
Water& Sewer Con nection/si nature& Date Driveway Permit
DPW Town Engineer: Signature:
�-- —
! FFRE DEP J-.� - - 4
s _ ATMENT TernpDumpster ora�site eyes n'oa�
Located 3 Osgood Street
Located,af t24tIVlainfSfre'et
Fire Department sgnature�date
t O'MMENTS -
_ L
Dimension
Number of Stories: Total square feet of floor area based 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 Pennit 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
Sprinkler Plan And
❑ Two Sets of Building Plans (One To Be Returned) to Include S p
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
Enter construction cost for fee cal - North Andover Fee Calculation
Construction Cost
S 30„000.00 m
$ - $ 360.00
Plumbing Fee $ 45.00
Gas Fee 100 comm. $ 110,:10:0)
Electrical Fee $ 45.00
Total fees collected $ 550.00
156 Chestnut Units 2 and 2A
989-2016 on 3/22/2016
Renovate Units
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� NORTI�
T® ® . : _ : t' Andover
No. 9S
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A- COC MIC Nl WICM
7.�s R�ttED Pp�'��y
U BOARD OF HEALTH
Food/Kitchen
'PERMIT T LD Septic System
THIS CERTIFIES THAT BUILDING INSPECTOR
........ .. .. . .. .. .. .. y :..... .. ... ..........
. Foundation
has permission to erect .......................... buildings on 1%... ....................-.,............................. ZA
Rough
to be occupied as ...........1:��. .0...........V �' .. �!'!, ..` �.. !!��� Chimney
provided that the person accepting this permit shall in every respect conform to he terms of the application Final
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspect' ,Alter tion and
Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR
&IOWA
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit. � �f
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION STARTS 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.
ate, TOWN OF NORTH ANDOVER
ap � � OFFICE OF
_ BUILDING DEPARTMENT
D 1600 Osgood Street,Building 20, Suite 2035
+1 North Andover,Massachusetts 01845
Gerald A. Brown Telephone(978)688-9545
Inspector of Buildings Fax (978)688-9542
HOME-OWNER LICENSE EXEMPTION
BUIDING PERMIT APPLICATION
Please print
DATE:
JOB LOCATION: 1 $ ( C I e STIJ LT A
Number Street Address Map/Lot
HOMEOWNER PAP4#4 9 R 111 A-K -- �, _
me 146me Plione Work Phone
PRESENT MAILING ADDRESS j S l C A0777-Ae ,' j-� l2-
D Ao �
City Town State Zip Code
The current exemption for"homeowners"was extended to include owner ocrupied 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 I I O 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 Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
HOMEOWNERS SIGNATURE W
APPROVAL OF BUILDING OFFIC
Revised 8.2015
Form Homeowners Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
The Commonwealth of Massa.chusetts
Department of IndustrialAceidents
-= tl 1 Congress Street,Suite 100
Boston,MA 02114-2017
www mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please PrintiLegibly
Name(Business/Organization/Individual):
71
Address: /0
City/State/Zip: �'T9/y�d�L`'� /� Phone#:
Are you an employer?Check the appropriate box: Type of project(required):
1.❑I am.a.employer with employees(full and/or part-time).* 7. ❑New construction
2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ElRemodeling
capacity.[No workers'comp.insurance required.] ❑Demolition
3.[ m a homeowner doing all work myself.[No workers'comp.insurance required.]t
9.
/ ❑4.�j�(I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition
i* ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5. 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet.
❑ 13.E]Roof repairs
• These sub-contractors have employees and have workers'comp.insurance.$
6.❑We are a corporation and its ofiicers.have exercised their right of exemption per MGL c. 14.❑Other
152,§1(4),and we have no.employees.[No workers'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 submif 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.
lam an employer tliat 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 MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
Ido hereby certify under the pains and penaltie ofp ry tliat thein ma n provided above is true7ad correct.
IfI
Si ature: loe
Date: �
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#:
Information and Instructions
Massachusetts General Law chapter '
Laws a er 152 requires all employers ers to provide workers compensation for their employees.
P q p Y p P , , , ,
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,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 an 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
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
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 local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance 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 fill-out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned 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 or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured 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 in the permit/license number which will be used as a reference 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 necessary)and under"Job 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. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to burn 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
Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 02-23-15 www.mass.gov/dia
RypRYFI .
o P" NORTH.ANDOVER BUILDING DEPARTMENT
�RSTED �y 1600 Osgood Street
�ssacwus�
North Andover
Tel: 978-688-9545
Fax: 978-688-9542
.BUSINESS FORM FOR TOWN CLERK
DATE:
NAME: 'c'
Yna �c� IeS Com .
ADDRMS;.
ZONINGDISTBTOT:
I
TYE OFJBUSMSS: l0cfy)e�
BUMDING LAYOUT PROVIDED: YES NO
A7VAiLAT,LE PARKING SPAMS:
ZONI NG BY LAW USAGE: 'YES NO
UDLD G IN OTOR %GNA.TUTPIE
BUSINESS FORM FOR TOWN CLERK
2.40 Home Occupation:(1989132)
An accessory use conducted within a dwelling by a resident who resides in the dwelling as his principal
address, which is clearly secondary to the use.of the-building for living ptuposes. Home occupations shall
'include,"but�.ot'limited to the following uses; personal services such as furnished by an artist or instructor,
but not occupation involved with motor vehicle repairs, beauty parlors, animal kennels, or the conduct of
retail business,or the manufacturia g of goods,which impacts the residential nature of the neighborhood;
4. For use of a dwelling in any residential district or multi-family district for a hoarse occupation, the
following conditions shall apply.
a. Not more than a total of three (3) people,may be employed in the home occupation, one of
whom shall be.the owaier of the home occupation and residing in said diw1ling,
b. The use is carried on strictly within.the principal building;
c. There shall be no exterior alterations, accessory buildings, or display which are not customary
with residential buildings; -
d. Not more than twent,-five, (25) percent of the existing gross floor area of;the dwelling u_uit.
so used, not to exceed one thousand (1000) square feet, is devoted to'such use. In
connection with
such use, there is to be kept no stock in trade, commodities or products which occupy space
beyond these limits;
e. There will be no display of goads or wares visible from the street;
£ The building or premises occupied shall not be rendered objectionable or detrimental to the
residential character of the neighborhood due to the eAedor appearance, emission of odor,
gas, smoke, dust, noise, disturbance, or in any other way become objectionable or �
detrimental to any residential.use within.the neighborhood; '
g. Any such building hall include no features of design not customary in buildings for residential
us
Signature D
a