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Home My WebLink AboutBuilding Permit #890-2016 - 157 WAVERLY ROAD 2/17/2016 r BUILDING PERMIT NORTF{ Ott LED q+0 16 TOWN OF NORTH ANDOVER �� y ' - ,.=6 APPLICATION FOR PLAN EXAMINATION y = Permit No#: tF/lam'^ -2 6 Date Received Sys R�rED�P��cS SACHUS Date Issued: c>27 f ' CI PORTANT:Applicant must complete all items on this page LOCATION `) U 0,04- 1-4 �/Print PROPERTY OWNER D f'-kc--, T i O v Print 100 Year Structure yes no MAP _PARCEL:—ZONING DISTRICT: Historic District yes o Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial J9Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other D;Septic ❑1Nell ❑ Flood lain Wetlands ,❑ G1NatershedhkDi, rice DESCRIPTION rOF WORK TO E PERFORMED: ✓� 1 a r^f i 1 o Y� U 4 i C, i Identification- Please Type or Print Clearly OWNER: Name: a +� r—SPhone: l Address: lb —1 ts,O-e Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ c6d0 0 FEE: $ r ®- try Check No.: I �Z' Receipt No.: S-a6 /7 NOTE: Persons contracting with unregistt reel contractors do not have access to the guaranty fund 1qna LII w , s 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 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 . 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 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 i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL f 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 - It 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 P1.nning Board Decision: Comments Conservation Decision: Comments Water& Sewer ConnectioniSignature Date Driveway Permit DPW Town Engineer: Signature: h Located 384 Osgood Street £x`# FIRE DEP,4R�TMENT ` Ternp ®umpsfer�onsitexyes= no 1gLocated at 1x24 Main Fire Departrnen�'�ignature/dater4 E 4aytK �� r► rr s .,." y ` '" � t ` z ssr Lt�� # !a ',� +' cn 7 t >. �d ♦ ;, COMMEIVTS�„ 'c,�' �:� � +� �•i� �; , ��;� �r;� �� o. -;us. .�. 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.$1oo-$loon fine NOTES and DATA— (For department use i i A ❑ Notified for pickup Call Email ' Date Time Contact Name Doc.Building Permit Revised 2014 II i 1 I i Building Department 1 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 i Engineering Affidavits for Engineered products OTE: 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 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 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 4. 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 NORTH BUILDING PERMIT oF�tLeo ,6 �tio TOWN OF NORTH ANDOVER �2 h�;i • ._'''•�6 APPLICATION FOR PLAN EXAMINATION + i e " Permit No#: /�� -2 6��' Date Received �4°°q,TEo ? A US Date Issued: 7 'IMPORTANT: Applicant must complete all items on this page LOCATION `) 0. 1-c f— I,,Print PROPERTY OWNER D ff G--) P� n Print 100 Year Structure yes no MAP fj _PARCEL:_ZONING DISTRICT: Historic District yes o Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ,oAlteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ❑Well Floodplain 'Wetlands .0 GUVate�shedlrDastnctx fl Water/Sewer DESCRIPTION OF WORK TO E PERFORMED: ✓� 1 `ri a�f i t tJ U Identification- Please Type or Print Clearly / OWNER: Name: rr� L -� Phone: Address: I -,) r Contractor Name: Phone: Email: Address: { Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: II� I 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: $ Oz�C� FEE: $ ®� Check No.: IZ- Receipt No.: � f NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 77 �. n, 7777771 V / I Location / 5 7 �Ja V- b �?67 No. �� 2 Date "Z • - TOWN OF NORTH ANDOVER � :, Certificate of Occupancy i $ Building/Frame Permit Fee $4°C Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#/ 30017 Building Inspector Location / t Oa vr, f o l No. ��_ d I�p Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy # $ Building/Frame Permit Fee t,,a-$<'Q Foundation Permit Fee $ •� Other Permit Fee $ r f• TOTAL $ Check#/2 f Building Inspector Location No.-,X-916 j l Date " f' 1 �� • - TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee --- Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# Building Inspector 3��ti� �p�- Civ .-e_ �Jkc-�v�z� (jkle.�l 3�lX�l� �. �� ,i M2- � 1 Nk 1 r. 1 NORTH - : : - .c0 ve- W* . -q% No. a_2a * -_ _ - h ver, Mass �T&qu" �1 2 T O LAME ' ' COCNICNEWICK V" X1,95 gAreo 11,PP�,�S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THATA..'OW......77"Wo � BUILDING INSPECTOR ............. .... . . .. ........... has permission to erect g Foundation .... .................... buildings 151................ .... ..... � � • Rough to be occupied as NAlk �1a !. �...!'!::� t1� I G'' C ................. ............ .... .... . ............ ........ Chimney rovided that the erson acce tin this ermit shall in eve res ect conform terms of thea application p P accepting p ry p PP 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 MOTHS ELECTRICAL INSPECTOR O UNLESS CON STRUCTIO AR Rough Service ................... ....... .%004�� ................................. 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. Ir 1 NORTH w: 1 : - id ve, � O - �► No. FID-20 * =� _ _ �P z 2-1 h ver, Mass 0 LAKE1 COc NIt Kl WICK y1. x.95 Rwreo "P�`,��(5 U BOARD OF HEALTH Food/Kitchen PERMIT L D Septic System � �� BUILDING INSPECTOR THIS CERTIFIES THAT .............. .... ................ .................................... Foundation has permission to erect.................. buildings on J51................ ... .....�.!.............. • Rough 11110t. 0 t0 be occupied as N w �a ..................... Chimney provided that the person accepting this permit shall in eve respect conform to tfie terms of the application p g p every p pp 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 MO THS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO ART 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. Thee Commonwealth ofMasffachusetts . Department of Xndustr^iar.A.celdents h 1 Congress Sheet,Suite 100 - Boston,MA.02-114-2017 www mass.gov/dia Workers'Compensation FTJ-�ED'QVZ H Ymsurance d��RM�TxT�TG.A.YJTHORXT�'.trczczansll'Iuxnbexs. lPlease Print I,e 'bl Alzcant Information Name(Business/Oxganization&r1i Address: WV-vim1- City/State/Zip: �eyp—(— 01 hong#: ired): Are-you an employer?Checltlie appi'oprlate box: Type of project(requ em to ees full. d an /or art time 7. El Now constraotion 1.❑I am a employer with •.. - p Y ( p �' 2.QIamasole proprietor orpartnership andhavenoemployees-Working formeia 8. gRomodelil g any capacity.[No workers'comp.insurance required.] 9. ❑Demolition IMI am a homeowner doing all.work myself.[No workers'comp.insurance required.]t 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I Vill 11.❑Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole . �---�- —-12:[�f Plumbing repaimor-adchttons. propzre o-{ rs w"ith no employees:°---�--�—T—"—�"�—'�""-� 5.❑I am a general contractor and I have hiredthe sub-contractors listed onthe attached sheet. 13.LI Roof repairs These sub-contractor's have employees and have workers'comp.insurance. 14.❑Ot11ex 6.0 We are a corporation and its ofjigers have exercisedtheirright o£exemption perMGl,c. 152,§1(4),andwehave n4.emplgyees.[No workers comp.insurance required.] r *Any applicant that checks lion#i must also fill out the section below showing theirworkers'compensationpolit s information t Someowners who su$riaiE this afdavit indicating they are doing all work andthert hire outside contractors must submit a new affidavit indicating such. ilJorneomm that o sffi his box must'attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. lfthe sub-cbnlracfozs have emplogees,they must provide their workers'comp.policy number. X am an erriployer that is pidvid!h9Vorkers'compensation insurance for my employees'Below is tie policy and joh site information. Insurance Company Name: Expiration.Date: Policy#or S elf-ins,Lic.#: • lob Site Address: City/State/Zip: Attach a copy ofthe-workers'compepsationpolicy declaration page(showing the polxcy:uumber 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 l penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a and/or one-year imprisonment,as well as civi map be forwarded to the Office of Investigations of the DIA for insurance day against the violator.A,copy of this statement coverage verification. X do hereby ce under t1,epains and allies erjV?11 Matt the information provided above is Prue and correct. /` Date: 2 ' Signature. Phone#: Official use only. Do notyvrite in this rea,to be.completed by city or toren official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health. 2.Building Department 3.City/Town Clerk 4.Mectx'ical Inspector 5.Plumbing Inspector 6.Other Contact}Person: }Phone#: TOWN OF NORTH ANDOVER OFFICE OF DU LDING DEPARTMENT P f 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 BUIDING PERM, IT APPLICATION Please prin DATE: JOB LOCATION: &L vie.r( O ( 4 140 O l 3 Number Street Addres Map/Lot HOMEOWNER r- Fro 6-j r- Name Home Phone Work Phone PRESENT MAILING ADDRESS 151 LV-tyt,r-`ti M . AV\ 44,rer— MA- 0t <7LI 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 I IO.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 jth said procedures and requirements. i HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL ,1/1 Revised 8.2015 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 , r r r ' 1 1 � I 1 r ! 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