The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #701-13 - 16 RUSSELL STREET 4/24/2013 O� NORTH BUILDING PERMIT 3r 4�.`.��° °~�L TOWN OF NORTH ANDOVER ° 701-1 APPLICATION FOR PLAN EXAMINATION 1 i Permit NO: Date Received Date Issued: �Ss�CHus�t IMPORTANT:Applicant must complete all items on this page LOCATION ECC- S I ,Brint PROPERTY OWNER 111012,;� f-"! Crf�✓L � 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 Pine family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial )-2;Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewerlot c G rte{rte✓ �L,�NLV� ,/�/�ijd�c� G+�//t.® G�'�i/ Identification Please Type or Print Clearly) OWNER: Name: �`t i ZG`-ceit Phone: C-I-R 3e)5' -7:220- Address: 220Address: CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. (" Total Project Cost: $ (- q of_c�U FEE: $ 1-7f.0 Check No.: ?h/C7 Receipt No.: �/_' 2,Q / NOTE: Persons contracting with unre istered contractors do not have access to the guaranty fund Signature of Agent/Owner klC ignature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ 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 ❑ i THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM � I . DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Server Connection/Signature& Date Driveway Permit DPW Tow Engineer: Signature: Located 384 Osgood Street FIRE DEPAIRTME' .NT - Temp Dumpster on site yes no Located at-124 MainStreet Fire Depar Mer t signature/date COMMENTS `' t c 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 Permit Revised 2010 i 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/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 MOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application o 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 ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products 40TE: 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 app;-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submated with the building application Doc: Doc.Building Permit Revised 2012 I .'�^7 .. ... •F[:. .' _.+, ..=c'w\ l"i-�+^rmRs.14a^f_:'R'7^�'I�RfVf''+�iw��iii��."r.c'�✓eac�'7wR�.n.� Location No. OZ Date . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ s ; � Other Permit Fee $ T � TOTAL $ Check# J& 263214'/Building Inspector Enter construction cost for fee cal - Notth And6ver Fee Calculation Construction Cost $ 65441 .00 m $ - $ 77.29 Plumbing Fee $ 9.66 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 9.66 Total fees collected $ 196.62 16 Russell Street 701-13 on 4/24/2013 Kitchen Remodel NORTy Town of No. ' � � � * ,7-sj�q - I� h h ver, Mass, � e,� �`� .2-d 13 �J- COCNIC.1..CM 1• 7,A �RgTED ►'Pp`�'�� S t] BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT / I. 1..........�7�Z . 44-14 BUILDING INSPECTOR has permission to erect buildings on d Foundation A(AA.�� 1�1+ / ' Rough to be occupied as .....................d4.. ...e'CA17C.e...�-✓ ............. Chimney provided that the person accepting this permit shall in every resp ct 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 CONSTRUCTI TARTS Rough ............ Service Final BUILDING INSPECTOR GASINSPECTOR 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. [1== REVERSE SIDE Smoke Det. f NoRTry TOWN OF NORTH ANDOVER OFFICE OF p BUILDING DEPARTMENT i 1600 Osgood Street Building 20, Suite 2-36 ♦ � � f North Andover Massachusetts 01845 �RSSACHt15Et� Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE: ! l� JOB LOCATION: Number Street Address Map/Lot HOMEOWNER Al Att r-4 TZ,G*t4t_> `t 7 3G S 7a'>-? Name Home Phone c Work Phone PRESENT MAILING ADDRESS /v- 04n111ba"t , fA of o!d'YS 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 The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lep_ibly Name (Business/Organization/Individual): ^nvOee, ' Address: !C /zoc5S4u City/State/Zip: /-4 ofr-b,,0001, 0114 Phone #: '�'7)? Q 7� 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. E]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. E] Building addition [No workers' comp.insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3!F/b I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions 11�` myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]f c. 152, §1(4),and we have no 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. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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 cerci under the gains and penalties of er'u that the in ormation provided above is tr�e and correct. - - -- Si nature: Date Phone#: `177P 707 7,1o�>l 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 4 %_�______ -------.-v..____.—__._._. --__182�,•....___._....._.._ —._...._..__.._._..----..--..... -.....;: Jn y 1 Lw Y i ...... t n ......._»...f :' 33, 53s � 39t". .----------- wreoa2 Burr VV3024 BUTT{W3042 BUTT { 1 �DWT6324 X 24 O BU $t 630 SUIT�30 GAS iiANGE D630 - Q .. -44, ; DB1$4QVA324 BUTT'.iI IN- .: i 24 BUTfi 1,, 6�.' I . " ' 4 � i ( - ; -42 .__ Ln , -80 Customer has reviewed and approved the design 1 1 i I t s All dimensions-size designations This is an original design and mast Designed:2/11/2013 given are subject to verification on ` not be released or copied unless Printed:2/14/2013 lob site and adjustment to fit jab ;applicable fee has been paid or job conditions. i order placed. j 121102fc7 ;7..egend Drawing#:1 No Scale.::