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Home My WebLink AboutBuilding Permit #1201-2016 - 163 KARA DRIVE 5/17/2016 BUILDING PERMITO� t%ORTH q TOWN OF NORTH ANDOVER 3 APPLICATION FOR PLAN EXAMINATION * y Permit No#: Date Received cHus��y Date Issued: HAI IMPORTANT: Applicant must complete all items on this page LOCATION b3 V94 4 .-1 «F I - j I PROrint PERTY OWNER +TY2ICV � , `��i Pl�+�'112�Lt� Print 100 Year structure -yes no EMAP 9� 'PARCEL:. o7 ZONING DISTRICT:'9 Historic District yes no Machine Shop Villa e' , es' . ISI TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building X One family ❑ Addition ❑Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial X Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ n Sep ictict ❑'1Nell ❑ Flo.odpla0 ❑Wetlands ❑ Watershed pistrict DESCRIPTION OF WORK TO BE PERFORMED: 1ZEpu46cmrzAj Identification- Please Type or Print Clearly OWNER: NameJ�►2i 4-x, A. Phone: 928 A07 Address: 1� 3 k-ARA DP—I ✓E Nott l+ 018457 1 Contractor.Name: Phone Email: = Supervisor's Constru:etion License: `Exp: Dater ' _ c Home Improvement License: Exp:: Date; , ARCHITECT/ENGINEER Phone: C„ r 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: s 3 000 FEE: $ 30�f Check No.: "f Receipt No.: - NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 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 :aBuilding 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 4. 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 J Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL V Public Sewer ❑ Tanning/Massage/BodyArt F1Swimming 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 o U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature . i COMMENTS HEALTH Reviewed on Signature COMMENTS A i coning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DE A�RTMENT �,Ternp ®wmpster on sit yes' Lecated tt1r24 Main S re Fire Dep rtmen sigr;� re tem-` a C®MMENTS yto 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 DANCER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$1oo-$1odo fine f NOTES and DATA— (For department use) i I i I ❑ Notified for pickup Call Email Date Time Contact Name ------------ Doc.Building Permit Revised 2014 Location No. Z_o Z v Date • • TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ " Foundation Permit Fee $ t Other Permit Fee $ a° TOTAL $ 5 Check#ZCP4 30382 Building Inspector %AORTH Town ® ndover No. t _ _ 2.* I. am ver, Mass, 04 o COC MICNEWICK V S ll BOARD OF HEALTH PER T D Food/Kitchen Septic System ATHIS CERTIFIES THAT . .......AAG...... Vc BUILDING INSPECTOR Foundation has permission to erect .......... ............... buildings on .. ... �+►.. --.-....•........•••••• p Rough to be occupied as ..... .. W�4E�!`, ........... .... .. .�.�!*1 ...................... Chimney p provided that the person acc pting this permit shall in a espect 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN.6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service .................. ... . 1.. .................................. 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. TI OWN OF NORTH, ANDOVER OFFICE OF ® A _ BUILDING DEPARTMENT g _ 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 UIDING PERMIT APPLIiCA ION Please print DATE: 41 A119Y Q016 JOB L4CATI®N: /63 leiqf?jq DQr VF Number Street Address Map/Lot HaOME,OWNER P*TIZ t C1G 4 . tD 1fArjKE_XQAJ_1 978- 98 Y--S_B5B Name Home Phone Work Phone PRESENT MAILING ADDRESS /43 k1+fZ 4 bkj ✓� Ab2neY j4A,12)9v-'Ci0_ MA City Town State Zip Code The current exemption for"homeowners"was extended to include owns-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, rop vided that the owner acts as supervisor. I 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 with said procedures and requirements. HOMEOWNERS SIGNATURE _( APPROVAL OF BUILDING OFFICIAL Revised 8.2015 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 The Commonwealth ofMassachusetts Department oflndustrialAccidents 1 Congress Street,Suite 100 Boston,K4 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): -rA i i2.1(,IL• Address: b3 KA(ZA !'O, RIN/C City/State/Zip: 001ZTH Alit)OVE< NA, DI Phone#: q76- 6 f `7'_ I S 77 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. F1 New Construction 2.E]I am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 3.XJ I am a homeowner doing all work myself[No workers'compAnsurance required.]t 9. El Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 E]Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.E]Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance. 13.0 Roof repairs n 6.F-1Weare a corporation and its officers have exercised their right of exemption per MGL c. 14.[0Other a 1 e1 d ow Ade t 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. i 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. Ifthe 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.Lie.#: 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 we]i 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_unDder thepains and penalties of per jury that the information provided above is true and correct. Sig ature: QC� Date: Phone#: SO 9—69 7— '79 7? 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): i 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: