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HomeMy WebLinkAboutBuilding Permit #1224-2016 - 163 SALEM STREET 5/23/2016 J ! BUILDING PERMIT 441,E'r FD a� 0D.'g��O �a. h�,.1. ...A, •6 TOWN OF NORTH ANDOVER o -:: ;• p APPLICATION FOR PLAN EXAM INAT ia1�I _ * 'Co . laa-��� °v� Permit No#• Date Received- ��'°°RaTEo �SS USES Date Issued: 2 IMRTANT: Applicant must complete all item!ron tbisrpage LOCATION LO J� �011-e M ,'5 4'V-C-e Print PROPERTY OWNER h arle5 E 116 n �oy_laa Print 100 Year'Structure yes oQ MAP PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition El Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ � Septic ��i tloo a1 �Wetlands; � ® Waters edl�Distncf DESCRIPTION OF WORK TO BE PERFORMED: a o � i(Ct6uCL41on Identification- Please Type o Print Clearly _ OWNER: Name: Cmae5 '} Phone: Address: � . Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp: .Date: -� Home Improvement License: Exp:,..-,Datf ARCHITECT/ENGINEER Phone: i Address: Reg..Nq. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COS-r-UAWE ;:,0X,$125.00 PER S.F. Total Project Cost: $ `-f/o0 FEE: $ ` Check No.: Receipt Nb_.,.... �"� IiTOTE: Pets s 0 t a t M gistered contractors do not have-access4o,the guaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ I TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Ahlnmg Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SEC TI®NS FOR OFFICE SSE ONLY INTERDEPARTMENTAL SIGN OFF e U FORM PLANNING & DEVELOPMENT Reviewed On Signature— COMMENTS i nature 9 — COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on__ Signature COMMENTS c 4 Zoniag Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planing Board Decision: Comments { Conservation Decision: Comments Water& Sewer Connection/ Drivewav Permit ]DPW Town]Engineer: Signature: Located FIRE DI=Pi4I�M N Temp Dum sfe�on site�yes :r ` ' des � " 384 Osgood Street - `" .�p 11 IV- OL .. Located at 124 Main StreetVl;, a Fine Depa Ment�i �r� .; x k4,. :r Yui /i1 g signature//date .. �x r`° r Pi,(.�✓i '��lr , �3` � p�y.4'•a`_"}i�. r �F'f�t�r"cs..'�,''.'' 4ac a° 1#•," .�3''.'rr ;"�lq 'jF..r.S�t'd��,^.}�.} `>��,"�ty ff' �';�,.3",,���,�5„SK�p'a� y�k �j�,�o- �ak':i��X�, �;'4�.1�, .,rl '1S:i�.. � 3'3iY''98:'19..^. w'i`idrrit&• t.'4° e.w.sf' fii tw . z i Dimension Number of Stories: Total square feet of floor area, baseff ` terior dimensions. Total land area, sq. ft.: r .. ELECTRICAL: Movement of Meter locafion, mast or service dro _ ices a Electrical Inspector Yes No � pp�®��I of DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine i • NOTES and DATA— (For department ease) i I i` I - I ® Notified for pickup Call Email E Date Time Contact Name Doc.Building Permit Revised 2014 °°` 1 Building Department The fallowing is a list of the required forms to be filled out for the appropriate per'lit to be obtained. r 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 OrProposed 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) 4. Building Permit Application 4. 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 Location i No. Date .��, � 1 .J . - TOWN OF NORTH ANDOVER ?; . i Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ Y` TOTAL $ Check# 4 3 0 cl 0 ( Building Inspector rip AORT#i own of 0 n.dover No. _ -t ver MassA42 ,Q cocN�c«ewec« 1' �.pS RATED 7 V BOARD OF HEALTH Food/Kitchen P T Ll ERMIT, ir Septic System AM% T �� o ' , 0 Q�� BUILDING INSPECTOR HIS CERTIFIES THAT ....... ...........q....I..................... ..... .. ......................................... has permission to erect .......................... buildings on ...Na... ...... 4 ..... ................. Foundation Aft Rough tobe occupiedas .. ... .. ..... ..... . .. .. .... ::........................................................................... Chimney provided that the person accepting#his permit sha I in ery 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 CONSTRUCTION STARTS Rough Service ................... .. ... ..4....•.• ...................... 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. � TOWN OF NOR TH ANDOVER 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 BUIDING PERMIT APPLICATION Please print DATE: ' JOB LOCATION: Number Street Address Map/Lot HOlV1EOWNER��° '� '('�� O Q "`�J�o� �c�,��y`�d0� Name Home Phone Work Phone PRESENT MAILING ADDRESS �j - Aa S City Town tate Zip Code The current exemption for"homeowners"was extended to include©weer 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. 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 Department minimum inspection procedures and requirement and at he/ e 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 of Massachusetts z F Department of IndustrialAccidents 1 Congress Street,Suite 100 ' Boston,PM 02114.2017 www rnass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information l Please Print Legibly Name(Business/Organization/Sadividual): Address: 1 �� � 3 �City/State/Zip: � °�4 0.9Q,� � � � ((�,��y Phone#: �7� � Are you an employer?Check the appropriate box: Type of project(required): 1.❑lama employer with employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working forme in 8. 0 Remodeling any capacity.[No workers'comp.insurance required] 3.F1I am a homeowner doing all work myself[No workers'compAnsurance required.]t 9. E!Demolition 4.F]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.❑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. ❑ � 13.[]Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.F]We are a corporation and ifs officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and Nye have no.employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also rill out the section below showing their workers'compensation policy information. t 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 fiaypemployees,they must provide their workers.'comp.policy number. rim 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 MGL c. 152,§25A is a criminal violation punishable by a fine up to p,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. X do hereby certify under thepains and penalties ofperjury that the information provided above is true and correct. Signature: 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 Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract ofihre, 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 enferprise,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 ofthe 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=contractors)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 * 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 nurp.bex 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 i _ 3eS W REGISTERED FABRIC ISSUED BY Date at Manufacture NUMBER JOHNSON OUTDOORS INC. BINGHA TON,NEW YORK 13902 - 0.fFarxur`actirr s at the finest J WARY 2007 Tent Products Described Herein This is to certify th3t the Products herein have been manufactured from material inhe�rert y flame retardant as her aft r pecifted y the material supplier- NAME: uppliser. NA flE: SUDBURY TAYLOR RENTAL CENTER = CITY. SADBURY MA Certification is hereby made The articles described on this certificate have been manufactured witi an approved flame retardant chemical in compliance with California State.Fare Marshal Code, NF€'A=r01% Underwriters'Laboratory of Canada, and have been Federal Test d tested in ago e eci;rca and or x e# h rlr Fi eci cati ns of MIL- 3tpp& , accordance +rtih the Tvpe, Cda(andweiaht of material 13 OZvantrt WHITE iE SLQCK Ct33 f t:.tescrintion of sterna certi€ E -PARTY CANOPY 20X3(} fFlame Re tardant Process Used Will Not Be RemOved Is Effective For The fife Of The Fabric ' Snyder Manufacturing,Inc. i Manufacturer of Flame Retardant Lrinui Lamina—- TENT VEPA 3flHRrSORt C} QRS tN rc#e Scale