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HomeMy WebLinkAboutBuilding Permit #858-13 - 182 SOUTH BRADFORD STREET 6/10/2013aj y BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: � Date Received Date Issued: Z/.'P//-3 IMPORTANT: Applicant must complete all items on this pane e— `2 LOCATION l 5. 2)roAf d Skme�� PROPERTY OWNER 9,CLY-&\Pb > ' runt Print MAP NO: -.-PARCEL:.W�ZONING DISTRICT: Historic District yes Machine Shop Village ves TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building )'One family MAddition - Pbc>\ ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well C Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer ;W t'�� 0 Identification Please Type or Print Clearly) OWNER: Name: Address: l b CONTRACTOR Name: Address: Phone: 0 ;1 If Supervisor's Construction License: Home Improvement License: Exp. Date: Exp. Date: 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. Total Project Cost: $ 5 -10 CD FEE: $ K"Opc, Check No.: Receipt No.: Ute_ NOTE: Persons co frac rn wrth unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner'gnature of contractor Plans Submitted ❑ It Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPO.SSAL 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 - U FORM PLANNING & DEVELOPMENT COMENTS DATE REJECTED DATE APPROVED ❑ ❑ DA I L REJEC I LU UA I t Al-YRUVEL) CONSERVATION ■ ■ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning 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 Located at 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes Located at 124 Main Street Fire Department signature/date COMMENTS no J 0 - TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page TYPE OF IMPROVEMENT PROPOSED USE Residential J Print ❑ New Building ❑ One family ,PROPERTfYr®WNERt. ❑ Addition ❑ Two or more family ❑ Industrial Print 100jYear®IdyiStructuret yes! no) MAP'NO:; ❑ Assessory Bldg _ H,IstoncDstrict yes; no} _ _ .PARCEL::__ _ . _ _ _ZO,NING1DIS)TRIC'T;, - _ MaehineShop)Villa:ge) _ yes = riot; p' W,atershedLRistn ... . f ❑tVVater/S,ewer=_ _ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ISeptici ®tUVellt �1Floodplam� ®i 66 cls p' W,atershedLRistn ... . f ❑tVVater/S,ewer=_ _ DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Aaaress: - -00NTtRAOTOR� Name:._ _ - ;Rhone : A'ddfess Supcense:_ EXp�, Home; Improgvgrnpfl icense-,-. ARCHITECT/ENGINEER Phone: Address Reg. No. FEE SCHEDULE: BULDING PERMIT: $92.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. 'Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund !Signature :of:Agent/Owner Sig �ature;of 'Contractor...,... Plans Submitted 11 Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans 11 Building Department The following is a list of the required forms to be filled out for the appropriate.permit to be obtained. R.00firig, 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 COTE: 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 TOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application Q 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) a Copy of Contract ❑ Mass check Energy Compliance Report ❑ 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 subm:-tted with the building application Doc: Doc.BuilIng permit Revised 2012 Plans Submitted ❑ Plans Waived❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF-SEWERAGEDlSPOSA Public Sewer Ta ❑ . Swimming Pools 11nnmg/MassageBodyArt Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATIO Reviewed on S,- Signa ure COMMENTS /U �a,L .) \\v\ Co o' HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decisionlreceipt submitted yes_.. Planning Board Decision: Comments Conservation Decision: Comments Water & Seger Connection/signature � Date Driveway Permit DPW To-vw! ]Engineer: Signature: Located 384 Osgood Street FIRE ®EPARTMEWT -Temp Dumpster on site yes no Located at"! 24 Main Strdet Fire ®epa Bert sign--�itiire/date COMMENTS 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 ®ANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A- F and G min.$10041000 fine Doc.Building Permit Revised 2010 Building Department The following is a list of the required forms to be filled out for the appropriate.permit to be obtained. R.00firig, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo C py Of H.I.C. And/Or C.S.L: Licenses ❑ Copy of 1 ontract ❑ Floor Pla'h Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products 10TE: All dumpster.permits require sign off from Fire Department prior to issuance of Bldg Permit l Addition Or Decks ❑ Building ermit Application ❑ Certified purveyed Plot Plan ❑ Workers 6omp Affidavit ❑ Photo Coy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cro�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 TOTE: All dumpster pe�mits require sign off from Fire Department prior to issuance of Bldg Permit New Constructipn (Single and Two Family) ❑ Building Permit Application o Certified Ptioposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers C�mp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Co intract ❑ Mass check Energy Compliance Report ❑ 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 appal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm:-tted with the building application Doc: Doc.Bui!ding permit Revised 2012 Locat on D a t e No. /—? Check #. TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee ,00 Foundation Permit Fee $ Other Permit Fee $- TOTAL Adding Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 51700.00 m $ - $ 68.40 Plumbing Fee $ 8.55 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 8.55 Total fees collected $ 185.50 182 South Bradford Street 858-13 on 6/10/13 Above Ground Pool r 0 C O H 0 JU QW LU 2 LL. o m OJ L O LL +�+ T N U1 to cc CL to Z Z 0 m C O O LL t O d' C L U LL a: OF V1 Z Z 00 C d ,C to O d' O iz cc N Z U W W L tw O U Q) (n _ C I.i W OU a Z N r bo O d' _ C LL Z W °� a W 0 LU LU U. N 7 O Z (A N +� u E N n • O lC p V IA ,1 CL 000- �E d Q d y t Icy W gyp+ O 'r�+ 0 �E_ c a ca lo CL M y J CD CD o = 4) > y _ -0 O o C'•� O� � O N o No cc m o r m > c C H CLImn •v� © o� c c • O_ N .r O O y LU I-- cn CL 0 0 FO W -LL •N O N y c O •V r V 0 WE vd O F- • U m 0 70 a) ► Q O N y �•pL O Z rc H. mO0 > Z O Z W w CL W H w CL w w -ba y ca W W OC W co otzr . }o�µ�nc b aya TOWIN OF NORTH ANDOVER >�- OFFICE OF BUILDING DEPARTMENT ."1600 Osgood Street Building 20, -Suite 2-36 �•ss �TM� " ��y North Andover, Massachusetts 01845 AF+tus . Gerald A. Brown Telephone (97$) 688-9545 Inspector of Buildings Fax (978) 688-9542 i G f 110MEOWNER'LICENSE EXEN.IPTION EWDING PERMIT APPLICATION Please print DATE: �j 1 13 JpB LOCATION: Number Street Address Map/Lot HOMEOWNER Vel i Name Home Phone WorkPhone PRESENT MAILING ADDRESS C;tyTow m Stw+w Zip Code The current exemption for `$omeownere, was extended to ilnclude owner -occupied dwellings to two units or less and to allow su;h homeov'mars to engage an individual -for hire who does not possess a license, provided that fine owner acts as supervisor). State Building (Code Section 108.3.5.7) DEFINITION OF HOMEOWNER Persons) who Qwns 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 andregulations. 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 7.2009 Form Homeowners Exemption ''$OARD OF APPEALS 688.9541 CONSERVATION 688-9530+ HEALTH 688-9540 PLANNING 688-9535 The Commonwealth ofMassachusetts , Department o, f IndustriglAccidents Office of Investigations 600 Washington Street Boston, ,MA. 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Sanders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLyib�l T Name (Business/Organi'zationgndividual): Address: City/State/Zip: $hone M J A-iiR-cA(�-tg(,P-7 Are you an employer? Check the appropriate box: Type of project (required): 1. D I am a employer with 4. ElI am a general contractor and I 6. ❑ New construction employees (full and/orpart-time). 2111 am a sole proprietor or partner - haveliiredthe sub-con#rac#ors listed on the attached sheet. I 7• []Remodeling ship and'have no employees These sub -contractors have 8. ElDemolition working for me in any capacity. [No workers' comp. insurance workers' comp. insurance. 5. [J We are a corporation and its g, [],Building addition 10.[] Electrical repairs or additions required.] 3. r%1 am a homeownedoing allwork r officers have exercised their right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and wehave no 12.[]Roofrepairs insurance required.] i employees. [No workers' 13.❑ Other comp. insurance required.] ".Any applicant that checks box#1 must also fill outthe section bel6w showing their workers' compensation policy information. I Homeowners who submit this affidavit indicating they ere 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 their workers' comp. policy information. lam an employer that is providing workers' compensation insurance for my einployees..Below is the Polley and job site information. Insurance Company Policy # or S elf -ins. Lic. ExpirationDate: Job Site Address: pity/state/Zip: Attach a copy of the workers' comp ensationpolicy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of.a fine up to $1,50 0.00 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 maybe forwarded to the Office of investigations of the DIA. for insurance coverage verification. l do hereby certo under the pains and pen ties of perjury that the information provirlerl above is ue and correct. Phone # Offccial use only. Do not tptite 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 CIerk 4. EIectrical Inspector 5. Plumbing inspector 6. Other Information and Instructions. Massachusetts General Laws chapter 152 requi Pursuant to this statute, an eres all employers to provide workers' compensation for their employees. mployee is defined as "...every person in the service of another under any contract of hire,• express or implied, oral or written." An em„ ployd 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 df 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 employes." 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 ofpublic 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 numbers) along with their certificates) 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 LL C or LLP does have employees, a policy is required. $e 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 pro of that a valid affidavit is on file for future permits or IicenseS. Anew 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 orpermit to burn leaves etc) said person is NOTrequired to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone acid fax number. Tho Com onwalth of Massoohv..se%ts Department of Zndustdat ,A,coldonts Woe o�Iu�e�ti�ati�ou� 604 WashiVoa Street BostonMA02111 TQL # 617-727-4940 ext406 or- 1-$77-N,CA.SSAFF, uo.,s a R9 -Y ;� 617.,7?7:.77!(0 NoMo o & ALNbU JLA i l 138 NEW MN RD. PLAISTOW, NH 03885 PHONE: 603.3$4.5 MORTGAGOR; RANDOLPH A. MARY ELLEN LASING DEW REFBIC 9M RG. 30 ADDRESS OF PRINCiP E BUILDING: 182 SOUTH BRIWMPo ST. NOFtTH ANOOVM MA OATS REF INSPECTION: JUNE 8, 2092 . SCALE 1"= W, ' car 7 Of A A Certifttionto: NEMOMMORTGWXLLC ThLs rP�at�Ywas Frsu�otamt+aIIdta �yfor The m�teloc�rion4Ethepx�ntCiplestFucbare/sEonfarns to rt apepumosw or and raced• wi►�horiwnbd u�ldingotb-ad;re4mremenirfn'effectwhet toestnblishanyMe ro TWsAmisnottobeased mnstruetedmAjotisaaemptfvmi* sionentorcemeat p pertyRnesforany urpose. No actionwaderff=B•LndeViLUnLp.•40A,Sec.7. responsibility isextendedtQtbehadovnerorocoVant Teprnoati isnot This Is a tape sttrveybased on the kcadm oisurvsgmarlc s ofothess. Incased e This p-hin isnot cobeusedfor buddmgpmm is oranysucb use spmW floodhowdarea assailed kom D MMSG/Z/1"3 age -0005Z Prepared for. LAW OJ FICI; Of MICiIAEi. L IGMIiARi} Me No. 32098 SSC job Na 22312 G