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Home My WebLink AboutBuilding Permit #926-15 - 186 ANDOVER STREET 5/15/2015 WN, ' BUILDING PERMIT NORT1i 4 OF,fit IED 16640 TOWN OF NORTH ANDOVER � - APPLICATION FOR PLAN EXAMINATION ry Ill Date Received Permit No#: ' SSACHUS Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER y may, Print100 Year Structure yes no MAP PARCEL: /V ZONING DISTRICT: Historic District yes no Machine Shop Village yes. no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential Li Building One family Addition El Two or more family ❑ Industrial ❑Alteration No, of units: ❑ Commercial nYRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic p Well 0-Flood-l=ain ❑Wetlands U Watershed District ! ❑Water/S'ewer- DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email-. Address: TJO W� r 0_10 Supervisor's Construction License: Exp. Date: . Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ Ly o a Q a FEE: $ Check No.: (OW Receipt No.: � NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ... Location ��`•-'l '�'� i No. q2t,0-16 Date TOWN OF NORTH ANDOVER f Certificate of Occupancy $ Building/Frame Permit Fee $�O J Foundation Permit Fee $ t i Other Permit Fee .. TOTAL $ c F Check#�DD i C Building Inspector 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 ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY � INTERDEPARTMENTAL SIGN OFF a U FORM PLANNING DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS T 1 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 DPW Town Engineer: Signature: 1 ,. ..,. Located 384 Osgood Street F IRE DEP-/�R<T erne Dump ste�'on siteay es 4 Lo aF—egt124p_stL, fg7it Y pair n sig Ufff-I%date � u f e t CQMMENT,�S;... 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 lies No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) i ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks G Building Permit Application 46 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) i 4. 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) I 46 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) j Copy of Contract 2012 I ECC 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 NORT1y Town o � .. . .�.. ndover 0 � - to No. a o h ver, Mass, dom 2-015 ��S RATED ►.Pp\�� V BOARD OF HEALTH { Food/Kitchen PERMT D Septic System THIS CERTIFIES THATBUILDING INSPECTOR ........................ ... N 11t 0.� ..... ........... Foundation has permission to erect.......................... buildings on . .. . .... �.... �/�.....,�, .. � ... Z/�.1`.: . .... Rough tobe occupied as ......... ........................................................................ Chimney provided that the person accepting this permit shall in every 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 eMOHS ELECTRICAL INSPECTOR UNLESS CONSTRUT 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. .+bs'YLv�.`4;;at-'a..SFY,sd:.a�.w»"*.ri,.•x_. ..-x.,.,.-a......xrr:a�[x`594"arw'.' .D�2'�,°L"'' Y.u «1Y t+�'�:; ... r L .<,x«. r.. Tv`a2n"a'� r t ti ' .,.> :��+ I The Commonwealth of Massachusetts F Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERNIITTING AUTHORITY. A licant Information Please Print Le 'bl Name(Business/organization/Individual): Address: f a- rA6-4 ttPAY S City/State/Zip,N1 AV#Y Phone#: Are you an employer?Check the appropriate box: Type of project(required): IF]I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. []Remodeling any capacity.[No workers'comp.insurance required.] 9. Demolition 3�i 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 will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.1,Roof repairs i These sub-contractors have employees and have workers'comp.insurance.: 14.Q Other 6.❑we are a corporation and its officers have exercised their right of exemption per MGL c. 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. t Homeowners who submit 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. 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 MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. coverage hereby certify under the pains and p`nalties of perjury that the information provided above is true and correct. / Date: Sigrrature S S I Phone# 7 9 6T.' 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 of hire, 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 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 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=contractor(s)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 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 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 f TOS'OF NOPTff ANDOvER I R �.y{,yy'��y5J3.'.y��'�JpCE Ott t,' jnW • ' Q ,y` :I6007Js90()dStreetBtxildiug24,•Suite236 7 h�Ri�,}Y,'t5 •••Nort7i Ando vexMassachusett 01 845 CrexaldA.$town Tblephotte(978)688 95 5 ThapectorofWIdiugs fax (978)689-9542 - M—MM49MR LICENSE MM&TION APPLICATION Ipleaseprint DATE: i J'OB LOCATION: Number Street A ddress N1ap/ ot ROMEOhI�R I - •• Name. . 33'ornel'hone WorkRhone . -MMSENT MAILIM ADDRESS s FT� , Mf4 o TAB current:exemption for,10meow_nere,was extended to iclude ownex occupied diuelings to two units-off•:ess and %o allow such 3�omeo�nexsto engage auhrdividual.forl�ire who CIO es aotpossess a 1 cense,pro vide d that the,ownerPei-visor).acts as a Pexvisor). StateBjitding (Code Seegon 7x8.3.5.7) DEFINITION OFROMEOVMP, Parson(s)who Awns a parcel of laud on Wbich he/sha resines or intends to reside,on wMr there is,or is intended to be,aoneortW0Familysixuotnms. Apersonwltoconstructsmom that-onehomeinatwayearpeziodshallnotbe considered ahoxaeowner. The undersigned` onleowner"'assumes zesponsz'biIiiyfozcompliances wzfh the StateBuilding Code and other .A.pplimble codes,by-laws,xules and-regulations. The rzvdersigned`homeopTnex"aex;$esthathe/sheisndexstandstheTownofl\TorthAadoverBuildingDeliartment nin Mum insPaotion pro eedUres anal regalrezmnts and that helshe wm comply with;said procedures and rectuiroments, ' HOMEOWN$RS SIGNAfiUR1; 'l .APPROVAL OF BIIZLDIN G OFFZCTAL Rayised 72009 I"ormBomeowners Exemption . rY , BOARD OFAPP33A72 689-9541 CONSER,VAUON 689-9594 - 13EALTH 6$5-9544 PTANAI1NCr 689-9535 02/17/00 THU 09:57 FAX 978 681 5550 CARTER & COLEMAN I�001 CARTER AN D COLEMAN 451 ANDOVER STREET - NORTH ANDOVER , MA 01845 (978} 681 -6000 (978} 681 .3550 FACSIMILE TRANSMITTAL SHEET O� FF OM:MARY ELLEN MCQUATF COMPANY: DATE: f FAX NUMBER: i TOTAL NO.OF PAGES INCLUDING COVER: PHONE NUMBER Q Q l�7C7`✓ SENDER'S REFERENCE NUMBER. RE. YOUR REFERENCE NUMBER: URGENT O FOR REVIEV7 ❑PLEASE COMMENT ❑PLEASE REPLY ❑PLEASE RECYCLE NOTES/COMMENTS: ��. - �w This fax una.. G✓�// y-�..e rj -t-0 5 e � n.. entity named /o P//� /r! a �hD�Ysra� or usage of the. /"� n. or Ifs SY TELE THE ORIGB FY T v �m ru ', CARTER AND COLEMAN ATTORNEYS AT LAW 451 ANDOVER STREET, SUITE 195 NORTH ANDOVER, MA 01945 02/17100 THU 09:57 FAX 978 681 5550 CARTER & COLEW 9 001 CARTER AND COLEMAN 451 ANDOVER STREET NORTH ANDOVER , MA 01945 (9 7 8) 681 -6000 (978) 681 - 5550 FACSIMILE TRANSMITTAL SHEET TO,� - FROWMARY ELLEN MCQUATE COMPANY: DATE: FAX NUMBER: /7 a'-d)'} TOTAL NO.OF PAGES INCLUDING COVER: HONE NUMBER: O 0 7 p� SENDER'S REFERENCE NUMBER: RE: YOUR REFERENCE NUMBER: i I I i I ❑URGENT ❑FOR REVIfi1w ❑PLEASE COMMENT ❑PLEASE REPLY ❑PLEASE RECYCLE NOTES/COMMENTS: I i I 1 I Confidentiality Notice Thia fmt tr'tnamiaaion aunt 6-potentia Y confidential or pri4ged idorrnuien.The infwmAtion n intended only forthe individusd or entity named on thin tmnamiasion ahect..If you.not the intended retipicnc,Pleaao be swat:chat air diodostfe,espying,e i t vidu'l or usage of the conretm of this FAX information u prohibited.IF YOU HAV$RECIEVED T�IIS FAX IN ERROR,PLEASE NOTIFY T eY TELEPHONE A3MEDIATELY$O THAT WE CAN ARRANGE FOR THE MR[EVALOR RFrTRANSMISSI o aF THE ORIGINAL FAX AT NO COST TO YOU, THANK YOU. IF YOU HAVE ANY QUESTIONS,PLEAS$CALL(978)681.6000 CARTER AND COLEMAN ATTORNEYS AT LAW 451 ANDOVER STREET, SUITE 195 NORTH ANDOVER, MA 01945 02/17/00 THU 09:57 FAX 978 681 5550 CARTER & COI.EAfAIV 002 1r11Vl�1%JtX%JL' 11\OJL L^�,A.1V1N i i X3LA,I Lw• ti / BOSTON 48 9sys SURVEY, INC. 97-08928 P.O. Box 220 Charlestown, MA 02129 (617)2411313 MAIN• (617)242-1616 FAX APPLICANT: CRAIG A.&MARY ELLEN MCQUATE LOCATION: 166 ANDOVER ST DEED/CERT. 4862/117 CITY,STATE.'' NORTH ANDOVER,MA PLAN REF: 2302 1 f j I 2 1 I i 260gOM,W 1 aa ! r/ I f . r I :STORY I i tufo ANDOVER STREET roes fw oaara+s+n+r sog�^r PREPARED: 11-10-1997 SCALE: lnoh=50 feet CERTIFIED TO: OLDS TOwNE MORTGAGE CORPORATION The permanent structures are approximately located on the �0) OF to According to Federal Emergency Management Agency ground as shown.They either conformed to the setback mlips,the major improvemets on this property fill to toan mquiremcats of she local ting ordinances in effect at C M area dalgnaled aS Zone A/n' /W 'ar)wd the time of comiruction.or are except from violation en TESTA Community Panel No: z spyF r O Vd6 4 forcemeat action under M.G.L.TATO V11.Chapter 40 A, No.18167 sha Section 7,and t there are no encroachmmu of major o Effecti-e Date: b -•y-9 J improvements either way across property lines except as yer a i ea` NOTE:Zone C Is area of mis"goodie(no thedntg).This shown and noted bacon- gyp 9�Rv aasgaaaart it not bts.ed on on aNvatlon"noleata. NOTe:Thta is not a bouraary Or arta trrowanoa.tavay.Title Plan era to ply sum taennkat taaraard.br Man"Leanbrispecime as amp" ut..ro ant land nwgyaa.250 CMR 645,WA uta fa art War pwpm to preaw•This Plan is not m be by the Massadatwlls tfdard a Ragiwatan d ptOUaakeW e^g used for recordbt.premirp dad dacr;pttota,0 game"a,