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HomeMy WebLinkAboutBuilding Permit #593-11 - 1925 SALEM STREET 3/7/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: �3 A �_I Date Received Date Issued: a - 11 IMPORTANT:Applicant must complete all items on this page LOCATION i SMT N -� - Print PROPERTY OWNER J O'11/l I G� r M l!L4�i 01W Wlf9ll?-0-fl ' Print MAP NO:/66. 3 PARCEL:00/-3 ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 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 "Septic O'Well [AFloodplain El Wetlands D' yVatersl edfID strict DESCRIPTION OF WORK TO BE PERFORMED: PvTP,� QC,Y wh-IL QN2 ,Pbr- PUI260 FLLL)2tN6 Identification Please Type or Print Clearly) OWNER: Name:;J 'n * M l6."1Z; Cttm m 1 colli Phone: qV 667337g" Address: A CONTRACTOR Name: /U/� Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COSTBASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $_TI Check No.: Receipt No.: NOTE: Persons contracting with I nregistere contractors do of have access to the guaranty fund i i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ i TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody 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 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 & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date I 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 DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10041000 fine I NOTES and DATA— For department use I I Ll Notified for pickup - Date Doc:.Building Permit Revised 2008 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 o 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 NOTE: 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 ❑ 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 NOTE: 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: Doc.Building Permit Revised 2008mi Location A No. Dates -1 MORTq TOWN OF NORTH ANDOVER go , O � 9 Certificate of Occupancy $ ► Building/Frame Permit Fee $ SACMUS Foundation Permit Fee $ Other Permit Fee $ rt TOTAL $ Check # <2-4a, 1 23964 uilding Inspector ORTH T f Andover 0"411111111il;M 0 No. " l/ `�� � __ :.�=•�� � Mass. - I�10 °�ndover, �— .� Y�� "HCl+if Ha�WICh`4r At "9 . BOARD OF HEALTH Food/Kitchen PER Septic System BUILDING INSPECTOR CGI. _w►-a.!�cL...T� Foundation THIS CERTIFIES THAT.... ... ..�.�•"`:��•••••••••���•��••••••• ............................... O �.............. Rough buildings on....�.. �. ...............�rIJC„ `--.....S has permission to erect:9.,;';*;'� ................-- . S f � Chimney (ti ................ to be occupied a .. ....--.....�..1.. .. .............. .................................... ................................lication on file in Final provided that the person accepting this permit shall in every respect conform to the terms of the app this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of PLUMBING INSPECTOR Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final �1 P'ERVIY ` EXPIRES 11N 6 MONT -1 I—I S ELECTRICAL INSPECTOR 1 UNLESS CONSTRUC—F � J Rough Service ............................ c� BUILDING INSPECTOR rRough naocc�.pancy I�er�rl.yt- Required io ccu,,PY g�. a GAS INSPECTOR s.. S L '� 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. �--- "n"' Smoke Det. IF SEE REVERSE SIDE71 Location 6' Date No. TOWN OF NORTH ANDOVER 41 ' • Certificate of Occupancy --.-} Building/Frame Permit Fee $ �•� Foundation Permit Fee Other Permit Fee TOTAL Check uiiding Inspector 23934 µORTH TOWN OF NORTH ANDOVER F �� OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 North Andover,Massachusetts 01845 1 9SS9CHUSE� Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978) 688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERNIIT APPLICATION Please print DATE: M ar Ch --7 2ol I JOB LOCATION: P Z,E Number Street Address Map/L.ot HOMEOWNER J t�M I M l iL C PEM Mftafln-n 506 f 34(14(81, Name Home Phone Work Phone PRESENT MAILING ADDRESS �� 5 N1� y , City Town States. 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 equirements and that he/s a will comply with said procedures and requirements. HOMEOWNERS SI APPROVAL OF BUO ICIAL Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 The Commonwealth of Massachusetts . Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 0211.1 www.mass:gov1dia Workers' Compensation Insurance Affidavit: ]auilders/Contractors/FIectricians]Piumbelrs ;Applicant Information Please Print I_,eaibly Name(Business/Organization/Individual): J FIM Y I{i t(V UL (_.CIM VVI&daf-VL Address: 12 Je- Sa U,i/v\ �" C City/State/Zip: N V Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. F1 I am a general contractor and I 6. ❑New construction. employees-(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. �• Remodeling . ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. workers'comp.insurance. y9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions equired.] officers have exercised their 3. I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing-repairs or additions myself. [No workers'comp. c.152,§1(4),and we have no 12.E]Roof repairs insurance required.]i employees.[No workers' comp.insurance required.] 13.❑Other *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. 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 their workers'comp.policy information. X am an employer that is providing workers'compensation insurancefor my employees Below is the policy and joh 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 DTA for insurance coverage verification. X do hereby cert d t gins andpenalties of rjury that the information provi/d�eyd�above is true and correct. Signature: Date: 1' I► ICJ t 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): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other ContactPerson: Phone#: ORTH TO'" of : ove r No. =. o dover, Mass., ^/ I� COCHICHEWICK ADRA-rE D S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.... ... ..q.�'' ��'r........c`�-w`'.!'!' Q.r�ra�.. Foundation has permission to erect... :...................... buildings on ..] tZ lll� . .. ........... Rough to be occupied as ......... Chimney ... .....T . .. ........ . ............................................. provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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 CONSTRUCSTARTS T........................ ...... Rough .... .......:.......................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. ORTH To'" of Andover 0 No. o _ AK o dover, Mass., CoCM"C"EW, ADRATED P �Cy S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.... ... ..6j R%,I.JG........e- .'..^'!!'`-a.✓..5��.. Foundation .................................................... ................. has permission to erect.... ................. buildings on .,J...�.z�.............,�d, !�-�-.....%................... Rough to be occu ied as........... .... (..ter..S..1,%_ ..... �"— Chimney p' 1. ......................................................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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 PERMEXPIRES IN 6 MONTHS Final IT ELECTRICAL INSPECTOR UNLESS CONSTRUCSTARTS T. Rough ............................................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocmpy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner. Street No. SEE REVERSE SIDE Smoke Det.