HomeMy WebLinkAboutBuilding Permit #028-2017 - 2 UNION STREET 7/7/2016 t%O R Ty
l� � � BUILDING PERMIT OF�t�eo bq�0
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#: VA-2-o,1
Date Received .,TEo
SSACHU
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3LDate Issued:
IM ORTANT: Applicant must complete all items on this page
LOCATION air,'O/✓ -fl -Lw -'q— 4"
A,-\, W'L'4
Print
PROPERTY OWNER &09�OLN r'►/ ��' �tl
Print 100 Year Structure yes 0
MAP ' PARCEL: _ZONING DISTRICT: Historic District yes o
Machine Shop Village yes o
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 ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer
DE CRIPTION OF WORK TO BE PERFORMED:
-
/L eir la3e t4-.(e o 11
Identification- Please Type or Print Clearly
OWNER: Name: e>gg °oN A edgey kl'V Phone: 335- qVc) - 7Z3/
Address: �u �`D S A o& 14 4N,,(o ue r-
Contractor Name: Bo o6eN A Iycf lZ e APhone: 35 C/ 7- Z- 3/
Email �'�,..Zolee glkl'v A ma 1-Z . com
Address: r A ',1Z 4 VeIL-
Supervisor's Construction License: CS - 10F 02 i�lo Exp. Date: n6 ZgTlaeo/l ! L�
Home Improvement License: /�'„2. Exp. Date: oZ o
ARCH ITECT/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: FEE: $ Jq'4
Check No.: ( � Receipt No.: �`��
NOTE: Persons contracting with nregistered c ntractors do not have access to the guaranty fund
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 - U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Signature
CG" IMENTS
I
HEALTH Reviewed on Signature
COMA>ENTS
r
r,
yZon�ig Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Plaining Board Decision: Comments
'Gnservation Decision: Comments
.;Nater& Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
_ _
Located 384 Osgood Street
F1=j
IR �DEPARQTiMENT - Temp,Dumpster onsite eyes ,nog r
Locatedlat 112,4 Maih,Sfreet,
COMMEND rS
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.$100-$1000 fine
NOTES and DATA— (For department use)
❑ Notified for pickup Call Email
Date Time Contact Name
Doc.Building Permit Revised 2014
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
4, Building Permit Application
:r 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
4. Building Permit Application
� Certified Surveyed Plot Plan
Workers Comp Affidavit
16 Photo Copy of H.I.C. And C.S.L. Licenses
4. Copy Of Contract
,4. Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Mass check Energy Compliance Report (If Applicable)
;ra 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
Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
,r< 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
m ust be submitted with the building application
Doc:Building Permit Revised 2014
Enter construction cost for fee cal - North Andover Fee Cakulation
Construction Cost
12,000.00 m
$ - $ 144.00
Plumbing Fee $ 18.00
Gas Fee 100 comm. $ 100.00
Electrical Fee $ 18.00
Total fees collected $ 280.00
6 Union Street
029-2017 on 7/72016
remodel kitchen and bath 11 replacement windows
BUILDING PERMIT O* NORTH q
2 batt`EO +r6'yy0
TOWN OF NORTH ANDOVER -
APPLICATION FOR PLAN EXAMINATION 70
Permit NoM Date Received
�•9 g0RATEo
SSACHU5�
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION
rmt
PROPERTY OWNER C�9 � /V .y�'!�c'�' k<rt1
Print 100 Year Structure yes o
MAP _PARCEL:__ZONING DISTRICT: Historic District yes o
Machine Shop Village yes o
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
otl= etl dt
DE CRIPTION OF WORK TO BE PERFORMED:
2 Uv t"4 We / , w, �Wo w S
A ep lag ekcteii �
Identification- Please Type or Print Clearly
OWNER: Name: 4oed6Lv 4n4ge �Ikly Phone: 33_ - 4yo 7Z3%
V
i
Address: C. " /c 11J S�- A o/L 14 kvdo ue rz-
Contractor Name: &,q o6aN A tic)r2ey,�/i&LPhone: 339 (Kyo ;x z /
Email: 4L -a1, e, k. LJ /-25D 4 rnar` coyer
Address: o� Coti.oXv !'
Supervisor's Construction License: 'S " 10F v2 ,;�10 Exp. Date:
Home Improvement License: / ,,2 Exp. Date: D��
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: $ /„7 COc . Cc) FEE: $
Check No.: IT Receipt No.: I} j�"l
NOTE: Persons contracting with nregistered retractors do not have access to the guaranty fund
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C)28- 26 (7 2
,� oh , ver, Mass �1
A- cocnichew.c.� y1.
7,�5 RArED 0 5
U BOARD OF HEALTH
Food/Kitchen
PERM LD Septic System
THIS CERTIFIES THAT . . .. .... . ... ..
` BUILDING INSPECTOR
............ .. ...... ... �� .. !� ........ ....................
.. ... . ... 4e4-
.......
....
tt� Foundation
has permission to erect ......................... ildings on ... ........ .. . .. ................ ......................
.....
/I__ 11 .. Rough
to be occupied as ..... ' �'�M. ..... ........�� �.....'!....... .. ........ . Chimney
provided that the person accepting this ermit 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 B -Laws rela 'ng to the Inspe on,Alteration and
itConstruction of Buildings in the Town of North Andover. " w
4D 's PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONST CTI T Rough
Service
. .. . ... . ..... .. ........ .. ............
Final
BUILDI INS CTOR
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.
TOW, N OF NORTH ANDOVER
OFFICE OF
BUILDW—G DEPARTMENT
a * 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
BIIID'ING PERMIT APPLICATION
Please print
DATE:
JOB LOCATION: (ze 7,/-
Number Street Address Map/Lot
HOMEOWNER �D 41iV' &o(f2
ame Home Phone Work Phone
PRESENT MAILING ADDRESS Gf°�I 1'09A1 1'
111,01e te'll 41V ofo
City Town State Zip Code
The current exemption for"homeowners"was extended to include owner oecupied dwellings of one or two family
dwellings and to allow such homeowners to engage an individual for hire who does not possess a license,provided
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 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 , mply 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
I
: The Commonwealth of Massachusetts
.Department of IndustrialAccidents
I Congress Street,Suite 100
Boston,MA 02114-2017
y�;�"` www mass.goh/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information A Please Print Legibej
ly
Name(Business/Organization/Individual): /jtD�e44 N A,Q x /,,- /
Address: 02 �y�` oN .f' /vo , 1/,?/4.-
city/state/zip:
/,/LCity/State/Zip: O Phone#: 39 Z,1'6/O •7 Z 3
Are you an employer?Check the appropriate box: Type of project(required):
1.❑Tama employer with employees(full and/or part time).* 7. 0 New construction
2.rl 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.rllar4atomeowner doing all work myself.[No workers'comp..nisurance required.]t
10 Building addition
4. 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.❑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. 13.0 Roof repairs
These sub-contractors have employees and have workers'comp.insuranceJ
6.FJ We are a corporation and its of�cers have exercised their right of exemption per MGL c. 14.Q Other
152,§1(4),and we have no.employees.[No workers'comp.insurance required.] 7.
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
Homeowners who subaf#his 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-co iiractors have employees,&i 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 S elf-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 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.
Ido hereby certify un er the pazns and naldes ofperjury that the information provided above is true and correct.
Signature: Date:
Phone#• v d ,z 3
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#:
Informati®n 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,ox 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&*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 Iirdustrial
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
7/4/2016 IKEA Home Planner Printout
All measurement in inches
Project name
6 union st kitchen rev black2
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Total Price:
$3,591.76
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6 union st kitchen rev black2 - Plan View All measurement in inches
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6 union st kitchen rev black2 - Island View 1 All measurement in inches
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