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Home My WebLink AboutBuilding Permit #619-15 - 207 FARNUM STREET 11/19/2015S6Ryvw6:,D — /I d j— /,r, BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: J S Date Received Date Issued: / ORTANT- Applicant must complete all items on this page LOCATION. _''tel 1 _.j4- CS' PROPERTY OWNER_ Ptint � 100 Year�Strdcture yes MAP, PARCEL: ZONING DISTRICT: _ Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building fine family Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ❑ We -Ili ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer OWNER: Name: Address: ra/� I Contractor Name: dC DESCRIPTION�OF WORK T IrERFORMED: fed lease Type or Print Clearly o /(/1(-/4 N Phone: Nf1 r.� a Email: Address: _ ()"J �J- Supervisor's Construction, License: _ _. r Exp. Date: ._ Home Improvement License: Exp. Date: ARCHITECT/ENGINEER S�� 1�'1 hl � hone: Address: IJ �`� K� 1 itil �I �t rlr� Reg. No.��-i 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: $ X00 Check No.: G 0 r Receipt Noe-\ /"*, I (tee NOTE: Persons contracting wit registered contractors do not have access to the guaranty nd X Oil er «l l — 91 v L�Signature of contractor- I l I tU I t Locatior�� f—:�rA U!n S No. —("Plf / (09::�p Check #/OE - 2 -696 D ate A / 4f - TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee' $ Foundation Permit Fee Other Permit Fee TOTAL 6,elc� Building Inspector Plans Submitted ❑ Plans Waived.❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Sing Pools 11Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc.ywqb,Pennanent Dwnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM NTNG & DEVELOPMENT COMMENTS SERVATION COMMENTS -) D k\\1111 Reviewed On - NmmflP Reviewed on Signature_ COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes .a Planning Board Decision: Conservation Decision: Comments 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 signatureldate Plans Submitted.❑ Plans Waived. [I Certified Plot Plan ❑ Stamped Plans ❑ YPE OF SEWERAGE DISPOSAL blic Sewer ❑ F Tanning/MassageBody Art ❑ Swimming Pools ❑ell ❑ Tobacco Sales - ❑ Food Packaging/Sales ❑ Private (septic tank, etc. Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM ,n A11114, /NNING & DEVELOPMENT Reviewed On ( ('��{`� Signature_ 4(-W,'/-' COMMENTSdtvc� 13�1 ,e - h�� C'NSERVATION Reviewed on COMMENTS V\Z 10i H X LTH Reviewed or 11 =5 Signature Sianature�-4)// 3� Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Com Conservation Decision: Comments Water & Sewer Connection/signature & Date Driveway Permit DPW Town Engineer: Signature: uocatea J64 Osgood Street +FIRE ,DEP,AIZTMENT _ TempDumpsterosite) yes _ ono ' Located ate 1r24�"Main,�St�eet Fire Depgftment,,si'gnature/date;..,. W11 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) Doc.Building Permit Revised 2014 Vj ' 1 I L) ❑ 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 ❑ Building Permit Application ❑ Workers Comp Affidavit o 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 o 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 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: Building Permit Revised 2014 LEGEND QQ DH DRILLHOLE N/F NOW OR FORMERLY BIT. CONC. BITUMINOUS CONCRETE W.F.D. WOOD FRAME DWELLING 0000 STONE WALL PROP. AWITM � N/F /Voo. 0406 _nom, FARNUM STREET (PUBLIC -VARIABLE WIDTH) NO TES 1. SEE TOWN OF NORTH ANDOVER ASSESSORS MAP #107A LOT #52 AND DEED BOOK #5701 N PAGE #202 E. N. D. R. D. FOR SITE. O 2. ZONING DISTRICT IS RESIDENCE 1. N 0 0 00 0 0 � I trhtiv t. r; ✓ae 10 23 15 SKI, R.L.S. DATE 17.72' t°48'25"E J'+L V L L I t PLAN OF LAND IN NORTH ANDOVER, MASSACHUSETTS DRAWN FOR THOMAS E. MIXON, SR. 207 FARNUM STREET NORTH ANDOVER, MASSACHUSETTS 01845 SCALE: 1"=40' DATE: OCTOBER 23, 2015 MERRIMACK ENGINEERING SERVICES 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 TOWN OF NORTH 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 d �5 DATE: G JOB LOCATION: palvi�bA /" d�� &Adwlmo- 015�5 Numbe Street Address Map/Lot ._ / Q A ISa HOMEOWNER �d �� (V `(�VA) % /7-Q, Name Home Phone Work Phone PRESENT MAILING ADDRESS ��'✓%�� /V City Town State Zip Code The current exemption for "homeowners" was extended to include owner 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, 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 e understands the Town of North Andover Building Department minimum inspection procedures and require ents and that he/shewill comply 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 0 s lJ Issued for Foundation Permit: 10\22\I5 Geyl ED.-IDSPro ect Name: Mixon Residence AdditionUDSSilverwatch Architects, LLC Prepared For: Tom Mixon207 Famam Road Architecture' Fngilreenng' Design' land Planning Pro ect Address: fsstom«mer Road -ndh-,Newnam �Nonh Andos'er Massochuseus ry Inhfre07087 Sheet Title: Basement\Foundation Plan —51Lvrawe c— 0 } 0 F w o' 0 0 Issued for Foundation Permit: 10\22\1 S yy1 Dmwn: UJDPro ect Name: Mixon Residence Additionch�toa: AppmvW: Silverwatch Architects, LLC Prepared For: Tom Mixon 707 f',,,—Rd Architecture' Engineering' Design' Land Planning Project Address: Norah Andorm Ma—chutctis 155 Londonderry Road Windham, New Namohire 07087 Sheet Title: Main Floor Plan Ua.ev..«so Project Name: Mixon Residence Addition Checked: JDS � APprmoa: rJM Prepared For: Tom Mixon 1 x� Project Address: 207 Pamom Road Nodh Andover, Ma85achLL HS w nate: rowans Sheet Title:. _. BasemenflFoimdation Plan ' Rn'ea No.: SA-SR1S'' Silverwatch Architects, LLC Architecture' Engineering' Design' Land Planning 155 L,ondondeny Road Windham, New Hampshire03087 ap3.a9a.Hl0 www.LLVERN'ATCX.COM r• 0 I I 1 i I m I I I I i I I I I I 1 I I I I I I I I I I I I I Project Name: Mixon Residence Addition Checked: JDS � APprmoa: rJM Prepared For: Tom Mixon 1 x� Project Address: 207 Pamom Road Nodh Andover, Ma85achLL HS w nate: rowans Sheet Title:. _. BasemenflFoimdation Plan ' Rn'ea No.: SA-SR1S'' Silverwatch Architects, LLC Architecture' Engineering' Design' Land Planning 155 L,ondondeny Road Windham, New Hampshire03087 ap3.a9a.Hl0 www.LLVERN'ATCX.COM The Commonwealth ofMdassachusetts ' a Department of IndustrialAceldents I C'ongr'ess Street, Suite 100 Boston, M4 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. lame (Business/Organization/Individual): - address: �9 o "_:ity/State/Zip: [- �2 kujC)� Are you an employer? Check the appropriate box: o `Xd Of XYs Phone #:�I� 1. ❑ I am a employer with _ _ _employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] -Pi am a homeowner doing all work myself. [No workers' comp. insurance required.] t a 5fl 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 proprietors with no employees. 5 ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.# 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.] Type of project (required): 7. F1 New construction 8. 0 Remodeling 9. ❑ Demolition 10 ( Building addition 11.0 Electrical repairs or additions 12. Plumbing repairs or additions 13. Q Roof repairs 14. ❑ Other "Any applicant that checks box 41 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. #C ntractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have e,;,1loyees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I cm an employer that is pioviding workers' compensation insurance for my employees.' Below is the policy and job site b i,l irmation. Ii :.arance Company Name: Policy ## or Self -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 a u-Vor 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 d•t , against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance c.y rerage verifi Aon. I do herehy un,deithe gains a penalties of perjury that the information provided above is t ue and correct. Date: % 11), 1'C le I ( PI?dl r 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/T'own Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone i o o��o o CD Q CD 0 ' cn z p in �; y C W�ID Cn o s N I _ = 1 �• C n N a CD N a r. Cn n o o CSD � =r� D Z N C = CD -a CD O Z CL -� o Cl) CD �Z CD sr Om o nCDW 03 <CD 0 CD NCD C CD� o m ,� �CD �` ca CL.� p 'CD to 'G CD O CD O Z toCD rt N� CDZ:�. c Q v �•>on O CD �• C � v `° to o 03 p, CD z O 70 y ; C 7 CD Z: CD -0 O � m c CL 3 pr (D N (D �* Z O co C O (� m mm a m -t T A O Oq G7 (AW m O T 5. N (D C rD x O QQ m m n z m 0 0 T 3 PO O W s C C) z m O 0 T n = _S 3 n rD \ \ x O DQ � m O O o.. O :3 C z to m O N (D �. n vi < 3 T O Q n W O m 0 S m x