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Home My WebLink AboutBuilding Permit #589-13 - 21 DELUCIA WAY 3/4/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0:5 Date Received Date Issued. IMPORTANT:Applicant must complete all items on this page LOCATION 2 �eGuc�`o� w^ j No&A fq��-e-Y! 114A 0 Print PROPERTY OWNER �P` '"`' Print 100 Year Old Structure yes no MAP NO: 2 Z PARCEL:( 4ZONING DISTRICT: Historic District yes an 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 ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: t Address: CONTRACTOR Name: Guy- � `.e �l'k Phone: 617— Address: /6-0 �lrl�'xc s" r �- fJJr�' C)-2/-35 Supervisor's Construction License: Exp. Date: Home Improvement License: CS lo 00 11-3 Exp. Date: 194a-6 �v13 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: $ //� &-" FEE: $ Check No.: ' I D-3'-� Receipt No.: �� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ;Sig.nature of Agent/-Owne� -� �- Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Location UGI !NA No. Date ' AJ i i '� • - TOWN OF NORTH ANpOVER s ,VIVLEnz,4 ' c • M Certificate of Occupancy3 ° Building/Frame Permit Fee $ 3 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# U 26187 Building Inspector 1 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEAL)k'H Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments !/!later & Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 OOs ood Street FIRE DEPARTME=NT - Temp Dumpster on site yes no - Located at 124 MainStreet Fire Department signature/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 DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use I Con )Ll— C,✓�" /1/�c0 D h d 6bk, LI Notified for pickup - Date f E 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. 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 ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) o 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 app;al 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 L;CJIVIIVICIV l v ---- -- Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost 111000.00 m $ - $ 132.00 Plumbing Fee $ 16.50 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 16.50 Total fees collected $ 265.00 21 Deluica Way 589-13 on 3/4/13 Remodel Bathroom in Attic � NORTfy Town of t E ndov' er O - to h ver, Mass, 13 C Oca1c sewlc, ��• 7 V+ BOARD OF HEALTH Food/Kitchen PERMI* T T LD Septic System �/V� ,.,,Md..51................... BUILDING INSPECTOR THIS CERTIFIES THAT ......... 6.1.!.l ....... � ....:....................................................... t--� . Foundation has permission to erect .......................... buildings on ..�. ...�......... .I tom. �..�•s?.Gr�.i4....�?. .�................... ^ �r.� //� Rough to be occupied as .... ..!!i�!.... JV.Q.I�{..... �k.d.h.....t. .`.. ... ............................................... 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 �2 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI N ST RTS 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. SEE REVERSE SIDE µaery ' • a4 7��0.6'�Y TOWN OF NORTH ANDOVER �- �° OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20,-Suite 2-36 '�S�Ausf��y ' North Andover,Massachusetts 01845 Gerald A.Brown Telephone(97$)688-9545 InspectorofBiiildings Fax (978)688-9542 x HOMEOWNERLTCENSE EXEMPTION BUIDING PERMIT APPLICATION Please print DATE: J013 LOCATION: a:/ • ,4k c,t Gv Alar-A An1_&uer lu,4 olg45- Number Street Address VMaplLot WMEOWNER 'ya vis 79— 37�_ Name Home Phone Work Phone PRESENT MAILING ADDRESS 2 I ./P-esu X4 A C tsi To,�,n . S+=+w zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units-or less and to allow such horneormers to engage an i_ndividual.for hire wino 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 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-yearperiod 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 and requirements and that he/she will comply with procedures and requirements, HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 /VA, A 1 A- -5- f , s i C', The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/ilia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/PIumbers Alpplicant Information Please Print Legibly Name(Business/Organization/Individual): Address: 2 / ✓��Gu c r W City/State/Zip: ►re you an employer?Check the appropriate box: Type of project(required): ❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors F1 am a sole proprietor or partner- listed on the attached sheet.$ E]Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 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.❑Roof repairs insurance required.] employees.[No workers' q ] 13.❑Other comp.insurance required.] ty applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. omeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ntractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. w an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site grmation. urance Company Name: icy#or Self-ins.Lid.#: Expiration Date: Site Address: City/State/Zip: ach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). lure to secure coverage as required tinder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a 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 ip to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of estigations of the DIA for insurance coverage verification. Itereby certify under the pains and penalties of perjury that the information provided above is true and correct. iatur . ' ta Date: ne#: )fficial use only. Do not write in this area,to be completed by city or town official. :ity or Town: PermitUcense# ssuing Authority(circle one): .Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector Other M;ISSachusettS- Department of p - Board of Buildin', Rev Public S<ttet� Construction Su 'erv"-ul tonS and Standard' License: CS 100043 pervisor License Restricted to: 0® - CHARLOTTE LIU 1540 COMMONWEALTH EALTH AVE N N MA 02135 • tE x nntisioner A ration: 6/1%2012 Tr#: 100044 p� ✓tie �ammxoouuea�i a�./�aaoac�ucaetCa ..__�' �\ Office of Consumer Affairs&Business Regutafion HOME IMPROVEMENT CONTRACTOR Registration: p"32 Type: Expiration: 46126Y2013 Individual CH LOTTE S.LIU CHARLOTTE 150 ARLINGTON ST2L BRIGHTON,MA 0213�Si Undersecretary Details Page 1 of 1 J Licensee Details Demographic Information Full Name: CHARLOTTE S LIU Gender: Owner Name: License Address Information Address: Address 2: City: BRIGHTON State: MA ipcode: 02135 Country: United States License Information License No: CS-100043 License Type: Construction Supervisor Profession: Building Licenses Date of Last Renewal: Issue Date: Expiration Date: 6/1/2012 License Status: Expired Today's Date: 3/4/2013 Secondary License: Doing Business As: Status Change: 17 Pre 'site Information No Prerequisite Information Disci line No Discipline Information Documentum http://elicense.chs.state.ma.us/Verification/Details.aspx?agency_id=1&license_id=288952& 3/4/2013