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Home My WebLink AboutBuilding Permit #193-15 - 2135 TURNPIKE STREET 8/22/2014 BUILDING PERMIT 1,D 6gti TOWN OF NORTH ANDOVER o= '`- " ' '` o m. APPLICATION FOR PLAN EXAMINATION `' x Permit No#: I Date Received ��SSACHUSE�� Date Issued: 2Z (, IMPORTANT: Applicant must complete all items on this page 54_ L>O:CATIbN IY J_5: _ 7_T�A 6l\- Print _ PROPERTY, QUVNER_ �_ y'ytit,G . .. �_� 2r'�-0 s �tc -_ - - ,_x- Print - 100 Year Strueture� s— .yes no MAP PARCEL 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 5L,Alteration No. of units: ❑ Commercial " Cf-Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic y❑1Nell ❑ Flootlplain V1/etlands ❑ 'Waters.hed D st'icta - - LL _I l Water/Sewer - DESCRIPTION OF WORK TO BE PERFORMED: I ed ow Identification- Please T pe or Print Clearly OWNER: Name: , hr% —immi'i Phone: P - 175t Address: 3 5� cMM Qbi t-actor'Name —'Phone'-- Add rO $ Phone:._Address: I A Supervisor's Construction.License _ - __ Exp. Date Home Improyement:License Exp Date:_ ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ONPER S.F. Total Project Cost: $ � ce)D FEE: $ 1 aw '�— Check No.: Receipt No.: a � 2 NOTE: Persons contrac ing with unregistered contractors do not have access to the guaranty fund - ._ _ :-� _ Signature of Agent%Owner „�.� ___ Signature of contractor_. Tl - _ 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 COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments c Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street cFIRE DEPARTMENT --Temp±Dumpster on site yes L.o_cated at 124Main'Street epmsign aueDtFFir COMMENtTS- 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 Pen-nit 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 o Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o 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 o Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o 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) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract Li Mass check Energy Compliance Report o 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 Location a t v �- t y ++ E No. Date • - TOWN OF NORTH ANDOVER; .. Certificate of Occupancy $ Building/Frame Permit Fee - Foundation Permit Fee $ Other Permit Fee $ R r'k t rLu,xv ` TOTAL. $ Check# 27937 Building Inspector � NORTF� Town ®ver �o >�h ti ver, Mass, L 41'K1�p My cocHICA '► S ItU BOARD OF HEALTH Food Kitchen PERMIT T L D Septic System THIS CERTIFIES THAT A.d BUILDING INSPECTOR .............. .......................... .�..... . 1. ..................................... a.1.3.r 0� Foundation has permission to erect .......................... buildings on ....... ........ ............... .1 .... . q Q Rough to be occupied as ......... e0 � p� �..... .......{/[4R.�.haV!:��........�.....�/.�~. ........�.�� .. .. �.............. Chimney provided that the person accepting this permit shall in every respect conf to the terms oi�+he 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 a PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR .UNLESS CONSTRUCTIO TS Rough Service ..............'. .... ........................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Recruited 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. ne Commonwealth ofHassachusetts .departmento•f. ndgsttrn1.Acc1d&fs • . Office o,fluvestigafeons 640 Washington.Street -Hoston,MA 02111 -www.massgovlcila Wgrkexo'Compensatzoubsurance.Afxdavit:BuRders/ContractorsIBlectricia)agl*berg .A.ppReant orma'dou PXea e. rizt e itbXy Namo(Business/drganizationikdz`vidual): . MV\ IIAJ City'/SLate%lip: J UVJ/h AM LA -- phow#: Are you an employer?Check the appropriate bOx: Type of project(required.): 1.❑ I am a employer With.- 4. lam a general contractor and I 6. E]New cbnsfruciion. f employees(Tullandlorpart✓time).* have,nedthesub-contractors Jt� 7• ��-emodeling 2.E] I am.a sole propriotor or parfn.ex listed on the attached shee ship and`havena•exnployees These sub-contraetorshave 8. [[Demolition wonting forme in any capacity. workerscomp.insurance. 9. E(Building addition LNo worRers' comp.insurance 5, []We are a corproratiom and its 101]Electxicalxepairs or additions xecluixed.� officers have exerclsed.their x am a homeowner doing all work right of exemption per MOL II..[]Plumbing,repairs or additions myseLF Uloworkers'comp. c•1.52,§1(4),andwehaven.o UPRoofxepairs insuraazcerec7uixsda employees.[No workers' Other comp.insurance required.] rapplieantthat checks box#Imusfial sofllloutthe section bB16Wshowingtheirworkam,comp Gus ationpolicyinfomiaiion. Homeownerswho submitibisafttdavit!ndicatingtheya• doing allworlVand then hire outside contractors must submit a now affidavit fndlceffig Woh, xConiractors tliaf obeektbis boxmust attached an additional shectshowingthename ofthe suh-contractors andtheirwoikars'comp,policyinfoimation. I ariz an empfoyep that 1sproV1tJ1 tg worters,eompe�r ation insr�raYtce foam erT ees: i3et w. is Chop lie andf b site infax'mation. h. suraace CompanyName:. policy#or Self ins.11ic.#: Expiration Date: Xob Site Address: CitylState/gip: Atfacla a copy of 4e,workexs'comp ensation)Folzcyfleclaxationpage(showing•Me,policynumbor and expiratiarz date). )Failure to secure coverage as requixed.under Section.25A ofMGL o.152 can.lead to the impositiorx of critninalPMalties of a Sze up to$1,50 0.�0 and/or oneyear iinprisoxvnent,as well as civilpenalties in the form of a STOP WORi,ORDER.and a fm.e ofup to$250,00 a.day against the violator. Be advised that a copy of t109 statementmay be foxwardedto the Office of Xnvestigations of the DIA.for insurance coverage vexffication. x do Xie�eby ce urider tr pains and penaltles of peP•iy glat tite mfor mradon vrovided a7 ove is true and Correct - Si atare: Date: Thon.e# �� Q (ods I -I g.:7 3 offi'elal use o,9ry. .Do notWite in trigs ON,to ire eoV10ted iiy city 0'-'ON o�ciai. City or Town: Permit/License 0 Issuing.t3 uthoxity(circle 67ae): 1.Board of Stealth?.Building)[Department 3.CitylTom Clerk 4.Electrical Inspector 5.En mbingfnspector f.Other - r - Information and Instructions - Massachaseffs General Laws chapter 152 requires all employers to provide workers'compensation for tlteit employees. .Parmait to this statute,an,erre,vroyee is do:r ed as`°,.,every p exsoxt hi.the service of another under any coxifract of hire, • express or implied,oxal or±wrifte,&, M eWfoye ig defined as"an individual,partnership,association,coxpoxafion or other legal entity,or anytwo oxmore ofthe Foregoingengaged inajointenterprise,and includingthelegalxepxesenfativesofa'deceasedempla ex,.orElie xeceiver oa;ttiistee of an individual,partnership,association cr other legal entity,employing employees. lowevex the owner of a dwelling house.havingnotmore thanthree,apartments andwho,resides therein,or the occupant ofthe, dwelling house of another Who employs,persons to do maintenance,construction ox repair work on sucl't dwelling house or onthegrounds orbuilding appurLenamtthereto shalinotbecause,ofsuch employmeatbe deemedto bean employer" MUL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the zsmance or renewal of a license or permit to operate a business or to construct buildings bathe commonwealth for a)ay applicant who has not produced.acceptable evidence of compliance Wath.the hiaurance coverage required;' Additionally,MGL chapter 152,§-25C(7)states`Neitherthe eommonwealthnor any of its political subdivisions shall enter into any contract for the performance ofpublic workunt. acceptable evidence of compliance with,the insurance xequirements ofUs chaptexhave beenpreseutedta the contracting authority," Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary',supplysub-confractox(s)narae(s),addxess(es)and�rhonenumbex(s)aIongwiththeir certiixcafe(s)of insiuxance. Limited Liability Companies(LLC)ox Limited Liability Partaerships(LLP)with.no employees other than,the members orpartners,arenotrequiradto carryworkers'compensatloninsuxance. HanLLC orLLP doeshave ernployees,apolloyismquired. Do advised thatthls affidavit maybe submitted to the Departruentof Industrial z Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should b e retnznad to the city or town that the application fox the permit or lt'censs is being requested,xto�the De�rartnzent of 7ndusttial Accidents. Should you have any questions regarding the law or if you are required to obtain.a*orkers' Comp ensaflonpolicy,please call the Department at the number listed below: Self insured companies should enter them• self-insurance,license number on the appropriate line. City or Town Mcials Pleasobesure thattheai zdavitis complete andpxintedlegibly. TheDepart7nenthas provided aspace attbebofL0m ofthe afdavitforyouto 0 Out in the event the Office of l vestigationshas to contactyou regarding the applicant: Please be-sure to M in.the pexmit/license number whichwill be used as a reference number, 7n addition,an applicant tliato4ust submit-multiple p ermitlilcense applications i a any givenyear,need only submit one,affidavit indicating current Policy Wormaflon(ifnecessmy)and under"Yob Site Address"the applicant should wxite"all loeat om in (city or toy&).".A:copy of'the of fidavit thathas been offloially stairped or marked by the city ox towumay be pxo-dded to the applicant as prboffhat a valid affidavit is an file for future p ennits or licenses. .A new affidavitratist be mpd.out each year.Marr,a lLome owner ox oitizen is obtaining a licrose ox permit not related to any business or commercial venture (i.e•a dog license orpermit to burn leaves eta.)said person is NOT required to complete this affidavit, The Office of lirves9gations would like to thank you in advance fox your cooperation and shquld you have any questions, please do not hesitate to give us a call. The Department's address,telephone aitd faxnumber: Dop ax Out ofkdu&ajAcc.1danto Osco otzox� 60G W441-?.gto:a Street B oaton,M.A 02111 Revised 5-26-OS Fax t 04 ear 'Sy TOWN OF i'TORTH AND O OVEP, OFFICE OF ' BUMI')JfNG DBBAR.TAV.[ NT • ' 600 Osgood Street BitIding 2D, Suite 236 NoxthAn& -r,Wassaehusetts 01845 - Gerald A.Brown • Telephone(978)588-9 45 Tnspectorof$uildings Fax (978)689-9542 ' HOMEOWNER•LTCENSE EXEMPTION Bi7ID)W PF-W-MT APPLE ICATIoN • please�rint • DATE: LA ' SOB LOCATION: ati 35 Number Street dress Map/Lot ' S5OMEO TER 1'ffg_S J Con Ie _ 18 35 11 - 358 - Name. Homs?,hone . WorkPhoue PRESENT N. ffMGADDRESS Zip Cod1 The current exemption for"homeowners,,was extended to i . re who does not nclude owner-o cctipied divelings to two tmifs•off-;ess and to allow sulbh homPo„vers to engage an.?ndividual•forhia 1icGaise,provided that the owner acts as supervisor). State Building (Code Becfion 108.3.5.1) DEFiNITION OFHOME0WNER Persons)who Awns aparcel ofland on which he/she resides or intends to reside,on which there is,or is infended to ' be,a one or two Family stracfures. A person who constructs more that�one home in..a iwa yearperiod shall not be considered ahomeowner. The undersigned"Acmedwaae'assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules andzegulations• The i mdersigned"homeownep certifies that he/she-Lnderstands the Town of North.A.ndoverBuildingDe&rtmeut finim'llm inspection procedures and requirements and that he/she will comply with,said procedures and requirements . .HOMEOWNERS SIGNATURE APPROVAL OF BMUNG OFFICIAL Revised 7.2009 Form Homeowners Exemption 'BOARD OF APPEALS 688-9541r SER'�rAMN6 CONT98-9530 BEALTH6$8-9540 . PLAIQNATG 688-9531