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Home My WebLink AboutBuilding Permit #654-13 - 214 OSGOOD STREET 4/9/2013Permit N BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received 6 9 — d Il -eZ of 3 Date Issued: _ % ?J IMPORTANT: Applicant must complete all items on this nage LOCATION /V a /,0 ( WLeo �6 •~\ 0 a \� o PROPERTY OWNER_..�}�t' Y 13 6A ,gMA4 � Print MAP NO: ._05, 13 PARCEL: ✓S' ZONING DISTRICT:Com- J -Historic District yes 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 PREFORMED: FAD A(f- /?o &_ r—-.Rr/°LAc-r- Identification Please Type or Print Clearly) OWNER: Name:Ay� X 131 A 9/,g Phoneft7 S) Address: CONTRACTOR Name: c's Ohl l Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12. 0P R $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Dts�®aA �5��a Total Project Cost: $ A� 1A gaa 3c g ®� FEE: $ ate 7-- �-A 1, Z O o p Check No.: Receipt No NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Ow -Signature of contractor I't, 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 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: FIRE DEPARTMENT - Temp Dumpster onsite Located at 124 Main Street Fire Department signature/date COMMENTS Locatea J64 vsgooa Street yes no ✓' 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 - 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 ❑ 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Location.�?A d Oa/ S�1— No. Date Oz.; Check#_3�66 2, 26265 TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL Building Inspector /�cl�Md� GSSG -/3 The -Co. onweal-th of Nlassachusefts Departmeht of Fre Services " Office of the State Fire Mrshal • ' P. 0. Box 1025 State Road, Stow, IvL4 OI7T5 ; PERMIT Date: North Andover -Permit No (Cih/ of Tawn) ( If Applicable) ° Dig Safe Number In accordance with the provisions ofA2 G L -Chapter / v Z 4$ Ghap.ter�as provided in sectiaa• 5 � 7 r MR 34 % Stmt Date This Permit is granted to: ��` e T -c Full name ofpersoa, Firm'or Corporation Pcrmissionto locate dumpster - for construction/renovation/demolition of building. ComTIICnts:' dumpster must be. 25' from structure if unable to place with re aired Ratrictioas:clearance dumps -ter must be coveted with 1 wood or tarp end of work day at / r� 4• / r (Give location by street and n ., or descnbc in 'mnoner as to provied adequate identification of locatioa ) Fec P aid S 50.00 Fire Chief This Permit will expire S io atrc of Otklqanting permit) Offtcal grantin crrfdt g�P 1- Q LL DZ O m t u Y I- o LL L E Q)m N u a ai '{n 00 W z z J D O O -a M LL s CLO K aJ c U m LL O W Z a s °�° K co LL O W Z V u J W s M W �Z N LL D: O d z c7 s M d' LL z W a c LL v E m O z +� a°1J N + aJ Y O N 0: r, L uj am a/ � O Qi v C W > •QL =a O CL `ZE m .r Z 4) i t :c� O �oo o V ai Q Z d :v d E Ol = Qi 0 0 LD L Gi J m � CD Cl) o moo• C w> m w �— > tNai C C ; The Commonwealth of Massachusetts, De i 111"Gr" EV ""ICIZU Office of Investigations 600 Washk-ton Street Boston, M4 82111 WWw-Mws.9VvMa Workers' Compensation Imfirane . e Affidavit: Buflders/Coubac.torgMectriciang/Plumbers Aigmt Information Please Print Levibly Name (BminewOrpoizatiorAndividual): —A&24A11A1-(1At Address. citylstawzip; Phone Type of project (requirel* 6. E3 New construction 1. 0 Remodeling, 8. FJ Demolition - 9. n Boding addition io-nElectrical repairs or additions 11-[] Plumbing repairs or additions 12.[] Roof repairs 13.0.0ther Homeown* who submit this aff'i'davit Wimfing thcy g wo COMIMMUM RIMY Information. am doing an wo* and that him outside contractors must submit a new AfU&vit indicz* koubuctors dw chmk this box row aftwW = adftOzW AM showing the name of do sub-co� wW their wod=, cc, such. m.P. WL y klinafton. am an employer that isppovi&n information. Z:w0,rkZM'c0Mpenzad&n iftsurnncefornW mployeeL fid&W iS-thePVrk7- and job site Insurance Company Name: Policy # or Self -ins. Lie . . EXphtion Daft: Job Site Address: iy6 C1titatmaip Attach a copy of;he_WqrkpWcompensation policy declaration page (showing the -Policy number and expiration d2*4 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 $U00.00 and/or One -Year imprisoninent, as well as civil Penalties in the fbM Of R STOP WORK ORDER and a fine of up to $250.00 R day against the violator. Be advised that a copy of this statement MRY be forwarded to the Office of investigations of -the DIA for insurance coverage verification. I do hereby Fen* under &e palm and penalties of that theinfi above is true and conTA certify Zr- 7", Si I - , �> -IM J GIR Offxhd use only. Do not write in this area, to he confhwad by * or town official City or Town: Permit/License ig Issuing Authority (circle one): I. Board of Health 2- Buildi%u Department 3. City/Town Clerk 4, Electrical Inspector 'S (L other Plumbing Inspector Contact Person: Phone M ----------- Are you an employer? Check.the appropriate bo I. F1 u Eirn a em with . p Oyer 4. E3 IX: am R general contractor and I emploYeer, (full and/or part-time).* 2.[] 1 am AsOle proprietor.orpartner. have hired the sub -contractors listed t on the attached sheet ship and have no employees, These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workerss comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their I am a homeowner doing all work Tight of exemption per MGL myself (No-workirs'comp. c. 152, § 1(4), and we have no insurance required,)1 employees. [No workers' comp. insurance required.] *Any applicant that o fill out the section below A-m— ch=ks bWft I must also Type of project (requirel* 6. E3 New construction 1. 0 Remodeling, 8. FJ Demolition - 9. n Boding addition io-nElectrical repairs or additions 11-[] Plumbing repairs or additions 12.[] Roof repairs 13.0.0ther Homeown* who submit this aff'i'davit Wimfing thcy g wo COMIMMUM RIMY Information. am doing an wo* and that him outside contractors must submit a new AfU&vit indicz* koubuctors dw chmk this box row aftwW = adftOzW AM showing the name of do sub-co� wW their wod=, cc, such. m.P. WL y klinafton. am an employer that isppovi&n information. Z:w0,rkZM'c0Mpenzad&n iftsurnncefornW mployeeL fid&W iS-thePVrk7- and job site Insurance Company Name: Policy # or Self -ins. Lie . . EXphtion Daft: Job Site Address: iy6 C1titatmaip Attach a copy of;he_WqrkpWcompensation policy declaration page (showing the -Policy number and expiration d2*4 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 $U00.00 and/or One -Year imprisoninent, as well as civil Penalties in the fbM Of R STOP WORK ORDER and a fine of up to $250.00 R day against the violator. Be advised that a copy of this statement MRY be forwarded to the Office of investigations of -the DIA for insurance coverage verification. I do hereby Fen* under &e palm and penalties of that theinfi above is true and conTA certify Zr- 7", Si I - , �> -IM J GIR Offxhd use only. Do not write in this area, to he confhwad by * or town official City or Town: Permit/License ig Issuing Authority (circle one): I. Board of Health 2- Buildi%u Department 3. City/Town Clerk 4, Electrical Inspector 'S (L other Plumbing Inspector Contact Person: Phone M ----------- MORTN TOWN OF NORTH ANDOVER �•'"� `,"° OFFICE OF p BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 °•....`� North Andover, Massachusetts 01845 Gerald A Brown Inspector of Buildings HOMEOWNER LICENSE EXEMPTION lease Print DATE:()'/ -4 3 Telephone (978) 688-9545 Fax (978)688-9542 JOB LOCATION: 2 /'f O s-6 o a p S1-13cET ,c3 /r 5 - Number Street Address Mgp(I,ptRc .Q MY HOMEOWNER 61Yint 78 3 --o 2 3 (,j S �j- S/ Name Home Phone Work Phone PRESENT MAILING ADDRESS -?-/y - 05 6 bop S7 - City Town State Zip Code The current exemption for"homeownerC 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, ptnvided 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 helshe resides or intends to reside, on which theme 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 complianves 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 said procedures and ztixlvu'ements• . HOMEOWNERS APPROVAL OF BUILDING OFFICIAL Reviud 101W5 Form Homeowom Eamon ROARD OF \PPE:u. S 689-9541 CU.\SERN'SrION 688-9530 HEAL.T1i 488-9534 PLANK' ING 688-9535 0