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Home My WebLink AboutBuilding Permit #335-2017 - 2147 TURNPIKE STREET 9/28/2016 i t10RTN , BUILDING PERMIT TOWN OF NORTH ANDOVER 0 _ APPLICATION FOR PLAN EXAMINATION * _ s Permit No#: J Date Received ACHU Date Issued: IPJ I PORTANT: Applicant must complete all items on this page 'n iOCATION _ kj I'�/I Print PROPERTY OWNER_— i -Print T 100 Year fu lure St ye no MAP. PARCEL n_, " Y ZQNING DISTRICT: Hi Or Distract no — Mach�ne,S�hop Village's Y nog: - 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: Other ❑ Demolition ❑ _ C7 Septic 1]°1Nella ❑:Floodplain Wetlands; WatershedDis#riot , C�Water/Sewer §. _ - - DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly �� OWNER: Name: y Phone: Y Address: C`ontraetorName - _on e u. T , AddressIld'y - ITT- _ Supervisor's; Construction, icense_: -- }_ EXpk _ - _ _ .� ate> H©m`ealm ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ��( '� FEE: $ Check No.: Receipt No.: L X61(a NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund _ p �ignq— gn�atg�tof ture of contractor:_ Ag,e: _ Owner - _ 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 p " I COM RENTS e. 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: D;EP� Located 384 Osgood Street .� t b -� NT Te F Dum stet RgTME , p � p:� r�onsite eyes, ,n© Luted att 1r24rMainxS#reet FFe�Department sig�n'AtUre/date r i 11 I I F 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 E MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) r ❑ Notified for pickup Call Email i Date Time Contact Name Doc.Building Pennit 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 p 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 o 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 o 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 i Doe:Building Permit Revised 2014 Location No. `L?ct� Date . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $r '' Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ti Check# 30964 �` Building I s ctor �� o0RTli q Town of t 6 ndover O ``l• ry I No. *M,,26 ; bth ver, Mass COC NIC Nl WKK V S U BOARD OF HEALTH Food/Kitchen PER ,T LD Septic System THIS CERTIFIES THAT ;e4 ..!. ........................................................... BUILDING INSPECTOR 40 has permission to erect ..... .................... buildings on4A.1141....I��... .NA.�%4 .VC....... Foundation Rough 04 to be occupied as ........ ... . .... A.... m ..................................................................... Chimney provided that the person acce tin "this ermit shall in eve respect conform to the terms of the application p p g p every p pp 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST CTION Rough Service .. ..... .. . . . ...... ... ..... Fina ILDING IN EC R 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. OF NORTHAtip TOWN OF NORTH ANDOVER OFFICE OF A BUILDING DEPARTMENT 1600 Osgood Street,Building 20, Suite 2035 994�RAisG��'.cy North Andover,Massachusetts 01845 �SSNCHUStit Donald Belanger Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please print DATE: JOB LOCATION: 2 J Y7d�m l-,/_f, ST Number Street Address Map/Lot HOMEOWNER ��Y�� '09 z2&a Y ' Name Home Phone Work Phone r PRESENT MAILING ADDRESS J z 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/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFI Revised 8.2015 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 1'he Commonwealth of MassaMusetts _ Department ofIndustrial.Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 yon www mass.gov/dia °�M sys • Workers,Compensationlnsnrance Affidavit:Buildexs/Contxactors/Electricians/Plum ers. TO BE PILED WITH THE PERMITTING AUTHORTI'Y. Please Print Ledl? A licant Information , Name(Business/Organzation/Individual): ( -- Address: p City/State/Zip: '��'�: 170(6 u_ y = Phone#: �Y fl) _ n Are you an employer? _eclt the appropriate box: Type of project(required); em Io ees(full and/or part-time,).'-' 7. ❑New`construction i.❑I am a employer with P y 2,F]I am a sole proprietor or partnership and have no employees Working forme in $. Remodeling any capacity.[No workers'comp.insurance required.] 9. Demolition 3,M I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.❑Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole []Plumbing repairs Or additions proprietors with no empl6ye6s. 5.❑I am a general contractor and T have hired the sub-contactors listed on the attached sheet. 13•. Ro6f repairs These sub-contractors have employees and have workers'comp.imurance.t 14.[j Other 6.QWe are a corporation and its,officers have exercised their right of exemption per MGL c. 152,§1(4),and weliav6 no empldydes.[No workers'comp.insurance required.] applicant thatchecksbox#iew aff davit ,mustalsofilloutthesectionbelowshowingtheirworkers'compensationpolicyinformation. *�Yare all work i Homeowners who check this liox must attached an addition sheet showing the avit indicating they name of the sub -contractors and.state whether or not thoseentities have TContractors that employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. ,am an employer tl7- is providingivorkers'compensation insurance for my employees. Pelow is the policy and job site information. Insurance Company Name: Expiration Date: Policy#or Self-ins.Lic.#:. City/State/Zip- fob Site Address: Li on p iolicy declaration page(showing the policy number and expiratioza.date). Attach a copy of the workers' comipensa e by a fiiib up to$1,500-00 Failure to secure coverage as required as er MOL c. olation punish civil enalties?in the form of 25A is a criminal T'OP�WORK ORDER Iand fine of up to $250.00 a and/or one-year imprisonment,as well P 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 nder the pains andpenalties ofperjuty tl-aat the information provided abave is true and correct. - Date: Si ature: Phone#: write in this area,to be completed by city or town official. Official use-only. Do not Permit/License# City or Town: Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5inspector .Plumbing 6.Other Phone#: Contact Person: Information 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,or 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 r'equilred." 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 the boxes that apply to your situation and,if necessary,supply sub=contractors)name(s),address(es)and phone number(s)along with their certificates)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 Industrial 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 wwwmass.gov/dia