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HomeMy WebLinkAboutBuilding Permit #146-11 - 216 FOREST STREET 8/20/2011 BUILDING PERMITNORTH TOWN OF NORTH ANDOVER o�tt��o �` 1+ APPLICATION FOR PLAN EXAMINATION Permit NO; Date Received Date Issued: 4�_oSSACHus IMPORTANT Applicant must complete all items on this page m�. (t�Y rr 4 n.tcl,k� "'r^A 17, 5� .'�"aF„tgy. .1�a'.+'k -ry r.. G'G'. ---1 V�1.N. d T-5 1 i y 1 d• t�T�4U 4 '�p *^Gac� gr--, r t •t hrr 4x,..,,NA5,N5 3 f.�- ..f' ks ,5�"•wS t .,Fr>. ".� �u.h. r 'Lb 3�i R �S3 i-4L{I L r — �" k U 1 D ` f - ..i 'r - ,r ^_"t;_ Y- 'r.:Jq.#1r'`<reh`„"�•-'.-..s .�yrt v-5 ,e ,••. a,r t 1 t Z .,a+ti� r,�'�.�t f `�`� �1 F{ „' h tW.� 'rhr9�'"-�7 �^ �Frc'T., +Y- ', It .Rnp,r c a 5..a1.,kr1-1—I-isf,�Xi,'cnit,.�i -Niba S'..... T ��as�a��cIslva�� �'� �� �'�1-�'•"u7�Af� sr�,�e�,-�.`��,r J Y��•"s �w ��gYr���''al'{ tax h7.��x' $fir'S r'�(r•T'i-17-',r'�-*a... 'i�;'r rR..ns v� S ,�r� ^• �..�{f a t�Y �7 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ne family Addition ore family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition { Other sTK`_" Ea ,` a2rr r'r'i� -{"s� eA '�...-,.. ........, t�u �rv��.�,.zx,,Y Ari d�t%�.�.,2tn'���zr*. ms-r�Y }�,'.Lr` "'! '�-,'ix F"X '�'��r�>�'�,•f�7'��� �n� f�a`t�riist�t+ �a DESCRIPTION OF WORK TO BE PREFORMED: Identification PIease Type or Print Clearly) OWNER: Name: p�y_��' jl� Phone Address: fG �aRES 5r A �. '+ .1'ay.�-. .t Fk^' kte " u 3 e H-...� $. , ',,,yg",hzv1 ta.:.-Pr',r�t.•;r.�- �-�-�,. '7��yY""`f`"4' '>�z� ;�-�''r�:,'.Y�y2",��'�S'r,:'a�t�. 9�n+'�'",�`�'-�T'�"; i�v��, °�'ri°��� -v �!�i, 3-#�'� c-r w -taa,"+?'' ^xr,3- v -r:,Yc ys -n r`'a tl yr� � .ir-+-ys '. 3 au' ^x" " %i• .r liclli `-..s '�4.'L'`IY^ "'+dr� r+ "" �'.'4 •- .- t E71` r #""t""s., 4�mr': ^' s�.,.'ar -7 ,��„ �rCK-ay's'-arc"+,;3'��c-c�' n h w�P t t � � a.-� "¢ `4��r�n r.,.�x�" 'L ��yi•,�s7e.'a�r'szT�{�.;�'�: �111—I'M ff n'dkSx * rl t 4 i.. < ''n " a t.!> 'i i"` 1 #r 'x�' - r f a 3 y7ti -€ . m � YY [ "fir. � s r"7'ali`"'� �`�'F G^i y r 7F'! ,mgt tt .. k/r`'� � 't ,. ��,.A..h rYrr _ $'L�r �s.," �i r tay .+:J: ., pla �' l,c•^,.�,�z- '�+ `5:w.': �P ��•4e REµ'.. r xt.a�rf 1. t� ....k°J b4.c ,{r �r.3 ay��Ebr'g � u 1 ext"'`�.� C,�'x.:l�rrTS�'T 33� ~ � iYii�,-aG ' ����,-�rx�H�,9,{�f�t� ,{�'+; ��i�.�,„ �ilN'x''" rFryF..="Jr�".�.r,I_�rr�-��y�d7�"?+�..,..'�>�r'xa ti•�aii`-^�q�� ,a � �5-'�3`�..t� a#r`J`�Y-',r� rcz 4'-`3 zrs r"'t mom-+ y. ,;� ARCHITECT/ENGINEER Phone: i 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: $ 2(�� .� FEE: $_ _/,(Do Check No.: Receipt No.:� �j. NOTE: Persons contracti g t I un g' er d contractors do not have access to the guaranty fund Sjgnat�ref ent/ ,uuner 'Signature off c an rector Location No. A& Date v w �QRTq TOWN OF NORTH ANDOVER 1 F jAL Alr� Q� A # Certificate of Occupancy $ Building/Frame Permit Fee $ sem- -2 CHUSE Building /Frame Permit Fee $ Other Permit Fee $ TOTAL $ Check #.1� '-- 2 3 3 %-% 233 %-%� Building Inspector Plans Submitted Pians 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 i CONSERVATION Reviewed on Signature �.CJif I\iiCN t 5 HEALTH Reviewed on Signature COMMENTS �-1 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: Located 384 Osgood Street F'�����E��►���IE�T .:f�er���Dur�p��e��r��ate� �e�`H -� r z z s 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 I NOTES and DATA— (For department use) ❑ Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The following isa 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) ❑ IVI "'ass 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 BuildingPlans (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 Clerk s office must stamp the decision from the Board of Appeals that thea appeal period i pp p s 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 2008 otstyeOF µORTH TOWN OF NORTH ANDOVER rE�tio ti 0� OFFICE OF BUILDING DEPARTMENT �o 1600 Osgood Street Building 20, Suite 2-36 �'�s��•,� "� North Andover,Massachusetts 01845 sgcause Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please print DATE: JOB LOCATION: 9 C COR r 12 Number Street Address Map/L t IiOMEOWNER ame Home Phone Work Phone PRESENT MAILING ADDRESS Az6v- City Town stat„ 'yip Code The current exemption for"homeowners"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,provided 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 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-year period 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"certifie e s der tanithe Town of North Andover Building Department minimum inspection procedures an( equirements d tha he< e will comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OF`FICLJ�/ Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 f NORTH ToVM of o - - .;. No. -o " dover, Mass., I� COC HICHEWICK 7�S RATED BOARD OF HEALTH Food/Kitchen Septic System .PERMIT T D BUILDING INSPECTOR THIS CERTIFIES THATV, r ...... .........�.:�...................................... 11-1........................................................................................ Foundation has permission to erect................... ..................... buildings on . .i�....- � T.. � ..................:....... Rou h to be occupied as...... -T....1. ...........e..-. C<. .: .... 6.....'.. ... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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 PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRU ST TS ELECTRICAL INSPECTOR Rough Service ............................... .......................... .................... . BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. The Commonweizith of 111zssachusetts Department of rndustrial Accidents Office ofinvestigations 600 Washington Street Boston, MA 02111 WWw-MaS&e ov1&a Workers' Compensation Insurance Affidavit; Builders/Contractors/Electricians/Plumb Aa licant Information ers Please Print Leo-, Name (Business/Organization/Individual); ©� /� Address:_ 0-16 &�(�V- 15; 1 City/State/Zip: Phone#:_ Are you an employer?er. P Y Check the appropriate boa: I•❑ I am a employer with 4. ❑ I am a Q Type of project(required): --------- general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6• ❑Nein construction 2•❑ I am a sole proprietor or partner- listed on the attached sheet $ 7. ❑Remodeling ship and have no employees These sub-contractors have ❑ working for me in any capacity. workers com . ' 8' Demolition [No workers' coin . P insurance. P insurance 5. ❑ We are a corporation and its 9. ❑Building addition egtured.] Officers 3. I have exercised then- 10•❑Electrical r am s ho repairs or homeowner doing all work right of exemption �.MG � � additions P L I Myself 1. Y [No workers co ❑Plumbingr insurance required.] t C. 152,§I(4) and we have no ��oradditions q ] employees. [No workers' 1-❑Roof repairs comp.ins I3. OtherR��� insurance required.] 'Any ?icsat Lhat ch=k boxmit also t Homeowners tui o. the senor ceior s^ca W.* � ers who submit alis affidavit indi=tin ,,w iContractOM+ g am'are all Grii and`' r••••••� t ch it this bo.*.must a bed an additional sheet sho'4*'the am outside contra =i ,. sbmit a new amriavif indicating such. name of the sub-contractors and their.workers•co -ram an employer that is providing workers'compensation insurance or rn em � Policy informatioa information f y Ployees Below,is the policy and.job site Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: Attach a copy of the workers' compensation policy declaration aae sho .City/State/Zip; Failure to secure coverage as required candor Section 25A of MGL P 152(sh lead to the policy number and expiration date). fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form oimposition STOP WOPK ORDER a of up to $250.00 a day against the violator. Be advised that a co penalties of i Investigations of the DIA for' overage verification Py of this statement may forwarded to the Office of fine I do hereby c fjr under p art!'d penalties o er .fP Jm"y that the information provided abov Signature: is true nd correct Phone#: Official use o>+ftji. Do not write in this area, to be completed by cite or tow,n official City or Town.: # Issuing Authority(circle one): permit/[,icense 1. Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbi>z� 6. Other a Inspector Contact Person: Phone n: Information an d 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 ox-other legal entity,employing employees. However the owner of a dwelling house having not more than three apartni ents 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 be cause 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 n license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of co3mpliance with the insurance coverage required." 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 ung acceptable evidence of compliance with the�r ranee requirements of this chapter have beeri presented to the cont acting 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 certificate(s)of incmanne. Limited Liability Companies(LLC)or Limited Liability partnerships(LLP)with no employees other than the members or partners,.are not required to carry workers'comp ernsation k m,a„ce. If an LLC or LLP does have employees,a policy is require& Be.advised that this affidavit, may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sore to sign and date the affidavit. The affidavit should be retained to the city or own that the auulicnd n for the perrm tor IIcez se uq being mq=scd,not the.Depa�eni.Of Industrial Accidents. Should you have any questions regarCh F?:e law or if you are re,ti d to obtaia 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 bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to than you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address,telephone.and.,fkx number..... The Conmonwmlt c Of Massachusetts. Department of fndugtrial Accidents Office of Inrestiaations 600 W&Siaington Street Boston,MA 02111. Te1. rr 617-72.7-4900 ext 406 or 1-s 7-1\,LASSAFE Revised 5-26-05 Fwa #6.17-72.7-7749 WVRW-Mass..gov/dia. --tZchanan Fireplace LLC Invoice Date Invoice# Your Local Hearth Store! 5/8/2010 2982 215 Salem St. 85 Providence Hwy. Medford, 02155 Westwood, 02090 (7S 1) 395-4808 (781) 329-2444 Terms Rep www.buchananfireplace.com 500/oDEP,Bal due @Install PB Bill Ta Ship To Rory hlartyn 216 Forest Street North Andover,MA 01845 Qty Item Code Description Cost Amount 1 HI305 Timberline... Hampton Timberline Brown Wood Insert 2,402.00 2,402.00T 1 300-925 Hampton Timberline Faceplate 495.00 495.00T 1 300-915 Hampton Timberline Blower 430.00 430.00T 1 ELLF-6-45 Elbow... 6"Elbow 45 Degree Stainless Steel 53.94 53.94T 1 LC6 6'Liner Coupling 35.39 35.39T 1 Labor-Install Install Fireplace,insert,or Stove,&venting 450.00 450.00 Discount Free Blower(promo item) -430.00 -430.00 Massachusetts Sales Tax 6.25% 189.77 Total $3,626.10 ot Credits $4,700.00 MODEL# SERIAL# Balance Due $1,926.10 We a reciateour business. Thank ou! All Deposits are non-refundable. No exchanges or returns on parts or products.Buchanan Fireplace LLC does not perform any gas work or electrical installation.If Buchanan Fireplace LLC pays for any permits,the customer is responsible for reimbursement of those permit fees,even if they are not included in the above invoice. REGENCY FIREPLACE PRODUCTS HAMPTON'S Manufacturers Certification Statement I American Recovery and Reinvestment Act of 2009 U.S. Energy Improvement Tax Credit 30%off the material cost of qualifying products up to$1500. Note: This a tax credit, not a deduction, so you get the full credit dollar amount deducted from your tax bill. HOW TO CLAIM THE CREDIT: �� � —�� 1. Purchase qualifying Regency and Hampton Fireplace Products(see below for a list of qualifying products),and install them between January 1,2009 and December 31,2010. 2. Save your sales receipt showing the material costs of the qualifying products along with this certification statement for your tax records. 3. Claim the tax credit associated with your qualifying purchase on your Federal filing for the 2009 and/or 2010 tax year. Fireplace Products International certifies that the biomass appliances listed below are"Eligible Building Envelope Components"that qualify for the tax credit allowed under Section 25C of the Internal Revenue Code. FBrand Type Model Regency Wood Stove F1100&CS1200 Regency Wood Stove F2400 Regency Wood Stove F3100 j f Regency Wood Stove S2400 Hampton Wood Stove H2O0 Hampton Wood Stove H300 Regency Wood Insert 11100 I Regency Wood Insert 11200,C11200&C11250 7 Regency Wood Insert 12400 Regency Wood Insert 13100 j Regency Wood Insert H2100 Hampton Wood Insert H1200 Hampton Wood Insert HI300 Regency Wood Fireplace FP90(R90-EX90) II Regency Pellet Stove/Insert GF55-GF155 Under penalties of perjury, I declare that I have examined this certification statement, and to the best of my knowledge and belief, the facts are true,correct,and complete. Tony Woodruff, President Fireplace Products International Ltd.,June 1,2009 Homeowner's Certification The following product(s)has(have)been installed in the primary residence of the following taxpayer: Homeowner's Name: . Primary Residence Address: Products Installed: Price Paid for Products. Date Purchased: Date Installed: Keep this document and proof of purchase or receipt with your income tax records. Fireplace Products International Ltd. 16988 Venture St. Delta, BC I Canada I V4G 1 H4 I www.regency-fire.com