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HomeMy WebLinkAboutBuilding Permit #044-15 - 22 BELMONT STREET 7/14/2014 c %AORTF/ BUILDING PERMIT OFtiED TOWN OF NORTH ANDOVER 02 46 O A APPLICATION FOR PLAN EXAMINATION '' A y vy� OR w �"T Permit No#: Date Received �, A0 ArED 9SSACHV`-'�� Date Issued: %�,�&_Ilf I P R ANT: Applicant must complete all items on this page LOCATION _ bE7( ..W�z7vC __ Print PROPERTY OWNER-_ --- Pnnt 100 Yeas Structure yes no MAP 1- PARCEL: ZONING DISTRICT __, T.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 ❑Alteration No. of units: ❑ Commercial repair, replacement ❑Assessory Bldg 0 Others: ❑ Demolition ❑ Other El Septic []Well, ❑ Floodplain OW4 I a h ds ❑ Watershed District El Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: �A �,`(�»S �� C `\ Phone: �el" ' 7 an. 0 Address: Contractor(Name: ___- ,Phone: Address: Supervisor's ConstructionLicense: LocationlL-1_ � No. Date 1 . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# ( 27771 Building Inspector Plans Submitted ❑ Plans Waived 0 Certified Plot Plan ❑ Stamped Plans ❑ I _T_YP_BOF-SE_WERA-GE-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 Siqnature COMMENTS e i i j i Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments i I Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street rFIRE;DEPARTMENT Temp Dumpster onsite yes _ _ no Located at 124'Main Street _ - Fire Departmen`tsignature/date t �COMNIEN'TS __ _ 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 Permit Revised 2014 i 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 o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work o 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 o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ 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) o Building Permit Application ❑ Certified Proposed Plot Plan o 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) o Copy of Contract ❑ Mass check Energy Compliance Report a 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 Q4 1��nrH.gy To rr.LY OF O.C4TA.ANDO ER ybtf •��•,sa d� OBFICE OF o �--•-,= r� ••ppUM•D-N •fie • �o��",� , •1600 05g'OQdrS`t:ieefB1I.L���lY.1 d%ng 20,•Suite 2-36 S�se+tus� t North Andover,Massaehusetts 01845 Gerald A.Brown Telephone(978)688-954.5 3nspectorofBuiIdings - Fax (978)689-9542 ROMEOWNER•LICENSE EXEMPTION BULDJNG PER IVJQT APPLICATION 1'leaseprin-E •' � DATE: JOB LOCATfON: Number SfreetAddress MapfLot • I�OMEOWNER �.` o •?? �. \ 3 Name Horne Phone _ WorkPhone )MESENT MADTgG ADARES ?,p Cods The current exemption for"-homeowners"was extended to fo allow such hompo:res to engage as Ldividual•for lire w:ao does notposse do I a license,provided that ed dv"Iffigs to two tfhe owner d acts as supervisor). Rate Building (Code Section x08.3.5.1) DEFMITION OFROMEOVMR Persons)who awns a parcel of land on which he/she resides or intends foreside,on which fheze is,oras intended to considered ahozneowner. • be,si one or two family struaures. A persou vdho constructs more that one home in.a two-yearperiod shall not be The undersigned"homeowner"assumesresponsibilityfo_rcompliances with the State Building Co Applicable codes,by-laws,rules audregulations, de and otherc Thetmdersigned"homeowner"certifies that helshe"lorstauds the Town of North AndoverBuildingDepaz-tment n,;nhnum inspection prooedures and requirements and that he/she wilt comply with;said procedures and requirements, HOMROWN•ERS SIGNATURE APP.RO'VAL OF BIMUNG OFFICIAL Revised 7.2009 Form 23omeowners.Exempt on - L 'EOARDOFAPPEALS 688-9541OOhSER'4 AT:(ON r r • 688-9530 HEALTH 688-9540 PLANNING 688`9535 The Coxn�rtonwealth of lVfassaeh.useits , - Department o,f'I'adustriglAceldd its Office o,fIfivesfigafeo s 6411 Washington.Street Boston.,MA 112111 www-mass gov/dlia ,Wworkexs'Compensation Ynsurance Affidavit:Bader sfContractorsfElectr ician;siTIiiinbex,s Anulieanoranatxon Please Print LeitbXy 'Name(Business/Organization/.Tndz`vidrzal): Address- l�� Phone 4: O� City/State/Zip: Z) �L�_ Are your an.employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. d I am a general contractor and 1 6. []New contraction. employees(full andlox part time)* have lifted-tho sub-contractors e attached sheet.� 7. ❑Remodeling listed on th 2111 am a sole proprietor or partner Demolition These sub-contractors have 8. [( engem to ees -, ship and lave P Y working forma in any capacity. workers,comp,insurance. g, Building addition [No waders'comp.jnurance 5. ❑We are a corporation and its 10[]Electrical repairs or additions officers have exercised-their 3. X azn a homeowner aging all work right of exemption per MGL 11.[(Plumbing repairs or additions orkers'eom . c.152,§1(`i),and we,havono 12, DOE16 airs m self: o w P Y CN iusurancerecluired.]; employees.[No workers' 1311 Other comp.insurance required.] KAny applicantthat checks box#1 must also fill outthe section below showingtheir workers'compensagonpolky to Ebrmation. i-Homeowners who submitting affidavit indicatingthey are doing allworKand then hire outside contractors must submit anew affidavit indicating such. xContractors that cheokthis box must attached an additional sheet showingthe name ofthe sub-contractors andtheir workers'camp.policy information. lam an employer that is providing workers'compensation insurmaeo for�ny employees Below is the,Poticy anrij0 site information. Insurance CompanyName;. Policy#or Sem 7ns.Lic.#: ExpixatzonDate: Tob Site Address: CitylState/Zip: Attach a copy of tie workers'comp ensatlon-polley declaration page(showing the policy number and expirations crate). ' o itioxt of criminal enalties of a Failure to secure covexage as xequixedundex Section 25A ofMGL o.152 can lead to theImp s � fine up to$1,50 0.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER.and a fine e0ceo lator . Be,advised that a copy of this statement may be forwarded t of h Office f ofup to$250,00 a day against the vio Investigations of the DSA for insurance coverage verification. ,l'do hereby ceYfZf l ll\der th alas antipenaldes of pei juiy tfiat trte information proviILed above is true and correct - Si ature• Date: Phone#: t OW use only.�Do not write in this area,to be completed by city or tont official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department I CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other tax,­M, Information and Instructions MassachusefF.s General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to fhis statute,an ergployee is defined as"...everyperson iii.tho service of another under any contract of hire; express orimplie0,oral oxwritten." An employes is defined as"an individual,partnership,association,corporation or other legal entity,or anytwo oxmore of theoxegoing engaged in a joint enterprise,and includingthe legal representatives of a-deceased employer,.or the receiver or.trdstee of an individual,partnership,association or other legal entity,employing employees. Plowever the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant ofthe dwelling house of another who employs persons to do maintenance,construction ox repair work on such dwelling house or on the grounds ox 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 ZiGensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth fox any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states'Weitherthe comm onwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapterhave baonpresentedta the contracting authority.." Applicants a` Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and;if necessary,supply sub-contractor(s)name(s),add-mss(es)and phonenumber(s)along with their carecafe(s)of insurance. Limited Liability Companies(LLC)ox Limited Liability Partnerships(LLP)with no employees other than the members ox partners,are notrequired to carry workers'compensation insurance. If an LL C orLLP does have employees,apolicyisxequired. Be advisedthatthisaftxxdavitmaybesubmittedtotheDepaztmentofrndustrial Accidents for con nation of insurance coverage. Also be sure to sign and date the affidavit. the affidavit should be xetuined fo the city or town that the application for the permit ox license is being requested,not the Department of Industrial Accidents. Shouldyou have any questions regarding the law or if you are required to obtain a yvorkexs' 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 printedlegibly. The Department has provided a space at the bottom of the affidavit fox 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 peamif/licen e number whichwill be used as a reference number. Tn.addition,an applicant that must submitmultiple permit/Ircome applications is any givenyear,need only submit one affcdavit indicating current P obey information.(if necessary)and under"M Site Address"the applicant should write"all locations in. (city or town.".AA copy of the affidavit that has been officially stamped or marked by the city or town may be provided fo the V applicant as pz`oofthatavalida�davitisonfilefoxfutuxepeimitsorlicenses. Anewaffxdavifmustbefilledouteach year.Where a home owner or citizen is obtaining a license oxpemlit not related to any business orcommercial venture (i.e.a dog license orpermit to burn leaves etc.)said person is NOT required to complete this affidavit. The,Office of investigations would like to thank 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 fax number: Th CQ ox�weaIdL oMO.sSac 0&otf q - Do pactMent ofkdu iaa Office offmN1Cvfxana BQaor�,MA021IZ Tom f 7`�-7-2.'-4900 opt 496 ox x-•877��A Revised 5-26-05 WtWmaago-VAR4 r 7 t%ORTFive" '* .� . - G No. � Z - a h ver, Mass, o C..CHew.c«P`y'l• x.95 U BOARD OF HEALTH PERM Food/Kitchen I %T LD Septic System THIS CERTIFIES THAT MMVBUILDING INSPECTOR has permission to erect 4,9. One./ • �S Foundation p .......................... buildings on .......... .... ...... Rough to be occupied as ............�Pgthis ......�.... .. ....... ...................................... Chimney provided that the person accep permit shall in every respecttatfing m to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws 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 ELECTRICAL INSPECTOR UNLESS CONSTRUCTION 6..%0000�1 T 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. - ' 4 Location` No. � Date t �oRTM TOWN OF _NORTH ANDOVER �o?oma,. •o_.•,Mon � . Certificate of Occupancy i Building/Frame Permit Fee11 $ . � SsAcMus i� Foundation Permit Fee $ Vs+ {. Other Permit.F6e $ Sewer.Connection Fee $ Water Connection Fee $ =: TOTAL` i Building Inspector A Div. Public Works ERatIT NO. — APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE I MAP tido. / O LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK ;PAGE ZONE L d I SUB DIV. LOT NO. �I — LOCATION PURPOSE OF BUILDING OWNER'S NAME ^ NO. OF STORIES SIZE OWNER'S ADDRESS < -�- BASEMENT OR SLAB 6 ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2NO 3RD _ BUILDER'S NAME /= % SPAN DISTANCE TO NEAREST UILDING v DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR "' GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING x IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION L/ IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TOAEQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST -� .SEE BOTH SIDES - EBT. BLDG. COST - PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. t, PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED B ATTACHED GARAGES MUST CONFORM TOST TE FIRE REGULATIONS PLANS MUST BE FILED AND A PROVED BY BUILDING INSPECTOR DATE FILED QUI BPECTOR SIGNATURE OF OWNER OR AUTHORIZED AGENT m F E E OWNER TEL.# / ' PERMIT GRANTED CONTR.TEL N 19 CONTR.LIC.# r t H.I.C.I/ mm.'A� Owl N - �P-. Ijo-7,!xo I Off r, Li 1 Are coo V10. bat b1wS�`wluo Ils! NORTH O Of ®Ver No. LAKE over,. MASS., 19 -CO "ICHEW I ICK ATED mw&- BOARD OF HEALTH Food/Kitchen PERMIT T U Septic System THIS CERTIFIES THAT............................... ....................C, fie,....... BUILDING INSPECTOR Foundation has has permission to erect........ ............. ................ buildings on..... .. .................................................................... ...... Rough tobe occupied as.......................................... . . ........ ......7�........................................... .. Chimney provided that the person accepting this p mit shall n every spect conform to the terms of the application on file in Final �11 i�ecl shall this office, and to the provisions of the Codes and By-Laws latingo 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 PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough .............................. ............ ...a..... . ............................................ Service B L ; "DING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove naghFiR No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. Burner FIRE DEPARTMENT Street No. Smoke Det.