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Home My WebLink AboutBuilding Permit #174 - 221 CAMPBELL ROAD 9/1/2009 BUILDING PERMIT aF NORTH q TOWN OF NORTH ANDOVER 3 ``t�eD ��` 4..;:�1 .,6 Q APPLICATION FOR PLAN EXAMINATION r Permit N0: Date Received 9 �••-K• 41 Date Issued: C`� SACHUS�� IMPORTANT: Applicant must complete all items on this page LOCATION /uhf t PROPERTY OWNERaL - P.nnte- MAP NO' PARCEL:_ ZONING DISTRICT: Historic District yes Machine Shop Village ayesno TYPE OF IMPROVEMENT PROPOSED USE Resident' Non- Residential New Building ne family Addition Two or more family Industrial Alteration No. of units: ' Commercial Re air re lacement Assessory Bldg Others: Demolition Other :Septic - Well = .Floodplain ; Wetlands Watersfied'District Water/Sewer. DESCRIPTION OF WO K TO BE REFORMED' /2 L � c / 6 Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name - #P�lone:" z - - Address { r Supervisor's Construction;L'ice ` a nse: - .E . ._ � .. - xp Pate: Home Im 1 ygMpnt{License; Exp.. -Date: 4 - ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. k Total Project Cost: $_ :OiDD FEE: $_ '�?u -�— Check No.: Receipt No.: 0a3 1 NOTE: Persons contractingwith unre 'ster contractors do not have access to the uara � n and g t1'f SignatureofAgent/Owner - gnature of contractor ' f F Location s Date No. �oRT� TOWN OF NORTH ANDOVER `. ' Certificate of Occupancy ` ° • ` ` Permit Fee $ +.;�•...°•�'�� Building lFrame SSACMUst Foundation Permit Fee Other Permit Fee $ • -- t' TOTAL $ 3 Check # �--- 223 R Inspector I Building i I 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 Sianature COMMENTS \j Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/si nature&Date Driveway Permit DPW Town Engineer: Signature: - Located 384 Os ood Street F1RE DEPARTMENT Temp_Dumpster on site, yes _ no _ Located.at 124 MainStreet -- - - -: Fire Department signature/date' �COMIIAFNTc - - _= Inc t0mrr0nwea1tk oflk=achxettt Departniat of ZRdmstrial Accidents Vice of 1n'nestig afions : 600 W=iirrrgtan Street i Boston, MA 02111 Workers' Cam nsatioa I>Qs' A a oiicant Infflrma*on uranee-4fficiavi ui ers/ContracforsM . eatrici;aas/Piambers Name Please Print Leeibf Susi ( Hass/ _ �F-�zadon/indry rd uall: Address: City/State/Zip: Phone#: , Are yon ae empioyer?Cheek.the appmpriis,te'bo= _ a empiayer wif}r �] Type of project(required):,' ernployees(fu•IT and/or part-,,! .* 4. haan a gfld themeral contractor and I 6 New can 2•❑Tam.asoievt d the srrb-corttrac ❑. shvcbon . proprietor.or pwtner. iistmd on the aftached sheetRerrrodeiing ship and have no employees' Thee working far rn ire sub-contractors have (Na Workers'co �'Cap�y. work=, comp.i g Q Drmoiition comp.finw=co 5. Q We nsuran 9. I3ur7di required] are a_corposaiian and its Q ng addi ian 3 Iain ofnce have exercised their 1Q.Q Electrical homeowner doing all R,o� rightrepans oraddiiions y myssI£[No work' of have PW MGL 1 I.Q pirrrnb' ng L52, §I(4),.and•we have no repairaoradditiorrs rrrsurartce'requaetL]:t .-employe-s [No work=! 12.0 Roof repairs *Ary eppiirmathat �P• usas►ce required t tdttxks bo:!#I mutt also fill Dirt the rection below ahowisB 8teit warkac'ab _ # wnwWners who submit this afiidevh i1w. tin they mpeoratioo oi' Coatn�r r g ey ms doing etl P *inibnnatioa. that cltesk this box mast w�tc and thmr hue outside ccmtreetors oust shit anew d sa addctiooel cheer showiztg. rratnc of tlr rut-cootrsct� affidavit indiaeda�ropy Md'Lite* I4lfi4=ear o),er titQt LRtrOrrr7Qtd�ltL "�f' '+ Bft�SfLTaliCe °7/l�f.pAlAt017e� Belojok site .E Instaanco Company Name: P0147#or Self-ins, Lic.#: Sob Site Address: ExPuatton Late' Atfscit a co of the workers' cam Crty� rp' Pensafion Poky deaiara ' two .ve showia� Failure to se" P$tr ( ,the ii nu . "tire m oovetagc as required under Sewn 25A of Po her and expir�fioa date. . fine up to$1,SD0 DO and/or one-year imprisonment, l�IGL c. ISZ teat lead to the imposition of a urinal Of up to$250.10 a � civ penatfies in the form of a Mp Wp}�O NQS of a invsti against the violator. Be advised be forwarded ffit�a fine gallons of the DIA-for irtsra$n��y �a copy of this stat„ecnerrt may rward.,d to ermp verincaticm. the OfnM of I do J' ertiJy oder the pants•and .. ° that`the ut n f nnatioarn Si � p rte, a6 a ane'aonrc� Date: l G Phone - offAcial use only, do not write in,tfris asra,m ba mmptet�/Y city or town o,�uza( City or Town: Issuing Authority(circle one): Permit/Licenm# rsfy 1.Other of Scarth L Buuiitiiog Department 3.C b.Otheren ky/Tcrwe Clerk 4. Mectrical Inspector J. Piumhiuo las peciar Contact Person: Phone#: i i Information a lid Instructions Massachusetts General Laws chapter 152 requires all emp I oyers to provide workers' =npensafaon for Choir employees. Pursuant to this statute,an w pioyee is defined as"..:every person in the service of another under any contract of hire, express Cyr implied,oral or written." An cirrpfayer is defined as"an individuate partnership,association,corporation or other It* entity,or arty two or more of the foregoing engaged in a joint enterprise,and includi"g the legal mpresentaiives of a deceased employer,orfho receiver orrt xtee•of an individual,partnership,associatioia Or other legal txttity,employing employees.'However the owner•of a dwelling house having not more than three apa rtrneft and who resides therein, or the occupant of th dwelling house of another who employs persons to do maimt=ance,construction ori weak m such dweltrChouse or on the grounds or building appurtenant therein shat not b=atm of such employment be d---med to be an employer." MGL chapter 152,925C(6)also states that"every state o:;-kits]6ceasinj agency shag withhold the ismancaor renewal of a tic em or permit to operate a business or tit o coosi rnet bund'mtga is the commonwealth for any appri fit wbo has not produced sept able evidence.ok'compliance with tbe.kwranae coverag=e required." Additionak, MOL chapter 152,§25C(7)states"Neither Unt cmmmonwealfh nor any of its polificttl subdivisions shall enter trite any eoruract for the petforum eee of public wanetmdl accepfa{ilo evidence of asoazrpiiairee withthe insiamicx mquire nmft.of this chapter have bean prosented tathe contracting authority." Appncan+ta Please fill out the workers',campenss6on.affidavit eompLmt:51y,by checking the boxes that apply to your situation and,if necessary,supply sub-cotrtractor(s)name(s),eddress(es):acid phone number(s)along with their cotificate(s)of insurance. Limited•Liabiiity Companies(LLC)or Limited Liability Parttrersliips(LLP)with no employe otherthan the members or partners,are not required,to carry workers'Mni-Tnpensation inswas ce. Van LLC or•LLP dots how: empioyees,a policy is required. Be advised that kris of demo t may be submitted tD the Departzaent of Industrial Accidents for confirmation of insurance coverage. Also'Ewe sure to sign and date the affidavit: The affidavit should be.returned m the city or tovm that the application for the permit or license is being roque ted,not1he Deparlmal of Industrial Aeeideata Should you have airy questions regal-cling the,law or if you are regaimd to obtain a workers' . oompensataon policy,please-tail the Department at the•nurmber.listed below. Self-insured comprnies should enter their selt�iszsaz�ncc license nurnc.:r on tbe'appropriate iirsr. City or Town 06icials Please be sure that the afndsvit is complet:and printed bgibly. The Departrnerrt 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 appiicmrt. Please be sure to fill in the permit/license number which w-ill be used as a reference number. In addition,an appiicarrt Haat must submit multiple permit/lic=appiicstions in any given year,need only submit one afrrdavtt indimting ctmzm policy'informafion(if necessary)and under"Job Site:Adds-ess"the appjjc;mtshoWd writo"all locations in _(city or town).`A copy of-the affidavit that has been.officixlI stumped or marked by the city or tnwn may be provided to the applicant as pmof that valid affzdovtt is on file far futme permits or licenses. A new afndavif must be Med out each year. V✓ =a home owner or citizen is obtaining a lic-fisc or p=it not related to any business or corninwa al vmttxm (i.t a dog license or permit too bum lcaw,.s etc.)said person is NOT.requirod to•compietz this afidaviL The Oftice of Investigations would li3ce to thank you in advaar►cc for your cooperation and should youhave any questions, please dw not.hesitate to give us a eafL The Depm mratt's address,L-Iephme and fax number. The Commommalth of Massachusetts Dcpart_Mt of Tindzrstzial Accidents office.Of.rimVeak-lifions 600 Washington Street Boston, MA 02111 TeL 617-72-7-4900 ti=406 or 1-977-14A.SSAFE Rzvised 5-2 45 Fax;9 61 7-727-774 wvvw.massgov{die ,.oRTM TOWN OF NORTH ANDOVER � Syeo � •4,t, �� dt`•. �`'.b°oL OFFICE OF A BUILDING DEPARTMENT _ 1600 Osgood Street Building 20, Suite 2-36 e g g ��,ree�.a <y North Andover Massachusetts 01845 SSACHUSE� Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please print DATE: I JOB LOCATION: Number Street Ad r s Map/Lot 7)11�C_��/�� HOMEOWNER .P !�� L�� —22- Name 2- Name Home Phone Work Phone Q PRESENT MAILING ADDRESS ��/ /G�� %Czr/, City Town State Zip 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) I 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"certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will mply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 i I V40RT#q 0VM Of 4Andover OSKr ~ '4••, f '. ;m. No. 17Y -=.. r o z; dover, Mass., COCMICMEWICK y1• 7�ADRATED S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System 1144. �� BUILDING INSPECTOR THIS CERTIFIES THAT......... �.. ....... .... ..... ... !f! !.................................................... "' Foundation has permission to erec g g �....................... buildings on ! ....................*...... Rough • to be occupied as... . ..........ea ep...4.................. ., Chimney provided that the person cepting thist 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 3` PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU k...................................ARTS RoughA MEMO i ......................................... 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. 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) I I ❑ Notified for pickup - Date Doc.Building Permit Revised 2009 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:Building Pe rmit Revised 2008 R Location No. Date i f Mol' #f TOWN OF NORTH ANDOVER ,. . A Certificate of Occupancy $ Building/Frame Permit Fee $ Z Foundation Permit Fee $ wcMus Other Permit Fee $ I Sewer Connection Fee $ Water Connection Fee $ I TOTAL $ E i Building Inspector 03/21/95 14:44 25.00 PAID G pp j ' p Div. Public Works voor PERMIT NCJ`� APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 AAP K-4O. /O LOT NO. 2 RECORD OF OWNERSHIP DATE BOOK 'PAGE — ZONE 1 I SUB DIV. LOT NO. LOCATION PURPOSE OF BUILDING Q OWNER'S NAME NO. OF STORIES VSIZE Li OWNER'S ADDRESS CA4 BASEMENT OR SLAB — ARCHITECT'S NAME /�� SIZE OF FLOOR TIMBERS IST 2ND 3RD on BUILDER'S NAME �/ SPAN ---- DISTANCE TO NEAREST BUILDING 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 IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS 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 EST. BLDG. COST ♦�j� PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PERICBQ. FT. 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 BY d ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR 1 DATE FILED BUILDING INSPRCTOR SIGNATURE OF OWNER UT AGENT F E E OWNER TEL.# PERMIT GRANTED 19 CONTR.TEL.# � I �" CONTR.LIC.# �� C H.I.C.# /a � � G BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY S;ORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA. APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE d 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ 1/1 1/2 % FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARD'!J'D _ ASBESTOS SIDING _ COMMON VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. d FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR ADEQUATE NONE rj ROOF 10 PLUMBING A GABLE HIP BATH 13 FIX.) GAMBREL MANSARD TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR d GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO g FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. d COLS. STEAM STEEL BMS. d COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS GAS 7 NO. OF ROOMS OIL B'M'T NO HEATING 2nd _ ELECTRIC 1st—1 3,d NORTH Town of dover 0 10 No., dover, Mass., Z 19 coc-c. WICK 0RA T E 0 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR T�IIS CERTIFIES THAT.................... .............. ...fo-.110... ....................................................... ......... Foundation has permission to erft.......... ......... buildings on ........�).5.Af............ Rough oiel". 71110 ......... tobe occupied as........................................................ ............ ............................................................................................... Chimney provided that the person accepting this permit shall In ev respect conform to the terms of the application an file in ;Jlil� 1�i�i 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 PERMIT EXPIRES IN 6 MONTHS Final • UNLESS CONSTRUCTION ST ELECTRICAL INSPECTOR Rough Service BUIL ING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR R Display in a Conspicuous Place on the Premises — Do Not Remove Finalough No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det.