The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #136 - 223 Boxford Street 8/12/2009 TOWN OF NORTHANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: JS 60 Date Received �' 2 Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION �45 &* a PROPERTY OWNER J` f- PrW101/n MAP NO: 106 PARCEL: .?4-,' Z N G PriDISTRICT: Historic District yesno Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential Ne Ltbe—f farm Additi Two or more family Industrial No. of units: - Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer ES RIPTION OF WO K T BE PERFO MED: he Identif ation PI T e or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: ..Home Improvement License: Exp. Date: Z 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: d. Oma. FEE: Check No.: ZI _Receipt No.: c9 3-5-7 NOTE: Persons contracting with, u regi er d contractors do not have access to the guaranty fund ignature of Agent/Owne Signature of contractor Plans Submitted LP Na Waived Certified Plot Plan Stamped Plans Location X 33 'go x-A0 No. Date IF11-3)6 MORTH TOWN OF NORTH ANDOVER O F � A Certificate of Occupancy $ CMUS<� Building/Frame Permit Fee $ 06 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ .� Check #z6zb 223 ;5 Building Inspector 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 1 OMMENTS c P HEALTH Reviewed on Signature r , COMMENTS 11�o/�-tet Z),4 —i Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments F Water & Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature]date COMMENTS 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: Doc.Building Permit Revised 2008 NpRTH TO" of Andover No. o dover, Mass., COC HIC HE WICK ADRATED P"? `S BOARD OF HEALTH PERM T T D Food/Kitchen Septic System BUILDING INSPECTOR _U THISCERTIFIES THAT....................1071t<........................................................................................................................................... Foundation has permission to erect........................................ buildings on .t: .Sox..eZ<- .. ..........................I.......... Rough Wsly �J C% sem' �r �� !y c'•;^e ( � t' 3e X!r Chimney to be occupied as...................................:....... :...:r�:. ...... ....... .......................................................................................... 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 ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough ................ r-*6-w. ......................................... 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. CERT/F/ED PLOT PLAN LOCATED /N NORTH ANDOVER, MASS. SCALE:1"= 40' DATE:811112009 Scott L. Giles R.P.L.S. Frank. S. Giles R.P.L.S. 50 Deer Meadow Road North Andover, Mass. BoXFoRD R=8 STREET 00 00 4->>s 40, N W #233 O EXIST. HSE. ' FND. 31' 15, EX1ST. 10'X 12'DECK TO BECOME 15'X 15'SCREENED PORCH WITH ROOF .� LOT#8 co PLAN #11726 N.E.R.D. o� 10 OF 0 N ..F, 72 oqr fC1STERE� ` LAND- I CERTIFY THAT THE OFFSETS SHOWN COMPLY WITH THE ZONING 9OFFSETS SHOWN ARE FOR THE USE BYLAWS OF OF THE BUILDING INSPECTOR ONLY NORTH ANDOVER AND SUCH USE IS FOR THE WHEN BUILT DETERMINATION OF ZONING CONFORMITY OR NON-CONFORMITY WHEN CONSTRUCTED. i a a Th i e Commonwealth of Afassachuseft Departnrernt of Industrial Accideais• � ' .;1 d ce of Investigations 600 Nlashinj0n Street M�. of Boston, MA 02111 Workers' Co Insurance wis�v n�assgnv/die . A `cant Information. Affidavit» Bw7ders/Coatrectors/Electncians/PI tubers Name (RusinPlease Print Le'"T ess/Qrganira6orAndividual); 'r City/5tate/Zip: Fhane#: . Are you an em ployer?Cheek.the appropriste box: I:Q I.am a employer with 4. ❑ I am a Type of Project(regnfred): employees(fun andltsr * gOS contractor and I pert-time). have Bred the Bubb-contzactors 6• ❑Now construction . 2. .I am.a.sole proprietor or pwln-. listed ship and.have no employees ,l,h `on the attached sheet 3 7. 0 Remodeling working far me in su'cO�ctors have any capacity, workers' comp.insurance. 8' Q Demolition (7Vo workers'comp, iasruarrce 5. [] We are a corporation 9. �]But'lding addition uired.] rP and its 3. 1 ain a homeowner doing all work o� have exercised their !0•�Electrical repairs or additions myself[No.warFci:rs,co of exemption per MGL 11.0 Plumbing t 152, §1(4),'.and,we have no TePsoradditions insurance required.]t .ernployems.[No workers' 12•�Roof repairs camp. irisarancerequireq I3.[],pm� _. ;`�+nJ appii-w fiat cheeks boz#t must also flit out the section below ahowia Homeowudr¢who submit this afti'davh indicating they am g theirworked'bomp_sation poi' cy Contractors that check this box must doing w-t and th=hire outside coom=tora taus mfnrmation clod rn adtf.�fiaasi sheetshowirng.the r>aenc ofthe cub- submit a new affidavit iudiasfisg such' I am,=a cartnactots and their worker'cceP_.r_!jC�fiMMt". rrfoyer that�ccnr�ovi�yr�:war�. ' �ert�o ixfarnaottnr_ irisarance for ploveMB P1 ,.,x r: . Pa•�y mid job site . Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date; lob Site Address: Attach a copy of the workers''compeaesatiouCity/5 �' policy declaration Failure page(showing the policy number and expirefioa date}Failureto secure coverage as required under Section 25A of MC3L c. 152 can lead to the irnpositian of cram' . fine up to$1,500-00 and/or one-year imprisonment, Of up to$250.00 a as well 13s civil penatfies in the farm of a ST17P WDRK penalhcs c f a dal against the violator. Be advised that a copy of this statamenf RK ORDE R anti a fine Investigations of the DIA•for insurance coverage veri5catiort. may be forwarded to the Office of I do he cern and the P eaalties o e P fP rlicry rifler the infnm=laR Pr oyided above is true Si and eorrea Date: Phone#: _ official we only. Do not write in this area,m be cornplet !i'3'�j,or town officraL C T u3'or ow a: FssuiPermit/Limnse# rea,Authorify(circle one): F. Board of Health L Suildiug Department 3.City/Town Clerk 4. Electrical Inspector 5.Plum ' 6 Other bt>d Inspector Contact Person: Phone#: I i i ,. Information a. lid In"tructions Massachusetts General Laws.chaptcr I S2 requires all emp Ioyers to provide workers' compensation for their employees. Pursuant to this statute,an enipinyee is defined as"..:every person in the service of another under any contract ofhir>_, express or implied,oral or written." I` An employer is defined as"an individual,partnership,assoi�ation, corporation or other legal entity,or arty two ormom of the'fbmgDing engaged in a joint enterprise,and includi"g the legal representatives of a dcccased employer,orthe Tct=ivar errtcsrstee•of an individual,partnership,associatiarr or other legal entity,cmpWng employees. 'Howeverthe owner-of a dwelling house having not more than th=apastrnents and who resides therein;or the occupant of the dwol1mg house of another who employs persons to do ma int=ance,construction or repair wa m such dweilinghouse or on the grounds or building appurtznant thereto shall no-t lxcause of such employment be deemed to be an employes." MGL chapter 152,§25C(6)also states fiat"every state os Weal licensing agency shall withhold tine ismanceor renewal of a license or permit to operate a business or *o construct buildings in the commonwealth for any appTcant who has not produced acceptable eviideum-of compliance widr the.insarance coveragge required" Additionally, MOL chapter 152, §25C(7)status"Neither tic commonwealth nor any of its political subdivisions shall enter into my contract for the pm*r;mm=of public worie until-acceptable e:videmce of complieiux with the insurance roqu rcments.of this chapter have been premed to the cartirscting authority." . .APPliceuts .. Please fill out fhc workers'compensation•affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-cor actors)name(4 address(es):and phone number(s)along with their certifica(s)of insurance. Limitz dLiabik Companies(LLC)or Limited Liability.Partnerships(LLP)with no=pioyees otherthan the members or partners,are nutrMAtired to carry workers'cr rnpensafion insraancx lfan LLC or LLP does have empioyees,a policy is required. Bo advised that this affi4mvit may be submitted to the Deparfaamtt of Industrial Aeeidm% for confirmation of insurance caveaage. Also be sure to sign anddate the affidavit The afrrdavit should be returned to the city or fawn that the application for the permit or iicetrse is being requested,natthe Departmem of Industrial Accidents. Should you have any questions regas-ding the law or if you are required to obtain a workers' oornpensation policy,pleasewcafl the Dqurtment atthe-nu m. ber fisted below. Self-insured compwies should enter their self iinsuranx iicenac m=bcr on the•appropriate irrsr. City or Town Officials Please be sure that the affidavit is sample a and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fiA 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 w-fll be used as a met inure number. In addifion,an applicant that must submit multiple parmit/Iicxnsc applications in any given year,need only submit one affidavit indicating-current poficy:information(if necxssary)and under".lob Site Address"the appficarg should writ.>"all locations in (city or town)."A copy of-fie affidavit that has bene,officfaily stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit res on file for future permits or licenses. A new affidavit must be filled out each year. V✓ =a home owner or citizen is obtaining a lic;.use: or permit not related to any business or commercial venture (Le, a Clog license or permit to bum leaves etc.)said person is NOT.mquimd to compfetz this affidavit. Thr,Office of investiggtions would liko 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:. The Commonwealth of Mamacbusetts Department of 1ndustiial Accidents Mee of rmweatte anions 600 Washington Stmt Briton, MA 112111 TeL 4 617-727-4900 ext 406 or 1-977-MA.SSAFE Fax 4 61 7-727-774Q Revised 5-26-45 www.mass.gov/dia ' µoRTH TOWN OF NORTH ANDOVER q OFFICE OF ° 1 - BUILDING DEPARTMENT as# 1600 Osgood Street Building 20, Suite 2-36 �q ..1rev�4a`yt`a North Andover,Massachusetts 01845 IV CHUS�� 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: a &6d4 f7�� Number Street Address Map/Lot HOMEOWNER - - in Home Phone Work Phone / PRESENT MAILING ADDRESS 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) 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 under nds the Town of North Andover Building Department minimum inspection procedures and requirements and t at e/she will comply with said procedures and requirements. HOMEOWNERS SIGNAT 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 t , I i i 1� r ( 1 r , f sa I - : I r 4 I : t 1 � 1 _ 1 .-�cl i LI--- A .S f' W k- DwE��NG i�o.9R r e z �X►si TAn�� FXIST, �" ISO GAL I P-sox N 8 p • S` LOT F ' 6' ,� 1 A �- O T / 0 F7, 120 Srr' 3'T'IP LOT 9 ICAC ,qD THIS 1S TO CERTIFY THAT I HAVE INSPECTED THE CONSTRUCTION OF THE SAID DISPOSAL SYSTEM LOCATED AT LOT 8 - ;QDXFok)D IPP. N. ANDOVW, MA. THE GRADES ARE AS SPECIFIED IN TIIE PIANS AND SPECIFICATIONS bATED F X 1,fARCtfIONDA & ASSOC., INC. �1 'qs fLRADM ELEVATION TO TOP OF PIPE PAUL b I DREI.I.ING: -- lLi2. ARC la(o I Mi-'; I No 9Q15 +° TANK IN: 162.Sp TANK OUT: 1&2.07 f — t D BOX IN: /59.72 � -�s� ► ', �`- -•� %� / I„� D—BOX OUT: A I3'9,Sv `+ 'f.. ATE B /59.50 C D AS BUILT SEWAGE DISPOSAL END OF DISTRIBUTION LDM- A /s7.oq SYSTEM PLAN D AS PREPARED FOR FL I/V74;0cis' SCALE 1"=40' DATE (ajj$ AfARCIIIONDA & ASSOC., INC. ENGINEERING AND PI MMING CONSULTANTS 60 I{API..F. STREFT R F.D. 16 STONEHAM, MASS. 021130 IIAIICHESTF.R Illi 03103 (617) 43'B-6121 (603) 434-872f, - ^rS1�'OYf'�C71�7PFR6TL4l6E'ielsr SkIIEi6.• �"iYLLi !L^.YA:LtiiWY.7!(.7e3.i¢.:5�•.4`. �:1.:___ __ __ —.. .... . i