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Home My WebLink AboutBuilding Permit #533-11 - 227 GRANVILLE LANE 1/10/2011TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: T W ORTANT: Applicant must complete all items on this LOCATION G "WQ LA-` UNh` Print PROPERTY OWNER �*MeS «CC Print MAP NO: 1 C C PARCEL: & ZONING DISTRICT: Historic District yes no Machine Shop Village yes no DES CR1 TIUN Ut' wUK& I b -b rJrrvtuvu✓u: Identification Please Type or Print CIearly) OWNER: Name: P<MC-S CA4Ac.� Phone: q70-6b&-,Sa'S% Address: CONTRACTOR Name: J Pch, z CAAC-� (CtJ Phone: • L►,_NWIM.:t Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. N FEE SCHEDULE: BULDING PERMIT. $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: FEE: $ 3� Check No.: ADO 5�— Receipt No.: NOTE: Persons contractingrah reg tered contractors do not have access to the guaranty fund zg�� Location 0 No. JT3 Date NORTH TOWN OF NORTH ANDOVER Oi�t.•0 :•,�O F w �a Certificate of Occupancy $ s��N�s <� Building/Frame Permit Fee $ Foundation Permit Fee $ i Other Permit Fee $ TOTAL $ Check # /06 Y 23�ill 5 i �01 Building Inspector Plans Submitted ❑ - Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody 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 COMMENTS HEALTH COMMENTyS Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments 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 L] 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 40TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals hat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording lust be submitted with the building application Doc: Doc.Building Permit Revised 2008mi NORTH TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT e m * 1600 Osgood Street Building 20, Suite 2-36 North Andover, Massachusetts 01845 Gerald A. Brown Telephone (978) 688-9545 Inspector of Buildings Fax (978) 688-9542 Please print DATE: I p JOB LOCATION: HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Street Address Map/Lot HOMEOWNER K-rAc, C Name Home Phone Work Phone PRESENT MAILING ADDRESS a� �2,�cnJ �► lU,C (I -11�- W City Town . Stag .zip 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. 11 The undersigned "homeowner" certifies that he/she minimum inspection procedures and requirements a requirements. Ir HOMEOWNERS SIGNA APPROVAL OF BUILDING Revised 7.2009 Form Homeowners Exemption the Town of North Andover Building Department e will comply with said procedures and BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 W W w• uj O d � . y C V O ` C N O C Ca C.3 dC R ® C H ;= O 0 L o a EQ wa�' a who w W w°' cn w ro w CQ cn o cn uj O 4-1 •'.4 ;� I =c caco p 'O A O O 'E m m co L O O D. d. Qm a ca C .� o= c cvCc v CD c Z m V h c c C O d � . y C V O ` C N O C Ca C.3 dC R ® C ;= O 0 L y = EQ CF CD o o c y o 0 v� E O �m ``�� m y Ma y V y.r m y .0 OC y y O O E m W c mo g O m C" ,C.cm 0a '0 m �O ) yz y. v O C C O d CM C •O Q : CA O C x f" m rt0+ :owc h 06 N W C c a��L z "r •N! cc '!.s �. CZ= Z 12, Q CO2 CZ C: m-LGo y0..Mm � O 4-1 •'.4 ;� I =c caco p 'O A O O 'E m m co L O O D. d. Qm a ca C .� o= c cvCc v CD c Z m V h c c C O d � . y The Commonwealth of Massachusetts Department of Inclustrial.Accidents Office of Investigations 600 Washington Street Boston, AfA 02111 www.mass.gov1dia Workers' Compensation Insurance Affidavit: Biiiiders/Contractors/Blectricians/Plumbers Applicant Information Please Print Legibly Name (B.usiness/Organization/Individual):, Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full. and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attacliecl. sheet. t ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its quired.] officers have exercised their 3JXA am a homeowner doing all work right of exemption per MGL myself: [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction. 7. ❑ Remodeling . 8. ❑ Demolition 9. ❑ Building addition 10. El Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12. FJ Roofrepairs 13.❑ Other TAny applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information. lam an employer that isproviding workers' compensation insurancefor my employees Below is thepolicy andjob site information. Insurance Company Policy # or Self -ins. Lie. rob Site Expiration Date:, City/State/Zip.- Attach ity/State/Zip:Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment,. as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to $250.00 a day against the violator. Be advised that a copy o£this statement may be forwarded to the Office of Investigations of the DIA fXR�surance coverage verification. X do hereby cefy urler th�ains andpenalties ofperjury that the information pro videdlrbove is true and correct. Official use only. Do not write in this area, to he completed by city or town official City or Town: Permit/License Tssuing Authority (circle one): x. Board of Health 2. Building Department 3. CitylTown CIerk 4. EIectricaI Inspector 5. Plumbing Inspector 6. Other ContactPerson: Phone #: