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HomeMy WebLinkAboutBuilding Permit #477-14 - 227 OSGOOD STREET 12/4/2013TOWN OF NORTH ANDOVER PPLICATION FOR PLAN EXAMINATION Permit NO: 4 Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION o?cP r7 6S6600 C Print PROPERTY OWNER V v s�r - C.' 1,11C91aLLb. Print 100 Year Old Structure yes no MAP NO PARCEL: _ ZONING DISTRICT: Historic District yes no Machine Shop Village yes no .TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building Yone family ❑ Addition ❑ Two or more family ❑ Industrial XAlteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic []Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: A&4ES- ralx lollgGLLc� Phone: q1,0 -317-766o Address: 0 07 of X660 J-7-- CONTRACTOR -7 CONTRACTOR Name: Phone: 97-0- ?02-3 566 e Address: y l 11))tftvi ^ 7 c. Supervisor's Construction License: 1, 63zla _ _ _ _ Exp. Date: !� -/ S --I Home Improvement License: Date: �--17— ARCHITECT/ENGINEER S4LMO C! Phone: 325'-55,Vo Address: /U%Z/C%CL�l /lilC-[%�� ��Reg. No. FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASE ON $125.00 PER S.F. Total Project Cost: $ 3�i,zi FEE: $ Check No.:_Y' Receipt No.:� i NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund gnatureof Agent/Ovvner Signature of contractor Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted -0 Plans Waived ❑ -Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF°SEWER-AGEDiSPOSAL- Public Sewer Tanning/MassageBodyArt ❑ .. 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: PLANNING & DEVELOPMENT' ❑ COMMENTS DATE.APPR-OVED CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on Signature COMMENTS r 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 Toiv2 Engineer: Signature: Located 384 FIRE DEPARTM NT -,Temp Dumpster on site yes n Located -at 124,Mair, Street -Fire Departure► t-sigatu n"r_e/date-' 4 COMMENTS— Osgood OMMENTS Os ood Street 0 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.fin.e NOTES and DATA — (For department use ® Notified for pickup - Date Doe.Building Permit Revised 2010 Building Department -"The fol owing is�=a-list of the retluired.forms to be filled out for the appropriate. permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits aBuilding Permit Application ❑ Workers Comp Affidavit o 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 o Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o 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) o 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 o 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 o Mass check Energy Compliance Report o 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 apw al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Builiing permit Revised 2012 Location No. / 74 Date Check # � -11 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building Inspector Enter construction cost for fee cal - North Andover Fee Cakulation Construction Cost $ 343500.00 m $ - $ 414.00 Plumbing Fee $ 51.75 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 51.75 Total fees collected $ 617.50 227 Osgood Street 477-14 on 12/4/2013 Kitchen Remodel d R: Z C7 X D D Oro 3 � M T. d�y am �' °% 3 o n 5 a ° ° " tv co m a Ali CO k 'a CL iCt-� m �— « o � �� d� ƒ� z// e © � 3ow / /A \\m s $ .C)/ ® 2 / 7 \ $ # 0 �+. \ C f 2 2. / $ % :'m '._0/ma\; ^ «r—j \ ƒ } g V e 3 a ƒ 0 CO x $3 n �ƒ _ eb »<q E/ « o C/\ Xy« z// .C)/ 2 / 2 4 § f7 § - & / $ % '._0/ma\; Iak _ eb � \ n 'V !sE9* r L O O O 2 Q. a) cc 4a c o � o £ a M v _ o - � C V N - r.LCc06J � L C m 4) o O - -0 O cm s Ew o L- oz CLW,- 0 = o� L • Q. 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O N ' C N O W Q E m m s ca .� O �+ V 0 !c O CL CL CF)a V Jca � .Q O ,}4y) C W c) U) cc C CL U) Crack -X 978-687-7577 p.1 Tel: 978-688-9545 Please print. DATE /;?/'/// � JOB LOCATION -?- d / Number "HOMEOWNER O � Town of North Andover Building Department `�,%,-=-- •�' 400 Osgood Street S�Mus North Andover MA 01845 HOMEOWNER LICENSE EXEMPTION U:S Cep 3 Number Home Phone PRESENT MAILING ADDRESS o� d -7 0 S-6od S� City section of -i own Work Phone The current exemption for "homeowners" was extended to include owner -occupied dwellings of six 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 109.1.1) DEFINITION OF HOMEVVOWNER: Person(s) who owns a parcel of land on which helshe resides or intends to reside, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures ac- cessory to such use and and/or farm structures. A person who constricts more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, try -laws, rules and regulations, The undersigned "homeowner" certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0 Construction Control. Crack -X 978-687-7577 p.2 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit d"? -7 0 47?r.-?f17- F— am a homeowner pbrforming all work myself. F1 I am a sole proprietor and have no one working in any capacity am an employes providing workers' compensation for my employees working on this job. Company name: Address City: Phone #• Insurance Go. Pol' v # Company name: Address CRT Phone #• Insurance Co. Policv # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 andlor one years' imprisonment as well as civil penalties In the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of the statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information pmvkLd above is true and correct Signature Date Print name Phone # official use only do not write in this area to be completed by city or town official- Building Dept ❑Check if immediate response is required Building Dept 0 Licensing Board 0 Selectman's Office Contac person: Phone #: 0 Health Department 0 Other FORM WORMAN'3 COMPENSAMN N p t O 40 ; ! Sui N= N 2 0 n z z p O U i= z e 0� m v 2 z �' ? t: 3�t �i�. U w O p `Z 4 O J v a m LLsl~�.� ui U Z a Z pul 1 EiTS 4 �O w o rw ' Z d '� V �. t7 W 116 Z o LLI U X v co LU3 ; of h-I N_ i .. i CL 5t tj[ O Z li J I_I z U tu .. — I I w CL us oaX I ( o — i ON t n I-'41 I `, 0 3 w z 6'd LL9L-L99-8L6 X-NOSIO