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HomeMy WebLinkAboutBuilding Permit #055-14 - 230 OSGOOD STREET 7/16/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: u�'�-T Date Received Date Issued: 113 IMPORTANT:Applicant must complete all items on this page LOCATION 30 6000S1. A4kjo ve )q4-mg. Print PROPERTY OWNER R Print 100 Year Old Structure es no MAP NO: PARCEL:DbkLt ZONING DISTRICT: Historic District yes o Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential .13Aew Building ❑ One family ❑Addition X*Two or more family ❑ Industrial ❑Alteration No. of units: 2 ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: re, rr, C910) o� .PluM � rn& Y`CPaIrg Ltlrl �� y �J dL)nL> . Id ntificat' n Please Type or Print Clearly) _ !- 5 - 35SO OWNER: Name: u«X� �h�ne: 7t n Address: 2 3z a.5 -1-aod g Ag;z N.g0d"o eZ R AA D / F �4 CONTRACTOR Name: Phone: Address. 16 U-NeA � Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 ER$1000.00 OF THE TOT TIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ dC Check No.: IS��o Receipt No.: NOTE: Persons contracting w' unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature-of contractor Plans Submitted ❑ Flans Waved 11 Certified Plot Plan 11 Stamped Plans Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF.SEWERAGE DISPOSAL Public Sewer x 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 Signature • COMMENTS J Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes . Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Toiv�! Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT Temp Dumpster on site yes no Located at 124 Mair, Street Fire Department signatureldate COMMENTS I i 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.$10041000 fine NOTES and DATA— (For department use ® Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The fol;49wing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofil,g, 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 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 submAted with the building application Doc: Doc.Buiiding Permit Revised 2012 Location '3 0yS sf �` S/,a, v No. Date 7 J • • TOWN OF NORTH ANDOVER • D r646 • Certificate of Occupancy $ • Building/Frame Permit Fee $J.? Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# ilding Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost _ .. �Q� .© m . $ - $ 120.00 -Plumbing Fee $ 15.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 15.00 Total fees collected $ 250.00 230 Osgood Street 055-14 on 7/16/13 Remodel First Floor r -1 NORTH - _ _ : w: :. . : . . : :. . . : ver 0 ILA— No. NAC, ," ver, Mass, 7// i COC MIC Nt WICN A04^TEO r`Pa�,�S S U BOARD OF HEALTH Food/Kitchen PERMIT TLD Septic System THIS CERTIFIES THAT ...d,l�� �� f.� '. ��`"�E' ................................ BUILDING INSPECTOR ........ .... .............. ........................:.�� Foundation has permission to erect .......................... buildings on _r2..........4� .. . ............................................. Rough r tobe occupied as ......... ...�.�ffs6e ....: ... ............................................................................ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in 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 Service ...... ..... .4 ...T...... ..... .. ............................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. SEE REVERSE SIDE ��Qt b or a ay4 • O"OF i*ORTE[ ANDOVER OFFICE OF o A BUILDING DEPARTMENT 1600'Osgood Street Building 20,-Suite 2-36 y9s°9Nusc�5 North Andover,Massachusetts 01845 Gerald A.Brown Telephone(97g)688_9$45 Inspector of Buildings Fax (978)688-9542 ' HOMEOWNERURCENSE EXEMPTION BUIDING PERMIT^APPLICATION Please print DATE: JOB LOCATION: 2-30-2-3'a Number Street Address Map/T,ot •HOMEOWNER 1 (� �✓�� Name. Home Phone Workphone PRESENT MA.ILING.ADDRESS 2 3 Q ( y(i J� - AVe 2 City Tov state• Zip Code The current exemption for"homeowners"was extended to h-iclude owner-occupied dwellings to Uvo units-or less and to allow subb homeoy"Mers 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 Persons)who gwns a parcel of land on which he/she resides or intends to reside,on which there is,oris intended to be,a one or two family structures. A p erson who constructs more that one home in a two-year hick ere o shall not e considered a homeowner. The undersigned"liomedwner"assumes responsibi Applicable codes,by-laws,rules andregulations, lity for compliances with the State Building Code and other The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requireme that he/she will comply with,said procedures and requirements, HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption 'BOAR A OF APPEALS 68&-954] CONSERVATION 688-9530 � HEALTH 688-95'i0 PLANNING 685-9535 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information �j Please Print Legib Name(Business/Orgmization/Individual): Address: 3 a- Z Z d S �6i' -! 'A City/State/Zip: j/e/L fL1 hone#: 7 9 l , � 3 SW O Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. F1 New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet.# �• [J Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3111 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roofrepairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit anew 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site Information. Insurance Company Name:. Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder 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 fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby cert u er Itepains andpenallies ofperjury that the information provided above is true and correct. Simature: itt7� Date: �� Z Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: