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Home My WebLink AboutBuilding Permit #395 - 250 ANDOVER STREET 12/11/2008 BUILDING PERMIT 0 NORTH16 q TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION q 1` Permit NO: Date Received s� �gSSACHUs�� Date Issued: v/ IMPORTANT: Applicant must.complete all items on this page LOCATION Z ARJJ:)oVe12 -ST Print PROPERTY OWNER M AAIL)EZ G'Ot LL /q/Z7- Print MAP NO: _PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One Tamil Addition Two or more family Industrial Iteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed. District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: e-c.J 43 10/1 Un-61-n r;�l,, e df SC�� r/cs o V Re�'1ca« ycl�x Idendhiication Please T e or Print Clearly) OWNER: Name: �(� I rOV L R7 Phone: Address: CONTRACTOR Name: Phone: Address:. Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: 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. � C?� Total Project Cost: $ _7 0 op o FEE: $ 511�0 I Check No.: ! Receipt No.: �y�s NOTE: Persons contractin unreg' tere cont, rs do not have access to the guaranty fund �_ignature of Agent/Owne licirtature of contractor Location asy d o cam•. --'�''(� No. 3� �� Date TOWN OF NORTH ANDOVER F 9 i Certificate of Occupancy $ CNUs t� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # i 2 1 63 Building Inspector 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 Signature COMMENTS 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 Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT Temp Dumpster on site yes no Located at 124 Main Street Fire Department signatureldate 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:Building Permit Application Revised 2.2008 's The Commonwealth of Massachusetts Department of Industrial Accidents `dl I k4 , ; ••. Office of Investigations �!rtc 600 Washington Street ii wi r`e Boston MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: guilders/Contractors/Eiectricians/PIumbers Apylicant Information Please Print Legibly Name (Business/Organization/individual): con Address:-2 -2, e,, ( S �-- City/State/Zip: O 1 L� (r, Q Phone Are you an employer?Check the appropriate box: 1.El I an a employer with 4. Type of project(required): ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6• ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. o workers' comp. insurance 5. 9• ❑ Building addition [�`l p. ❑ We are a corporation and its 3)required.] officers have exercised.their 10:❑ Electrical repairs or additions I 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.❑ Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13.❑ Other t*Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. , Homeowners who submit this Ei%�davit indicatin_they arc dviit=a!;a,.'-and ihc;.hi you side contractors r1ti5t submit a new am«avit indicatirgs� ZConvaziors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information I an employer that is providing inffoormation. workers'compensation insurance for my employees. Below is the policy and job site Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Sob 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 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 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. I do here b ertify under the pains and penalties of perjury that the information p vided ab ve is true and correct Signature- 1146Al/ Da 0 Phone#: Official use Only. DO not write in this area,to be completed by city or town official City or Town: PermittLicense# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: t%ORTy' Town of . . _ _ . Andover , 0 NO. - o LA o dover, Mass. • �- zy"� COCMICMEWICK '�. � � ADRATED P,? \, �C7 `S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System 11 V44 /sow, BUILDING INSPECTOR THISCERTIFIES THAT....................�...................................................................................................................................... Foundation has permission to erect........................................ buildings on . ........AAWOV%"�� ....... Rough......... ........... to be occupied as...pl�l ..... .......xo*44 � .. � � Chimney ........... ....................... 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 3` PERMIT EXPIRES IN b MONTHS R ELECTRICAL INSPECTOR UNLESS CONSTTART Rough ..... ...... ........ ..................................:.............................. Service BUILDING INSPECT 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. Permit# Permit Date f RESchack Software Version 3.7.3 Compliance certificate Report Date: 12/10/08 Data filename: C:\Program Files\Check\REScheck\North Andover,Mass Noel's.rck Energy Code: 2000 IECC Location: North Andover,Massachusetts Construction Type: Single Family Glazing Area Percentage: 2% Heating Degree Days: 6322 Construction Site: Owner/Agent: Designer/Contractor: Manuel Goulart Owner 250 Andover Street North Andover,MA 01845 978-902-7555 G1 ?CQ911020 w CI3 r.. Ceiling 1:Flat Ceiling or Scissor Truss: 140 38.0 38.0 2 Ceiling 2:Cathedral Ceiling(no attic): 240 21.0 21.0 6 Skylight 1:Wood Frame:Double Pane with Low-E: 9 0.500 5 Wall 1:Wood Frame, 16"o.c.: 128 15.0 15.0 6 Wall 2:Wood Frame, 16"o.c.: 140 30.0 30.0 4 Wall 3:Wood Frame,16"o.c.: 140 15.0 15.0 6 Window 1:Wood Frame:Double Pane with Low-E: 10 0.340 3 Boiler 1:Gas-Fired Steam:95 AFUE Compliance Statement:The proposed building design described here is consistent with the building plans,specifications,and other calculations submitted with the permit application.The proposed building has been designed to meet the 2000 IECC requirements in RE eck 11 7.3 and to com with the mandatory requirements listed in the REScheck Inspection Checklist. Builder/Designer Company Name Date Page 1 of 4 NORTH TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT * 1600 Osgood Street Building 20, Suite 2-36 North Andover,Massachusetts 01845 1sswcaustt Gerald A Brown Telephone(9 78)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION lease PILut DATE:D,G 2.0 of JOB LOCATION: Z!E�(7 A tQ 0—)Vt-t2 Number Street Address Map/Lot if.. HOMEOWNER MAu(�E _ G O I_� 2 L Name Home Phone Work Phone PRESENT MAILING ADDRESS 2-�;-® - _NQ(Z-TL4 8;NZoQV ;TZ: MA - City Town State Zip Code The cw=M 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 helshe 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 comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homeowous Esemptkon BOARD OF WE:\I-S(,SR')541 CONSERVATK1\r.,8R-953 IiE.11;1'I3rxg-9jip PLAN-NI\G(88-9535 I 7 : : : : , : : C-Lbs -I : C�Uio N� � w�PJv u E L G du L A►czT )N Ft : ADD RE� S 2,50 via E – — — — o 0 : : : OA/ -V �T u9 F ��E : , � oN� FLoo� :