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HomeMy WebLinkAboutBuilding Permit #164-14 - 303 BERRY STREET 8/19/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: I IMPORTANT:Applicant must complete all items on this page Lt CATION �—S Pnnt. PROPERTY,OWNER,-- a ,nnt' 4 DD 100 Year6QldlStructure yes' no MAP*NO:: �O'�jC PARCEL:. 03 ZO:NING1YISTRICT:, .�!` Historic Distncf ye no Machine:Shop Village. ye no', TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One.family �ddition ❑Two or more family 11 Industrial ❑Alteration No. of units: ❑ Commercial El Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic 01Nell ❑ Floodplain ❑Wetlands Vllatershed'pistnct pSWater/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: PhoneZ`fiz�G e�h 612,V39V,2/0 Address: CON !RAGTOR N me; Phone: _—Z_uY�1U Address: Supervisor's Construction License: _ Expj Date: Home Improyement,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. Total Project Cost: $ �� FEE: $ 7s O� Check No.: 7 0✓� Receipt No.: 7� NOTE: Persons contracting wi unregist contractors do not have access to the guaranty fund Signature of Agent/Ovuner Signature of contractor.. �. Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑ Location No. -� Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# o Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE.DISPOSAL 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 DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on t Signature COMMENTS 40 HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes-.. Planning Board Decision: Comments Conservation Decision: Comments Walter & Sewer Connection/Signature&Date Driveway Permit In, tha DPW Toiv;! ]Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at,124 Main Street. sire Departrnefit signatureldate 010MMENTS . . M Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: f 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 B Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The following is a list of the required forms to be filled out for the appropriate.permit to be obtained. Roof-ng, Siding, Interior Rehabilitation Permits ❑ Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L: Licenses u Copy of Contract o Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products gOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o 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) a Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products 40TE: 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 o Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit .� F ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (if Applicable) C a Copy of Contract u Mass check Energy Compliance Report o Engineering Affidavits for Engineered products D. 40TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit [Fl 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 appy 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'Ated with the building application i Doc: Doc.Bui!;iing Permit Revised 2012 �1 The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 c Boston, MA 02114-2017 x � www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): a , r Address: 3 City/State/Zip: y Phone #: U7— / f Are you an employer?Check the appropriate b Type of project(required): 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 6. E]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 g. ❑ D olition workingfor me in an capacity. employees and have workers' y p �'• 9. Building addition [No workers' comp, insurance comp. insurance.: equired.] 5. EJ We are a corporation and its 10.❑ Electrical repairs or additions 3. I am a homeowner doing officers have exercised their all work 11.❑ Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §](4),and we have no 13.❑ Other employees. [No workers' comp. insurance required.] *Any applicant that checks box 41 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 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. Lic.#: 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 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 hereby certi the pains ntes er'u that thein ormation provided above is true and correct. 01 Sijznature: IDatel 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. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: OORT14 TOWN OF NORTH ANDOVER OFFICE OF ° . p BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 North Andover Massachusetts 01845 SSACHUsf Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE: l JOB LOCATION: -:70 Number Street Addr s Map/Lot HOMEOWNER��`'VI :- / Co�7-(y2� ' A� Name Home Phone Work Phone PRESENT MAILING ADDRESS J©,3f,&l Alii--1 4.Alaw2 A17,41 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 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 Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 NORTH own o . t E 1� \Andover o No. _ KII h , ver, Mass, ( « �3 COCMIC"IWICK �qS R�tTEO PPp��S U BOARD OF HEALTH Food/Kitchen PERMITT, L D Septic System THIS CERTIFIES THAT ......... �' C'��� ............................. BUILDING INSPECTOR has permission to erect buildings on,,,.z�.�,,, .. Foundation .......................... .�l`:..�....�.................................. Rough to be occupied as ................�� ......T,%Q ........ :^.....y1.�1. ..1/ ................................................... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO STARTS Rough / Service ............ ...... .r,- .................. .................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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