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HomeMy WebLinkAboutBuilding Permit #252-2017 - 32 MARBLEHEAD STREET 9/8/2016 ifm BUILDING PERMIT TOWN OF NORTH ANDOVER PPLICATION FOR PLAN EXAMINATION Permit NO: �j Date Received 'jj9°owAreo''" Date Issued:0 ,f ®e tel,% SSgCHUs� IMPORTANT: Applicant must complete all items on this page LOCATION 32 Marblehead'Street Print PROPERTY OWNER Lynne Rudnicki Print - MAP NO: 8 PARCEL: OM `ZONING DISTRICT: R4" Historic District yes Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building X One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other [] Septic []Well ❑ Floodplain 0 Wetlands _ ❑ Watershed District ❑ Water/Sewer - , Remodel Kitchen-return kitchen ceiling to original height. Relocate pantry opening. Relocate sink, install dishwasher,new cabinets,counter tops with breakfast counter wall. New recessed lights and relocate electrical and plumbing. Identification Please Type or Print Clearly) OWNER: Name: Lynne Rudnicki Phone: 978-771-5564 Address: 32 Marblehead Street North Andover,MA 01845 CONTRACTOR Name: Si 'Phone: .y 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. ------------- Notal Project Cost: $ FEE: $ Check No.: D Receipt No.: 30061 NOTE: Persons contracting with unre ' tered contractors do not have access to the guaranty fund Signature of Agent/Owne Signature of contractor BUILDING PERMIT ��0T b TOWN OF NORTH ANDOVER 3� '- ,a o o APPLICATION FOR PLAN EXAMINATION _ Permit No#: Date Received 79ADRATED gSSiCH�15�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Ij.Septi:c' ❑illlelll! , ❑#Floodpla'in; 01Net _no`s Watershed)®istn ,0_Wate`r/sewer --__ ---�'._--- �r --- - - - -- DESCRIPTION OF WORK TO BE PERFORMED: r Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email: 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$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost.- $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the_guaranty fund 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4 Building Permit Application Certified Surveyed Plot Plan 4 Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/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 1�110TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) �6 Building Permit Application 4 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 Revised 2014 Q J O Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swunining Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ i COMMENTS CONSERVATION Reviewed on Signature s 60MMENTS HEALTH Reviewed on Signature COMMENTS I Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Wafter & Sewer Connection/signature ®ate 1f Driveway Permit DPW Town Engineer: Signature: I Located 384 Osgood Street FIR�EDElARTMEIVT�� ,TempDumpster}on;site :yes, , ,�� � 9,no�.����t�:€� '���. Locayted ata�124"IVIamtSt�eet ^, .. `F,. = yy FireDepartment signature/crate "!f-!r.,._�"'�' S• r.- .4 �1.;F.. i� ..r''f 1. s.}..y+�l�c�t F'SS,-�'� },+K'7a'}�f?—.+�`� ��i'+S. COMMENTS . .,*`�„ . , ;� t �,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.$100-$1000 fine NOTES and DATA— (For department use) I ® Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Location /mak 4-1 64)6- No. Date i • - TOWN OF NORTH ANDOVER' v_ Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ ' Other Permit Fee $ i TOTAL $ Check# � k � 30861 Building Inspector - _ I NORTH Town . of s _ : 6Andove*r , O •1. •. No. 0 V. - Ah ver, Mass, a0/6 coc MIc"twic.f �7S R�TEO I.PR��� U BOARD OF HEALTH Food/Kitchen PERMIT _T LD Septic System THIS CERTIFIES THAT L�..J.�yt, .r ..u.p�y.�. BUILDING INSPECTOR ............. ....... .. .... .............................. p1� AIAA Foundation has permission to erect ............Mxn_ ..... uildings on .... ...... .L ���...5?'* Rough .......................................................................... Rough to be occupied as ...�.�..��.. �,��� 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 CONST TION RTS Rough Service .. ...... ...... .... Final BUILDING I PEC OR 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. 512" 1,5.1 Dishwashery Sink 2.9 t - Range i 8'3�� o� Refrigerator Cabinet 7111" aft Eft feet floor®planner °E No OTR TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT �„^ + 1600 Osgood Street Building 20, Suite 2-36 rob } North Andover,Massachusetts 01845 CHUS� Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print 9/8/16 DATE: JOB LOCATION: 32 Marblehead St Map 8 fleck 9z�� Phit-EL g Number Street Address Map/Lot HOMEOWNER Lynne Rudnicki 978-685-7506 (h) 978-771-5564 (c) Name Home Phone Work Phone PRESENT MAILING ADDRESS 32 Marblehead Street North Andover MA 01845 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 Town of North Andover Building Department minimum inspection procedures and requirements and tha a/she wil omply with said procedures and requirements. r HOMEOWNERS SIGNATU APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 The Commonwealth of.Maassqchusett•s .. : Depa ytment ofindastrzal.Aceldents 1 Congress Street,Suite 100 .Boston,MA 02114-2017 4 ww w.mas,.go-oidia © kers'Co�npeztsatzonZusuz'ance.Af�.davit:BTdldens/Contxac�ors/Eleetrzcians/PZioanbexs. TO BE Fff XD w1'I7f TBE PERl&TI.ING ATJTICORITX. A licant Woxmation please Print iegibly Name (Easiness/Organization/Indivzdual): L '11 N�G � �� Address: 3 m p-�g 1.1��-@ <5-1— pld�.m . -pi)to CitylS�ate%exp: Phone#: q'—1P� �� �'S (O S � . Areyou an employer? Checkpriate box: Type of project(requixed): 1.0 I am a employeru&h s employees(full and/or part time).* 7.• N&w corlstnetton 2.EjI am a soIe propaeb:ror parinership andhave no employees Working forme in 8. Remodeag any capacity.[No workers'comp.insurance required] 9. ❑Demolition. 3F�lamahomeownezdoingallworkropeZENO Wa vers'comp.-:h=encerequirad.]t 10 ❑$ujlc�ngaddition ¢.XIamahomeownwandwiIlbehiruigcontractorstoconduct all workonmyproperty IV&I 11 �-7 Electrlcalrep airsox.additions ensure that aIl conhactors either have workers'compensation�-�cr,ranne or are sole .L! proprietors wifino employees. 12:Q Plumbing repairs or additions 5.n I am a general contractor and I have hired the sub-con-Tractors listad on the attached sheet 13.'[�Roafr ep alts Tlese sub-aoniracters9iave eiuployees andhave workers'pomp_insurance. 14.❑Other 6.Q vie are a cozpozaf imi pod#q officers have exereisedtheicrght of'exemption perMUZ c. 152,§1(4),a ndweha9ena_einployees.Wo workers,comp.insmanceregnized.] '-.Anyapplicauttbatcheclab&4.11 must also IIoutthesection below showiugtheirworkam'compensaHonpoEcyinfozmation. t Homeowners Rho u&l Hi Obis affidavitmnccatmgthey are doing allworkaadthenhire outside confractorsmusI-submit a neer affidavitmdicatmg such Contractors_;hat check&l 13a�- un.4Pglled an additional sheet showingthe name ofthe sub-contractom a_ndstate whether ornotThose entitieshave employees. Ifthe sub-corairacfors have employees,they must prczvidetheir workers'comp.policy number. I amore are emAlayer t1i at zsprovzdang7vorkers'cornpewadon insarancefor my ef'Tf iyees'Beloi�v is thepoZicy urid jog site � 172f03�Ylatl0r2. - - Insurance Company 2Tame: Policy#or Self-ins.Zic.#: ExpixationDate: Yob Site Address: City/,State/zip: Attach.a copy of thewo?rkers' compep4ationpolicy declaration page(showing the policynumber and expiration date). Failure to secure coverage as required under MGL e. 152, §25A is a cximin:al violation punishable by 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$25'0.00 a day against the violator_A,copy of Ibis statement maybe forwarded to the Office of Investigati6ns of the DIA for insurance coverage verifloatioll- I do hereby cer ' user tr ` andpenaldes ofpetjzW that the infomaiionprovided above is�tue and correct. Si ature: Date: e-/ Phone#: official use only. .Do rzot-Nurite in this area,to be completed by city or toxon official City or Town: Permit/License# Issuing Autliority-(circle one): ; 1.Board ofHealtiCi 2.BuildingDepartment 3.City/Town Clerk fir'.Electrical Lispector 5.Plumbimgfnspector 6.Other Contact Persolt: Phone#: Information and Instructions Massachusetts General Laws chapter X52 requires all employers to provide workers'compensation fortheir employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hare, express or implied,oral or written." Aro,employer is defined as"an individual,partn.ersVp,association,corporation or other legal entity,or any two or more of the foregoing engaged iu a joint enterprise,and including the legal representatives of a deceased employer,or the receiver-or trustee ofan individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house Laving not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shalt not because of such employment b6 deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shaIl withhold the issuance or renewal of a license or permit to operate a business or to cons-tmet buildings iu the cornmonwealtl4 for any applicant-who lias not produced acceptable evidence of compliance-with the insurance coverage req iZred." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants 1ble-as e f -out-the workers' compensation affidavit completely,by checking1he boxes that apply to your situation and,if necessary, supplysub=contractors)name(s),address(es)and•phonenumber(s)alongwiththeirceztificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)withno employees'otherthan the members or partners,are not required to cant'workers' compensation insurance. if au LLC or LLP dohs have employees,a policy is required. lie advised that this affidavit may be submitted to the Department of•In.dustrial Accidents fok con-Lunation of insurance coverage. Also b e sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you•are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-ib. u 6d companies should•enter their • self-insurance license number on the appropriate line. City or Town Officials Please be-sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the of-davit for you to fill out=a the event the Office of Investigations has to contact you regarding the applicant. PIease be sure to fill in the permit/license number which will be used as areference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit notrelated to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department,of IndustrialAccid-ents 1 Congress Street, Suite 100 Boston,MA 02114-2017 TeL# 617.727-4900 ext. 7406 or 1-877-MASSAFE Fax#617•-727-7749 Revised 02-23-15 www.mass.gov/dia