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HomeMy WebLinkAboutBuilding Permit #403-15 - 326 CHESTNUT STREET 10/28/2014 BUILDING PERMIT of No oT f TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 1� 4A Y`y10 L � O Permit No#: I Date Received q ORATED�P" 4`� SSACHU`�kt Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION - -v�uv. of A" Ra Rr Print11 PROPERTY OWNER 1'�-�lJ� �•._ VLQ _ �� A�Lt Z� __ _ V� Priry 1(0 Yeaf structure yes no MAP V PARCEL: ZQNING DISTRICT: Historic District yeso j =Machine Shop Village, yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building XOne family XAddition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other E Septic El Well El Floodplain ❑`Wetlands ❑ Watershed District Water/Sewer N`° DEESCI IPTION F WORK TO BE RFORMED: �. " � r r Identification- Pleage Type or Print Clearly OWNER: Name: 2-V�\„ GrAltZcbPhone: �'i�8'a9y' Address: �-�"If�v �l A) A cg _ d 1 'C(S� Contractor Name: Phone: _ r_ Address: _ Supervisor's Construction Lic nse: _ _.._ _ Exp. Date: Home Improvement License: Exp. Date: __v ARCHITECT/ENGINEER )V i0q Phone: Ct `l 8 Address: 3o)-b d"Q S4"t U, 1 , /Va„ /'U4 eg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ `o`o� , ©Ca o FEE: $ � Check No.: Receipt No.: Z NOTE: Persons contracting with uXged contractors do not have access to the guaranty fund ignature of Agent/Owner `e� Signature of contractor I i Location ST (QW No. T�, Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ C Foundation Permit Fee $ Other Permit Fee $ TOTAL $ F F j Check 281 9 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS P Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes 4 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 signature/date 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) i ❑ Notified for pickup Call Email Date Time Contact Name = Doc.Building Permit Revised 2014 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/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) j ❑ 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 Revised 2014 Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost 22,0010.010 m $ - $ 264.00 Plumbing Fee $ 33.00 Gas Fee 100 comm. $ 100,00 ; Electrical Fee $ 33.00 Total fees collected $ 430.00 326 Chestnut Street 103-15 on 10/28/2014 Finish Second Story Addition : w: 0 c ve: ,. No. yah ver, Mass, coc Nic„ew.c« 1' �•9 A°Rwreo �PP�,��(5 S U BOARD OF HEALTH Food/Kitchen PER IT �� LD Septic System THIS CERTIFIES THAT .1/.�i..� A..Alad ... . �.- ....... BUILDING INSPECTOR ...... .. .... ................... .. ,. Foundation has permission to erect .......................... buildings on .......�1.�..... tke's4VA**.... • ` % Rough to be occupied as ... ........v*.....Z.., A'. .. Il1&..................... y provided that the person accepting this permit shall i 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 6N ELECTRICAL INSPECTOR • UNLESS CONSTRUC T TS Rough Service l ..................... ....................................................... 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. � p ��rk 4 yo C} i`1 Opma A�DOvj p, =�,'` ° ONCE OB B�[TMI)ING IDV+PARTT&NT • ' a •�" .-1600 DsgocdsireetBtuld�ng2Q Suite235 R � �Acau5 �5 NorthAudovex,Massachusetts 41845 Gerald A.Brown - Inspeetorofnt ldings Telephone(979)W--95445 . I OMEC W)- R-LICENSE EKEMPTIO (978)688 9542 BUEDBa,' pEl2 '�61. )?LICAT`ION Plea—sau_Tint '. . ()B LOCATION: 3" s-� VI� � Nuznbex Street Address S .` Q✓� �-2�- (h 4, O k 8 q( MaplL,ot .xOIVI_C)WNER Namev t Z G v R ' 02� ' C0O6 Home Phone Work Phone sE1�TC.DDRESS 3 s ; aThe current exemption for"-homeowners"teas extelded to iachl�7e owner occupied dt4vellings to Iwo units ox;ess and c allow su;h l,omPo�to 13 engage an ildaviaual•forhire who c?oes notpossess a licanse,provided That the owner acts as supervisor). S, fe 3uilding (Code Section 108.3.5.1) DEDWITION OP'ROIVIEOWNMR Persons)who fang aparcel of land on which$e/she resides or intends to reside,on which theze zs,or is intended to be,a one or two fa y siruetures. A person who coustraets more that.one home in a iwoyearpeziod shall not'be considered ahoxneowner, The undersigned".homeowner"assumeszesponszhility£oxcompliances with•the SfateBuilding Code and other .A.pplicable codes,by laws,xales andTegalafions. t The rtndersigned`�omeownez"cert;$esfhathelshenmdersfaudstheTo nofNorth,AndoverBaildiagDgep Ging minimum insper-lku Pmoedures and requirements and that he/she mply yTith�said pxacedures and xequir-ements, HOMEOWN$RS SIGNA'I'rJRE � T APPRO�1AI.OF BUILDWO OF. ICIAL Revised M-009 Foun Homeowners$xempvon , 'gOARDOFAPPEALS689-9541 r r ` • COASER'�A'I�ON 688-9530 HEALZ�T 6$8-9540 p�„ - . OMWG 688-9535 The Commonwealth of Massachusetts - Department of IndtistriqlAccidints Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation ZnsuralnceAffidavit:Builders!Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/tudividual): y1P V N V% Address: 3 a� C J.Q S4V_y� S) City/State/Zip: JU a,\,k� ✓' Phone#: C! 02q 0 Are you an employer?Check the appropriate box: Type of project(required): J.❑ I am a employer with 4. El am a general contractor and I 6. ❑New construction employees(fall and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.IT 7 ❑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 10.®Electrical repairs or additions required.] officers have exercised their 3.01 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 12TJ Roof repairs insurance required.]f employees.[No workers' 13.❑Other comp,insurance required.] 'Any applicant that checks box 41 must also fill outthe section below showingtheir workers'compensation policy information. i Homeowners who submit this affidavit indicatingthey ale doing all workand then hire outside contractors must submit anew affidavit indicating such. 1Coatractors 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 thepolley and job site information. Insurance Company Name% Policy#or Sol£-ins.Lic.#: Expiration Date: Job Site Address: CitylState/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 wellas 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 maybe forwarded to the Office of Investigations of the DTA for insurance coverage verification. I do liereby certtgunder thepaln5 dpenaltles ofperJary that the Information provided above is true and correct. - Signature: 01 Date: k o g 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.PIumbing Inspector 6.Other - - - Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,- express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a-deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having 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 shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced.acceptable evidence of compliance with the insurance coverage required." 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 Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone numbers)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policyisrequired. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation o£insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be retained 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-insured 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 affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference 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 may be 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 homeowner or citizen is obtaining a license or permit not related 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 Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth ofMossachusetts Dgparftu ut Qf f dusWal,A.coldexlts Office ofInvestig loins 600 Washington.Street Boston,MA,021.11 Td, 617-727-4900 at 406 or 1.-877-MASS.AFE Revised 5-26-05 Fax 0 617-727-7749 749 wwwmaagovfdia.