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Home My WebLink AboutBuilding Permit #264-14 - 327 MIDDLESEX STREET 9/23/2013 TOWN OF NORTH ANDOVER 4 PLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must com Tete all items on thisage LOCATION • ; Pnn PROPERTY OWNE _ pmt 100 Year Old Structure ye no. MAP NO: ., PARCEL: ZONING DISTRICT. _ .. Historic District y s no _ - _ Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 0 One family ❑Add 'on N-TW---O-or more f am ilyElIndustrial ->�ft C4eration No. of units: ❑ Commercial ❑ Repair, replacement 0 Assessory Bldg ❑ Others: 0 Demolition ❑ Other 11 Septic ❑Well 0 Floodplain 0 Wetlands 0 Watershed District El Water!S6ver DESCRIPTION OF WORK TO BE PERFORMED: bo'c� k)kqrfC-V) —1den 'fi ion Please Type or Print Clearly) OWNER: Name: 1v� �-1 Phone: � Address: CONTRACTOR Mme:.- Phone: _ Address:. . Supervisor's Construction License: ,Exp. Date:. Wome Improvement License:_ _ Exp, Date: - I ARCHITECT/ENGINEER Phone: • L Add ress Reg. No. FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASEQON$125.00 PER S.F. Total Project Cost: $ ,� FEE: $ Check No.: I Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund gE ture ofAgent/Ovvner_. �h� S. egafure of_contractor; _ r` Plans Submitted ❑ Pla s Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ r` Building Department The fol-owing is-'a-list of the requited 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 cans if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apo.-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.Building Permit Revised 2012 . 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 Nater & Sewer Connection/Signature& Date Driveway Permit DPW Tow;: Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Mair, Street - -` Fire Departmen -signature/date' ' COMMENTS 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 DANCER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A-F and G min.$100-$1000.fine NOTES and DATA— (For department use i El Notified for pickup - Date Dor—Building Permit Revised 2010 Location �N 1 Y►1(�� No. Date 1 S • - TOWN OF NORTH ANDOVER 0 r , r Certificate of Occupancy Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 26891 Building Inspector �~ NORT11 Town of t _E �. Andover No. O LAMS h , ver, Mass, 3 13 A_ COC NIC N�WICK y1� 7a ORATED 1S U BOARD OF HEALTH R IT T LD Food/Kitchen PE Septic System THIS CERTIFIES THAT .......... .....kaw. art. ...P!. BUILDING INSPECTOR .`... ......... .. .. . ........................... .... Foundation has permission to erect .......................... buildings on 4,54.................! ....... . ........... ...� ,/� Rough .� �� to be occupied as ..... � ts•`.�ri �., .... ........... J� R........ 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 30 ® UNLESS CO S NSTRUCTI IST Rough Service ............... ....... ................................................. 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 •' �osTy . T0'Pff OF I�TORM AND0WR OFFICE OF M BUILDING DEPARTMENT � ;1600 Osgood Street Building 20,-Suite 2-36 ry�S�A�uus�� North Andover,Massachusetts 01845 Gerald A.Brown Inspector of Buildings Telephone(978)688-9545 HOMEOMMR-LICENSE EXE11/jpTION Fax (978)688-9542 - [TIDING PFRMC[T.APPLICATION Pleaseyrint • , ' DATE:An JOB LOCATION: umber Streetd �V t� A dress Map/Lot FJOVM()VWR 1 1� o c Qca* Name. - Home Phone Work Phone PRESENT MAILING ADDRESS Cit,Tn�=fin stAe lip Code The current exemption for"•homeowners"was extended to include owner-occupied dwellings to two units or less and a allow such homeo:,, ers to engage an dividual•for hire who does Rot possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Persons)who Qwns a parcel of land on which he/she resides or intends to reside,on which there be,a one or two farc�ily structures. A person who constructs more that one home in a two-yearperiod shall n be or is intended to considered a homeowner. The undersigned"homedwner"assumes responsibility for compliances with the State Buildi Applicable codes,by-laws,rules and regulationsn, g Code and other The undersigned"homeowner"certifies that he/she understands the Town of No minimum inspection procedures and requirements and That he/she will comply w th srth and procedures and dover Building Dep requirements, HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption 130ARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 The Commonwealth ofMassachusetts Department of IndustriglAccidents Office of Investigations 600 Washington Street Boston,MA 02.111 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electrci:cians/Plumbers Applicant Information Please Print LeAbly Name(Business/Organization/lndividual): �V A tj&vti N Address: City/State/Zip: ( Vl .)Phone#• l (c)— A.re you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction employees full and/or part-time).* have hired the sub-contractors � 7. � modeling m a sole ro rietor or partner- listed on the attached sheet.. 2. 1 a 1 ❑ 'proprietor p These sub-contractors have 8. ❑Demolition ship and'have no employees , working for me in any capacity. workers'comp.insurance. 9, (]Building addition [No workers'comp.insurance 5. El We are a corporation and its 10.❑Electrical repairs or additions quired.] officers have exercised their 3. 1 am a homeowner,doing allwork 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 required.]insurance re employees.[No workers' �� 13.❑Other comp.insurance required.] xAny applicant that checks box#1 must also fill outthe section below showingtheir workers'compensation policy infotrnation. Homeowners who submit this affidavit indicating they tie doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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.#: ExpirationDate: 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 o. 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 maybe forwarded to the Office of Investigations of the DIA.for insurance coverage verification. I do hereby certA the ns aukenalties ofperjury that the information provide above is true and correct. - Sign ature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License 0 Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5•Plumbing Inspector 6.Other - Ph nn a R. Information and Instructiolm's 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 employeY 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 li"nsing 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 ofpublic 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 certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are notrequired to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be 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-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"Many given year,need only-'submit one affidavit indicating current policy information(ifnecessary)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 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 Goxr monwaltl of MUssarhmettis Dgp.az elit ofzaduAllal,Acoidents Offlee ofI11yestigatims 600 Wasbiugtoa Street Boston,MA 02111 Tel,#617-727-4900 ext 406 or 1-877 MASSA'F Revised 5-26-05 Fax#617-727-7749