HomeMy WebLinkAboutBuilding Permit #911-16 - 34 SAUNDERS STREET 2/24/2016BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#: �� Date Received
Date Issued:
ANT: Applicant must complete all items on this
LOCATION Si4-eCA
T A Print
PROPERTY OWNER ACY`-
P 'nt 100 Year Structure
MAP 2'1 PARCEL:_ ZONING DISTRICT: Historic District
Machine Shop Village
yes no
yes no
yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ One family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Meration
No. of units:
❑ Commercial
41"Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Other
-11-Demolition
11Septic ❑ Well
❑ Floodplain' 1Netl""ands
strict
❑ Watershed District
Water/Sewer_
DESCRI TION OF
not V-L)�c-
RK TO BE PEKFUKMEU:
Q � a b aA4,\,r o ov►-
Identification - Please Type or Print Clearly
OWNER: Name:�.�n�� G�To� iCS Phone: 'A
Address: S-,v,no�l✓S
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 $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ 5� 000 FEE: $ (000 _
Check No.: _� d Receipt No.: 0 y y
NOTE: Persons contracting WitCunregistered contractors do not have access to the guaranty fund
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 m U FORM
PLANNING & DEVELOPMENT Reviewed On
COMMENTS
Signature.
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH
COMMENTS
Reviewed on
Sianature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
' Conservation Decision: Comments
a Water & Sewer Connection/Signature & Date Driveway Permit
PW Town Engineer: Signature:
Locatea jd4 usgooa Street
FIREIDER RTMENT�` Ter'np�Dumpsternox`
R .:,.. #. -ice s= , ;" F- SY tat t �' r b s . o - - ...s.. _..F......,... •�
Lrocated dt 124lMam#Street
'Fire3Departmen 4signat rU / a
ae dame
t-:: ,. .il�.Y . :�{� ayj _ ;. �" i .,Y ,�},, , _ !r. r �„+rs:•r ..+.� -. _mss. .,.. ... a ,.... >. _!
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, rust 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 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
4. Building Permit Application
4. 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
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)
Mass check Energy Compliance Report (If Applicable)
Engineering Affidavits for Engineered products
TE: 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
4� 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
Location
No.
Check #
Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee
TOTAL
$
Building Inspector
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Location
No. Date
Check # 4? 0
TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee
TOTAL $
Building Inspec'tor
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Enter construction cost for fee cal -
North Andover Fee Calculation
Construction Cost
$ 5'50,000.00
m
$ -
$
600.00
Plumbing Fee
$
75.00
Gas Fee 100 comm.
$
100.00
Electrical Fee
$
75.00
Total fees collected
$
850.00
35-37 Saunders Street
911-2016 on 2/24/16
2 family remodel
Gerald A. Brown
Inspector of Buildings
Please print
DATE: Z j Z3 11 lQ
TOWN OF NORTH ANDOVER
OFFICE OF
BUILDING DEPARTMENT
1600 Osgood Street, Building 20, Suite 2035
North Andover, Massachusetts 01845
HOMEOWNER LICENSE EXEMPTION
BUIDING PERMIT APPLICATION
Telephone (978) 688-9545
Fax (978) 688-9542
JOB LOCATION: 3S- 34 3 ay no1er S-�-
Number Street Address Map/Lot
HOMEOWNER V1 ,rk
NameJ Home
PRESENT MAILING ADDRESS 1 V\ E
Work Phone
i. Cory-)
3 � C d v m I ; n 9-000( �4 (9 (4 ,
City Town State Zip Code
The current exemption for "homeowners" was extended to include owner occupied dwellings of one or two family
dwellings and to allow such homeowners to engage an individual for hire who does not possess a license,rop vided
that the owner acts as supervisor.
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 dwelling, attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two-year period shall not be considered a homeowner. (780 CMR
Section I IO.R5.1.2)
The undersigned "homeowner" assumes responsibility for compliance with State Building Code and other applicable
codes, by-laws, rules and regulations.
The undersigned "homeowner" certifies that he he understands the Town of North Andover Building Department
minimum inspection procedures and requ' m n s and that he/she will comply with said procedures and
requirements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Revised 8.2015
Form Homeowners Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
.I^ N. sy4y
�7'mrkers' Compensation Insurance Affidavit: Baders/Contractors'7COBEP'XLED'i�Tl[THT>�OG� RMi'�'Z'�G�.A.UTJE(OR�T•i'.irczcia�xs/�Xumbexs.
Please Paint X,e 'bl
in
A licantSni'oxm.ation ��
Name (Business/Oxganization&dividltal): .51'ryq ✓
.A•cldress: )�
Gty/State/Zip: N.
Are -you an employer? Ch"t& appz oprlate box:
Phone #: al -4'�s - zo C' -4 913 -
1.� I am.a employer with , employees (full and/or part time)-*
Z,Q I am a sole proprietor or partnership and have no 0 ployees workirig forme in
any capacity. [No workers' comp. insurance required.]
3.� am a homeowner doing all. work myself [No workers' comp. Msurance required.] t
4.E]I am a homeowner and will be hiring contractors to conduct all work on my property. Iwill
ensure that all contractors either have workers' compensation insurance or are 9010
5.C] I am a general contractor and I have hired the sub -contractors listed on the attached sheet.
These sub -contractors have employees and have workers' comp. insurancet
6.[1 We are a corporation and its oft gers have exercised their right o£'exemption per MGL c.
152 91(4) and we have nQ er•4playees. [No workers' comp. insurance required.]
Type of project (requited):
7. El New construction
8. p�Remodelirig
9. ❑ Demolition
10 [] Building addition
11,n Electrical repairs or additions
13.E] Roof repairs
14.E] Other
*Any applicant that checks ate#1 must also fill outthe section below showi ag theirworkers'compensation policy information.
checs
i Homeowners who cec56ikthis affidavit indicating they are doing all work andthea hire outside contractors must submit anew affidavit indicating such,
rConfractors that check flumust, attached an additional sheet showing the name of the
s box sub -contractors and state whether or not those entities have
__, .,ee� 7f+hP snh_rnncaclors have employees, 16i must provide theta workers' comp. policy number.
W am an employer that is pidvidirxg workeps'
information.
insurance Company
Policy #- or Self ins, Lie.
compensation insurance fop my employees ' Below is tie policy and lob site
Expiration Date:
City/State/Zip:
rob Site Address:
pensation policy declaratlou.page (showing the policy nar
uAvoer and emu ation date).
Attach a copy of the workers' com
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to $1,500.00
as civil penalties in the form. of a STOP WORK ORDER and a fine of up to $250.00 a
and/or one-year imprisonment, as well
copy of this statement may be foa warded to the Of%tca of Investigations of the DTA for insurance
day against the violator. A
coverage verification.
I do.aepeby eerie ur2
tree pains andpenalties ofperjurY that the inf"4tion provided above is true anu wrr etc.
„a+R. ;-71 1 � l,.v
q9 -
I
Official use onty. Do not write in this area, to be completed by city or town Official.
City or Town:
Permit/License 9.
lssuingAuthorzty (circle one):
1. Board of lfealth 2. $uil&ugT)epartment 3. City/`Town Clerk 4. )ElectAxcal Inspector 5. Plumbing Inspector
6. Other
Phone #:
Contact Person:,
The commonwealth ofmassachasetis
Department ofrndustTialAceldents
I Congress Sheet, Site 100
Boston, HA. o2114-2017
wyvw.Mass gov/dia
.I^ N. sy4y
�7'mrkers' Compensation Insurance Affidavit: Baders/Contractors'7COBEP'XLED'i�Tl[THT>�OG� RMi'�'Z'�G�.A.UTJE(OR�T•i'.irczcia�xs/�Xumbexs.
Please Paint X,e 'bl
in
A licantSni'oxm.ation ��
Name (Business/Oxganization&dividltal): .51'ryq ✓
.A•cldress: )�
Gty/State/Zip: N.
Are -you an employer? Ch"t& appz oprlate box:
Phone #: al -4'�s - zo C' -4 913 -
1.� I am.a employer with , employees (full and/or part time)-*
Z,Q I am a sole proprietor or partnership and have no 0 ployees workirig forme in
any capacity. [No workers' comp. insurance required.]
3.� am a homeowner doing all. work myself [No workers' comp. Msurance required.] t
4.E]I am a homeowner and will be hiring contractors to conduct all work on my property. Iwill
ensure that all contractors either have workers' compensation insurance or are 9010
5.C] I am a general contractor and I have hired the sub -contractors listed on the attached sheet.
These sub -contractors have employees and have workers' comp. insurancet
6.[1 We are a corporation and its oft gers have exercised their right o£'exemption per MGL c.
152 91(4) and we have nQ er•4playees. [No workers' comp. insurance required.]
Type of project (requited):
7. El New construction
8. p�Remodelirig
9. ❑ Demolition
10 [] Building addition
11,n Electrical repairs or additions
13.E] Roof repairs
14.E] Other
*Any applicant that checks ate#1 must also fill outthe section below showi ag theirworkers'compensation policy information.
checs
i Homeowners who cec56ikthis affidavit indicating they are doing all work andthea hire outside contractors must submit anew affidavit indicating such,
rConfractors that check flumust, attached an additional sheet showing the name of the
s box sub -contractors and state whether or not those entities have
__, .,ee� 7f+hP snh_rnncaclors have employees, 16i must provide theta workers' comp. policy number.
W am an employer that is pidvidirxg workeps'
information.
insurance Company
Policy #- or Self ins, Lie.
compensation insurance fop my employees ' Below is tie policy and lob site
Expiration Date:
City/State/Zip:
rob Site Address:
pensation policy declaratlou.page (showing the policy nar
uAvoer and emu ation date).
Attach a copy of the workers' com
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to $1,500.00
as civil penalties in the form. of a STOP WORK ORDER and a fine of up to $250.00 a
and/or one-year imprisonment, as well
copy of this statement may be foa warded to the Of%tca of Investigations of the DTA for insurance
day against the violator. A
coverage verification.
I do.aepeby eerie ur2
tree pains andpenalties ofperjurY that the inf"4tion provided above is true anu wrr etc.
„a+R. ;-71 1 � l,.v
q9 -
I
Official use onty. Do not write in this area, to be completed by city or town Official.
City or Town:
Permit/License 9.
lssuingAuthorzty (circle one):
1. Board of lfealth 2. $uil&ugT)epartment 3. City/`Town Clerk 4. )ElectAxcal Inspector 5. Plumbing Inspector
6. Other
Phone #:
Contact Person:,