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Home My WebLink AboutBuilding Permit #535 - 34 SAUNDERS STREET 3/20/2008Permit NO:5c3 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received 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 Sepik�3� ola�ralar da Dasnci a#eyed 4 DESCRIPTION OF WORK TO BE PREFORMED: 11 r SIMoni, 11�Q Identification Please Type or Print Clearly) OWNER: Name: &:� V 14-k "b - Phone:./- Elk-t'S-v - Y5Y A A-4 _....... /l%A%.A VVV. ARCHITECT/ENGINEER Phone: Address: FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ J 6—/,-v FEE: $ Check No.: Receipt No.: arae NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 0wI,% �i U h 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 COMMENTS HEALTH COMMENTS Zoning Board of Appeals: Variance, Petition No:_ Planning Board Decision: Conservation Decision: DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED Comments Comments Zoning Decision/receipt submitted yes Water & Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street 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) ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 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 a 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) Energy Compliance RepUo-* ('f ;, pplicable) ❑ Mass check Ener-- C ❑ 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: INSPECTIONAL SERVICES DEPARTMENI:BPFORM07 Revised 2.2007 Locationy� No. .� Date NQRTq TOWN OF NORTH ANDOVER .•,hOOR O?O•,,`,O F 9 ' ' Certificate of Occupancy $ �'�s "•n° • t<� 3ACHUs Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 4 5- 5 Check # 1 0 G Y Building Inspector CA m m m X CO) F) m C2 y CD � O t9 Z y CL r = , o d = y 0 o C2cD CDCL o Q d CD CCD O CCD mw P. c CD c . CL0 y CO CD I S O CO) O 1 Z CD � o � CD 0 cCDD cn cn n O cn C� e O z cn d. b y t 0 c�� m =_ So y m H CO) � EO 0 O n f CL ii 1 ca . c 1. = = d Mr, N � w � In m a =r _ m �O O con D y O K = O y : CCD, R O L.O. n aO �=� CA CL m ��H` - m 'om a,� m� CD d y C d P C W �k Q m t IE CD H m C .d► N to O n • o : • �V- 7N� pAi CD 0 0 9 m ..► : v mx 0 CD f m yIJ CD CP H CL. � 0 : rm 0;MCE O �• = cn z O. 5 cin o� M d � GO n ?� ro z ;z M n 7O '71 r G z t7l cn G o v • omi 0 9 0 omh s µperp TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT .: 1600 Osgood Street Building 20, Suite 2-36 North Andover Massachusetts 01845 Gerald A Brown Telephone (978) 688-9545 Inspector of Buildings Fax (978) 688-9542 HOMEOWNER LICENSE EXEMPTION Please pri DATE.:— , R — i / —„ 0 z " JOB LOCATION: 3 ,'2 . ), , n c Z-4 r S T 1:2 — / z_ Number Street Address Map/Lot HOMEOWNER C t, -,�,e. i.= /� �.. Nam— Home phone work Phone PRESENT MAILING ADDRESS 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 tion 108.3.5.1) DEF NMON 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, niles and regulations. The undersigned "homeowner" certifies ies that heJshe understands the Town of North Andover Building Department minimum inspection procedures and requiremenm and that he/she will comply with said procedures and HOMEOWNERS APPROVAL OF BUILDING OFFICIAL Rey ind 10.2005 Foam Homwwws Exmpfim BOARD OF \PPE:V_S 698-9541 CONSERN'_1TIO` 688-9530 IIE.1L11i 08-95.30 PL.1\ VIN'G 688-9535 The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street W .Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricans/Plumbers Applicant Information Please Print Le2ibIy Name (Business/Organization/Individual): Address: City/State/Zip: X/ /I -r Are you an employer? Cheek the appi 1.0 I am a employer with employees (full and/or part-time).* 2.0 I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance equired.] , 3. I am a homeowner doing all work myself. [No workers' comp. insurance required.] t Phone.#: / - 9 2 �_.�Log — / 3 6 3 riate box: 4. 0 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. insurance.: 5. 0 We are a corporation and its Officers have exercised their right of exemption per MGL c. 152, §1(4), and we have no employees. [No workers' comp. insurance required -1 Type of project (required):., 6. ❑ New constriction 7. ❑ Remodeling 8. ❑ Demolition 9. Building addition 10.0 Electrical repairs or additions 11.0 Plumbing repairs or additions 12.0 Roof repairs 13.0 Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. ' t Someowaers who submit this affidavit indicating &.ey are doing all work and then hire outside contractors must submit a new affidavit indicating such. +Contractors that check et this box must attached an additional sheshowing the narne of the sub-con"-Mc'torsand stat., whether or not those entities have employees. If the sub-contractorshave employees, they must provide their workm' 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. #:' Job Site Address: Expiration Date: 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 Investieations of the DIA for insurance coveraLye verification. I do hereby certify / n / �i y under the pains �and penalties of perjury that the information provided above is true and correct i not write inthis area, io City or Town: or town official. ]Permit/License # Issuin; Authority (circle one): 1. Board of Health 2. Building Departm 6. Other ent 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 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 Iicense or permit to,bpera'te�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, §25CO) 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-coniractor(s) name(s), address(es) and phone number(s) along with their cerdficate(s) 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 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,orif 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. A new 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 Commonwealth of Massachusetts F)ep tm5nt of Indo al Accidents Office of Inve.s6pt ons 604 Washington Street Boston, MA 02111 Tel. # 617-727-000 ext.406 or 1-877-MASSAFE ` Fax # 617-727-7749 Revised 11-X22-06 ww.mass-gov/dia Permit N0: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received OF New Building Addition Alteration Repair, replacement Non- Residential One family Two or more family No. of units: Assessory Bldg Other DESGKtP t tun Vr rrvr�n � v v� r n�..+�.••��y• Industrial Commercial Oth_._._._._- Identification Please Type or Print Clearly) OWNER: Name: Phone: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BUUNNG PERMM $12.00 PER $1000.00 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 i T1 l Department of Fire Services r = Office of the Sime Fire? Marsh P. O. Bas.IO2i..State Road; Stow, MA 01MPERMIT" Date: _� /%—o�� North Andover Permit No { Cibl. of Tawn) .(If Applicable) =Da r in.accordacic with the•provisioas of M: G:L.l 4 8.C -ha" pter 1 G as provided in section 34:•:_ This Permit is granted'to: Full name of person 4ra or Corporation Permission to locate dumps.t'er for construction/renovation/demolition of building. _.Comments;. dumpster must be • 25' from structure if unable to lace with re wired Restrictions clearance dumps -ter must :be covered with Plywood or tar end of 'k da 'work 7 (Give location by street and no. or descriibe is such mar, r -s to proane uate 'd tiF q t en cation of location ) Fee P aid $ 50.00 Fire Chief This Permit will expire• S ignature of oft"rcal granting permit) OftrcaI granting.permit (Title )