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HomeMy WebLinkAboutBuilding Permit #286-15 - 343 OSGOOD STREET 9/22/2014 BUILDING PERMIT of"O oT"�ti TOWN OF NORTH ANDOVER o� 5 _h,'° o° APPLICATION FOR PLAN EXAMINATION j o Permit No#: Oq J Date Received 'Jf9 A°gwTED�Pp�4c7 SSgcHus� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION GA Print PROPERTY OWNER,,na /, t._ Print 100 Year Structure yes, no MAP PARCEL'ZONING DISTRI-CT. Historic District yes no Machine Shop village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ O e family El Addition o or more family ❑ Industrial 11 AI eration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic El Well ❑ Floodplain El Wetlands ❑ 1Natershed District ater/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identifica on- Please Type or Print Clearly OWNER: Name: 52,e,�J�/9- ,o0Z,�W6 9& S,-,�J . �nZe: Phone: q26 / 7f G 9� Address: © C fIi2 \AC1Y9-�--` 04 :�7/9/0 Contractor'Name:(!$�/?,+/h 'Phone: r17 _ �(i G.�/ � �z _ Address:. _ _Cz ;;4 . -�a _ Supervisor's Construction License , , _ - ,Exp. Date: Home Improvement License:�� �/ _ Exp. =Date: // lC%/ -____.__- ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BA DON$125.00 PER S.F. Total Project Cost: $ FEE: $ I Check No.: �o Receipt No.: � NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Ow er �. Signature of contractor r i 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) ❑ 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 I 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 i COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes 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 Du.mpster on site yes _ no Located at 124 Main Street ;Fine 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) Ii i i ❑ Notified for pickup Call Email Date Time Contact Name I Doc.Building Permit Revised 2014 I� Location J``� 't3 �X e� No. Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ t Building/Frame Permit Fee Foundation Permit Fee $ s. Other Permit Fee TOTAL $ Check! �Q�� 28040 Building Inspector NORTH Town of Andover No. - h ver, Mass1 "QA CO[M1C 1st WICK �1' • �G �■ V BOARD OF HEALTH PERMIT Food/Kitchen Septic System THIS CERTIFIES THAT ... ..... ... f. Q111t,. ..... rl�„J ��t BUILDING INSPECT OR has permission to erect ..................... .. buildings on ... Foundation .. .. ....... Rough to be occupied as ... P.! :. .,,, , M, ►W1 .. ....... .......................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in this office, and to the.provisions of the Codes and By-Laws relating to the Inspection, Alteration and Final 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 CONSTRUCTION''_-" Rough Service BUILDING.INSPECTOR. Final Occupancy Permit Required to Occupy Building Rough GAS INSPECTOR 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. i De Comonweaft of ffassachnsetts • . Office offnesfigafeovs 00 Washkeow NiTeet Boston,MA 02111 vow.mav go-vIdlr r workexo'CoxnpemagonYhouxanceMUM:BuRderigfCod.factor$fElectre�cza)lsgl*bUP A-P- cantWornaa'Zon Please Print Lemq Nam(Businossl0rganisafioa�ll' &idizal):� �Nl /M/J/1��� Y7: g !�C City'/watdA) Ara yotx an e�m-ployer?cheek- the appropxi to P9 : Type of project(�eg rox eco): �, am.a general contractor and S 1.Q I am.a exnployex with ______� s. �]?tTaw c6nsfxuction employeesoauanNoxpattimedT veDked�thosub-contzact s 7, Remodeling 2.E] I am a solDproprietor orpartnex listed on the attached sheet.- ship and`iiavana.employees These 5ab-confractorsh:ave Demolition wox7 fox mein any capacity. workers'comp.insurance. g, �(Building addition g 5. ❑�l e are a co oration and its �Z�1'o workers comp.pzsurance �-' '101SX1eetxiealxepair3 ox additions reclaired.] offloars have exerersed.their 3.Cl z am a homeowner doing all work right of exemption perMOL 11=11'lmbingxepairs or additions mysGE [go workeya' oworkers'camp. c.1.52,§1(4),andwehavono 72: oofxepairs Wo irr�surancere ed. i employees. workexs' 13N0tTiex 161n, /1; /-e comp.insarancorectuired.] �.Auyapplicantthat cliecksbox#rlmustaJso;711onttlzese�fionbelowsho-wingtheirworkers'compensatioapolicyinfozmafion. ' ' iIfozneownerswiLosabmit:t&affidaYitindicati gfheyY'redoing AworgaudthmUaoutsidecontraotorsmust submit anewaftidagitindicatingsize&. xcontracforsthat 611MI(thisBOXMustattachedanaddiiionatsheetshowingthenameo chesub-contractors andtheirworkers'comp.policyinfozmation. yam IM etn r�ysN thaiis,vroviding workers'cornpe a ation insuxccYtee fo ray Ioyees'. i3erow istkepolley willo.0 site irafo�mutio�t. Lrrsuxance Campanp�l'ame:. _ Policy#or SDI&ins.VD.#: Expirafzon Date: lob Bite Address: City/S Eate/Zip: Affach,a copy of 1a worka)rs'comp ensation-poltcy tleclarafion page(slz0w1U9,Me policy number anri expirratzoDL date). Ra3lure to secure covexage.as recp�ixed under Section 25.A.ofMOL 0.152 can lead to the imposition of criminalVenalflas of a 3xue up to$1,500,�i)and/or one�year impriso�.ent,as well as civilpenalties in�.e form of a STOP-WORK ORDER.and a fMG ofW to$250.00 a day againstthe vlojafor. De advised that a copy'ofthis statementmayba forwardedto the Office flf• fanvestigations of the DfA.for iiisnrance,coverage vexMCation. X 40.riereby cert trieyain.�axuipera Sieg o�pelfrary trial Ale-inflormation provid'e(I oVe i t�zxe ar�cieo�a�eet,Data: Si afore: . Rbone g. Ojf1cia1 Uge 0,,1y, .Do nol vrVe in trim azea,to be eoxwreted 4v cite or town o,f eiaf City or Town: Berznit/Liceztse# fissnfng. ntlxarity(circle one): Z.Board of ealth 2.)3Ugding)gepartment 3.Ctyf'�own Clerk 4.B+lectxicalxnspeetor 5.>•DluzmS�zngJfizspector f.btlter - ~ _ lnfo6iation and Instructions Massachusetts General Laws chapter 152 xequixes all employers to pxovidewoxkers'compensation for them employees. Pursuant to this statute,an e�2,ployee is daf ed as",.,every person k the service of another under any contract of hire. express oni*A oxal amitten!, ' Au ergo ge :s defned as"kindividual,partnership,ass0clat104 corpoxatzon OX otherlegai eafity,or anytwo ormore fore . . of the orngengagedinajointenterprise,andincludingtolagalxepxesenfatvesofWdoceasedOPPIPPx,.ox•tbe receiver orixusfee o�'anindividual,pattuership,association ox othexlegal entiEy,employing employees, �Sowevextha owner of a dwellinghousehavingnotnmxethantkee apat-tments andwho resides therein,oxthe occupantofae, dwelling house of another who employs persons to do maintenance,cousfatction oxrepak work ort such dwelling house ox ontlregrounds orbuilding appuenanttbexefo shallnotbecause ofsuch employmentbe deemedfa be an exnployex" MUL chapter 152,§25C(6)also states that"every state or to cal&oeensing agency shall withhold the issuance or renewal of a Incense or permit to operate a business or to coust'ruct buildings ixt the commonwealth for any applicant who has not produced-acceptable evideztce of compliance with the insurance coverage ree paired." Additionally,MCxL chapter 152,§25C(7)states'Weitherthe eommmnwealthnor any ofits political sub 6M1ons Shan enter into any contract for the performance ofpubllc work unfil acceptable evidence of compliance with,the insurance requirements of ft chaptexhave b 0 M pros onto d to.&6 cgntracfing authority." Applicants Pleaso fill out the workexs'compensation afixdavit completely,by checking the boxes that apply to your situation and,if �.ecessaxy,supply sub-contractors)names},aczdxess(es}and�honenumbex(s)alongwztb.tbeix cexti�cate(s)of ins�axanGo. limited MbilityCompanies(LLC)orLimitedUabilityPartnerships(LLP)w.ithno employees otherth,4the members oxpartuexs,arenotxequixedto catryworkers'compensatioxzinsuxance, Si an YL C or LLP doeshave exnployees,apolicyzgxequired. Be advised thatthisafxdavitmaybesubmitted tothe Department,of Industrial Accidents for confirmation ofinsuxance coverage. Also be sure to sign and date the 2ffidavit Ike affidavit should bexetumedto the city or town thatthe applicafionfox thepem-dt or license is beiogxequested=)tot theDqpaxtm.ent of Iixdustr al A ceidenfs, Shouldyou have any questions regarding the law ox i you are xaqukod to obtain,a*oxkexs' comp ensationpolicy,please call theDepaxfinentatthenumbexlisted holow Self insuxedeompaniesshoutdentexz eix • seI'E insuraazce lZcense number orc the appropriate line. . City or Town OMCIA Plcasebesuxethattheaffidavit iscomplete aridpxintedlegibly. The Department has provided aspace attho,bottom ofthe affldavitfoxyouto:,511 out in the event the Office Oflnvestigationshas to contactyouxegardingt o applicant Please be-sure to nll inthe pe7mit/110ense number Mdo will be used as a xeftence number, fn addition,an applicant ifliatrnust submitmultiple permit/license applications is any givenyear,meed only submit one azFldavif indicating current P olicy information(ifnecessaty)and under"J b Site Address"the applicant shouldwxite"all locations in (city or tov )".A capyolthDaffidavitthat has beenofficiallystampedoxmarkedbythecityoxtotivnmaybeprovidedtothe applicant as vtbofthat avalid afRdavit•rs anfile oxiiaft�repexmits orlicenses. new azddavifmustbetilled out each year.Where ahome owner or cifi�en is obtaiujng alicense oxpemtitnotxelafed to auybusiness ox comm,exciaZ venture (x•e,a dog license orpermit to burn leaves etc)said person is TOT xephad to complete thig affidavit. The Office of pnvestigations would like to tTink you in advance for your coapexafzon and should you have any gtxesfxons, please do Ito 1 hesitate to give us a call. The Department,s address,telephone andfax numbext Tho G�? 4n�?�a� I o ��SzchnP 600 aWngt(a Ston,9A. 02111 r TOL 617-7-2Z,4900 v#40,6 Y✓.i 1-877- M Rovised 5 2605 `a � www-Maq,%govkh'a 960WEIL0 JauolssiwwoC) s,l 91910 VAI?IBAOQNV (M 21VQla 13 Q6W I INV 01S• *: O£6690-S3 :9sua31-1 - �__ Josi.aadn$au. 3nrasuo0 spJepue;S,pue su04eln6a8 Gulp{Ing;o pieog /t;ales:)Ilgnd lo;uaualaedaQ-s}lasnyaesseW . '. V/ie. {i.orr/vri(.[YruuEIFGLIL a�C-/4LftGlaE�ttJeGt1• Office of Consumer Affairs Rusidess Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. It found return to; eg'istraWon. ,1,3738; Type: Office of Consumer Affairs and Business Regulation xpiration 1115/2014 Private Corporatic 10 Park.Plaza-Suite 5170 Boston,MA 02116, Lasting Impressions Custom Design&Buil Stephanie Moore 8 Cedar rd: gam_ Andover,MA 01810 Undersecretary , of valid wit out si afore