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HomeMy WebLinkAboutBuilding Permit #062-2017 - 35 BELMONT STREET 7/20/2016 L NORT}j �B BUILDING PERMIT ���T`E°A. 'bA44 q'�< V ' TOWN OF NORTH ANDOVER fo ; -_. . -• -' APPLICATION FOR PLAN EXAMINATION _z _ _ �. ���� ° , ,- Permit No#• Date Received meq°RATE° SSAGHU Date Issued: W6 - IMPORTANT: Applicant must complete all items on this page LOCATION Print I PROPERTY OWNER Print 100 Year Structure yes n MAP PARCEL: n ZONING DISTRICT: Historic District yes Machine Shop Village yes n i TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential r El-New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement- ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other �.. SID Sep i.c a l = fl Floocip ain ®Wetla ds ®',allVa'te ed D strict k ®�11�te> Sewe _ s 3 � DESCRIPTION OF WORK TO BE PERFORMED: Identification-'Please Type or Print Clearly OWNER: Name: 1+�taw a Phone: Address: `?S l /YL�9� , 4-�q&(/ger' e 'r Contractor Name: Phone: Email: - Address: Supervisor's Construction License.- Exp. Date: Ex Date: Home Improvement License. p s ARCHITECT/ENGINEER Phone: - . h Address: Reg. No. FEE SCHEDULE;BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $� 0Od/�/16 aa FEE: Check No.:_ Z-3 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund s o t � �%0RTy BUILDING PERMIT o` T�E° 'a 6 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION � a -e Permit No#: Date ReceivedCH ��. 9SSgcHuS�' Date Issued: IMPORTANT: Applicant must complete �/alll items on this page LOCATION 3 S t r?.��,19/I AJ' 14nCOl,4ev AA4 C21,?K�- Print PROPERTY OWNER Ld o(���, Print 100 Year Structure yes n MAP _PARCEL: ZONING DISTRICT: Historic District yes n , Machine Shop Village yes n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ElOne family ElAddition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement- ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Ali I e Floodp atn etla d to ed ►istnc ater =e e DESCRIPTION OF WORK TO BE PERFORMED: a-too Identification- Please Type or Print Clearly OWNER: Name: - C"q b PIAIVL t9n d Phone:4 Address: S Psi n'1Ong` S /t/, )qr 4ye)V141 C'o` 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.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ 4 ( &P/'d IZ2 FEE: $ / 0 Check No.: 7--3 6-L Receipt No.: :300e� �2 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fiend F i ��•,° g ?,� •.. --own- Location d It Ali No.06 Z Date 6:?- • • TOWN OF NORTH ANDOVER z, Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# Z307 - 30637 Building Inspector . , . S ❑ I Flans Submitted El Plans Waived ❑ Certified Plot Plan ❑ Stamped flan TYPE OF SEWERAGE DISP - f J Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Permanent Dempster on Site ❑ - THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING a DEVELOPMENT Reviewed Onf Signature &�'---- COMMENTS I Df P 1 CONSERVATION Reviewed on ,-YD I to Signature COMMENTS �y'. 1 HEALTH Reviewed on Signature COMMENTS 1 - Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes 1 ' Planning Board Decision: Comments 8: Cor��servation Decision: Comments r Dater& Sewer Connection/Signature &®ate Driveway Permit DPW Town Engineer: Signature: Located, 384 Osgood Street -DEPARTMENT- Temp Dumpstei on�site, ryes ,r ��� sno tLroc` atetl at 12.4 Main Street y Fiore Department s g ature/date y ,:rte. y. :- : 5• •. ,, .� � ,�.�.�• 41 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ F OF SEWER-AGE DISPOSAL Sewer ❑ Tanning/MassageBody Art ❑ Swin ingpools ❑ 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 ,/1®6 COMMENTS /I 11L'1fv?q kj `C? I CONSERVATION Reviewed on A-VD, I to Signature COMMENTS v�,-� w- "�lo���� �,, V" HEALTH Reviewed on Signature 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`DEP�4RtTMENT Terr p?Dumpster on site . ;yes11 �tMV 5 ? a 4 r x fr xc dl $�4o1noD . �a Locatetlratx12.4 M3�ain Street:r" —11 ;. " t ti k� Fy, w LLX �u ,m slt;� * c n 'nr'G° 1� r� � aL tr4� Fire De artment}signature/date44-i4'14 , ,F ` �,.�1$ 'h*' ,.d�'��+s;.:, .iLF ... ;w i i h t p, X�. �"'1 to- x n r CUIVIII/IEIVI S° tf vw y � � fe }:�Y 4 • s •C . w,,• Y `f* ;z ka �nw cbydn ayYtSz tiCi t? rrsro "$ 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) f I I ® Notified foricku Call Email P P Date Time Contact Name Doc.Building Permit Revised 2014 Building Department artment 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 _ OT,E: 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 ;rF 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 OTE: 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 1 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 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 i tliat 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 i Doc:Building Permit Revised 2014 I� r 1 mil��6mwl RT1.1 _ : WL .c . : ve:r No. oh , ver, Mass, LTd COCNICNIWICN y1. 'll.9s RArED U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ...w5C0.7rVilfAV !..4.402F �,� ............................................... BUILDING INSPECTOR ........ jY,1&1#4.&.qVZr ... Foundation has permission to erect .......................... buildings on ... .5.... ....�_.r!k..... Rough to be occupied as ... .s�� ..QOWSV*... �i M. ............................................................ 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 UNLESS CONST TION Rough Service .. .. .. ..... . .. .. ..... Final BUILDING IN EC OR 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. 1 IJV1�1'IJ1Lli 1 VVL vVl�llAl\ 1 ,N 511 Na o Park 738 North Main Street 139 Lunenburg Street 33 West Boylston Street Summer Market PI e Y11 Rte.IOTA g g Fitchburg,MA 01420 W Boylston,8351 886 58 Chelmsford,250 A 0 24 P`�3 g NH 1 (978)63 5144 01720 x(978)537-72234 (978)342-7362 (508) ,,,�-� � PHONE: 611, �7`C 1 TO: t./11 t l Uj � lwu 3S `�� _ ORDER TAKEN BY: TAKEN 16 NA tX AMOUNT DESCRIPTION ... POOL SIZE/MODEL a f LINER FILTER PUMP/MOTOR 'Raw � SKIMMER L VACUUM LADDER " U4t� MEDIA TEST KIT CHEMICALS LIE WINTER COVER .2 SOLAR COVER 62 �J PCU INSTALLATION '��` �` "`' �`� 3 Cq � 00 MACHINE TIME .tt �1 TOTALMATERI)kLS:$ ����� dV P6 4+- a 16 TOTAL LABOR:$ TAX: $ SO 1(� / TOTAL: 3 13 (nooF' About.. cVOuel 10% S 1 r6 TOWN OF NORTH ANDOVER OFFICE OF f" 2� BUILDING ILLDING DE AR]L 1`G E T a X 1600 Osgood Street,Building 20, Suite 2035 North Andover,Massachusetts 01845 Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE:.( JOB LOCATION: 3 s ' eef mowl- - Nurnber Street Address Map/Lot HOMEOWNER ID Name Home Phone Work Phone PRESENT MAILING ADDRESS ' 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,provided 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 l I0.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/she understands the Town of North Andover Building Department minimum inspection procedures and requirements 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 The Commonwealth of Massachusetts zF Department of Industrial Accidents d I Congress Street,Suite 100 Boston,MA.02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE]FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Iudividual): Address: 2:: City/State/Zip: o4 4� s-Phone Are you an employer?Check the appropriate box: Type of project(required): I.F1 lam a employer with employees(full and/or part-time).* 7. Q New construction 2. I am a sole proprietor or partnership and have no employees working for me in 8. [J Remodeling any capacity.[No workers'comp.insurance required.] 3_ 9. ❑Demolition I am a homeowner doing all work myself.[No workers'comp..nisuranee required.]t 10�Building addition e er and will be hiring contractors to conduct all work on my property. I will Ansure am a hom own g that all contractors either have workers'compensation insurance or are sole 11.[�Electrical repairs or.additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.msurance.1 6.Q We are a corporation and its of�cers have exercised their right of exemption per MGL c. 14.F1 Other e o C 152,§1(4),and we have no,employees.[No workers'comp.insurance required.] 7. *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. Homeowners who suhrivftbis affidavit indicating they are 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 state whether or not those entities have employees. Ifthe sub-c6n6c'tors have employees,they must provide their workers'comp.policy number.' lam an employer that is piovidi ig workers'compensation insurance for my employees'Below is the poliey acid job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: 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 required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct Signature s1/moi — `� Date• — ;j Phone# 6¢f—Fz— S Of leial 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#: Inf®x°mation 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 ofhire, 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 commonyealth 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-contractor(s)name(s),address(es)and-phone number(s)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 not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. lie advised that this affidavit may be submitted to the Department of-Ifidustrial 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 in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"fob 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Departments address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MA.SSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia i N M IO F 86.54' /D 'Mm�mu SeibQG� I � I 184.0 /-SF co _ PARCE S` A 2 y, lGk3z �ObL H PRv eo 0. Poo Q /d i 0 I 0 � o / o — �" - - — — — 1.8 W i U)) 1.5 STORY; Q (' 3 2' #35 5.0 DRIVEWAY 90.05 °' 485:05 BELMONT STREET I CERTIFY-THAT,THIS PLAN WAS MADE FROM CERTIFIED P LOT P'LA ' s AN INSTRUMENT SURVEY ON'THE GROUND AND.THE STRUCTURES ARE LOCATED AS LO CAT ED IN ._- SHOWN HEREON,AND DOES NOT LIE IN - ZONE(ZONE X)PANEL#250098- 0 NORTH ANDOVER- MA,Sr 0003CO3C,,JUNE 2, 1993 .. REFERENCES: PREPARED FOR: JOAN M DUGAN DEED:.BOOK 50WPAGE 275 35BELMON Twi.STREET a PLANS:PL#033 #9098,#373 . NORTH ANDOVER-,MA;_ SCALE: 1 INCH 20 FEET DATEil MAY12,2003": ;" ' pNj" Of 4(� GEORGE ' { C ' COLI-INS BOSTON 784 A9 ., SURVEY;IC.sslopr ' '9 Qf 6`.k. - UNIT C-4SHIPWAYSPLACE - c?` � jr} •S CHARLESTOWN,MA 02129 } y. g � " (617)242-1313 JOB#03-00236