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Home My WebLink AboutBuilding Permit #072-2017 - 35 MILTON STREET 7/22/2016 4604U' 131.111-DING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: bla, Date Received SS� Date Issued: 2 CH Applicant must complete all items on this page LOCATION- 3,9 /rl 1') 1-0 n. S 4- A10(M Ai(Le f In A c4kk5 ,print PROPERTY OWNER ekt,oi-ze ,r Ac 00, Print MAP NO: PARCEL: ZONING DISTRICT: —Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential 0 New Building KDne family [I Addition D Two or more family 11 Industrial —kAlteration No. of units: 11 Commercial El Repair, replacement El Assessory Bldg El Others: _E1 Demolition 0 Other 0 Septic 0 Well 13 Floodplain El Wetlands El Watershed District 0 Water/Sewer 12o -env C4A,0,i I LL c&/C 0 1(k r 1'/?4 -C. ►�1 e_ Pcxl, I A Cr /e4lnt Identification Please Type or Print Clearly) OWNER: Name: A d rei-j- c //Please Phone: Address: 2s 41.1 5+ �Joc* d Q LJ 4 /04 CONTRACTOR Name: Phone: L. Address' I Supervisor's Construction License: J U Y V 11[,U U"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.; $ co FEE' $ Check No.: AAIA Receipt No.: 22(%c-�K NOTE: Persons contra ting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signatureofcontractor � � v.� z 4� Y .� r�..,�.r ,� 4 Vii- �.� of NORTy 9 BUILDING PERMIT ��LED q. TOWN OF NORTH ANDOVER o� APPLICATION FOR PLAN EXAMINATION �o . A x y Permit No#: Date Received °RATED fa"' c`• �SSACHUS�'C Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition El Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement- ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other p a -`T {�'Flood:Ia n= �Wetlands 's ® 1/llater ed ®istrict = `• , ® Se fis 0 We I ,®11Vaterl'""`ewe;��.' � �,' F r.� •_ ��. y A , DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: 4 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$92.00 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 f►�AaPntlO `" Sianature�of�c®ntr�ctor� ' 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4- Building Permit Application Certified Surveyed Plot Plan 46 Workers Comp Affidavit 4, 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 1�1i OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) 1 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 2012 IECC Energy code Engineering Affidavits for Engineered products t Bldg. Permit OTE. All dumpster permits require sign off from Fire Department prior to Issuance of g i In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals l that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording i must be submitted with the building application Doe:Building Permit Revised 2014 F Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL t. Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming pools ❑' Well ❑ Tobacco Sales ❑ Food Packaging/Sales 1 ❑ 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_ COMMENT'S CONSERVATION Reviewed on Signature COMMENTS . HEALTH Reviewed on_ Signature COMMENTS 4 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�DEFARfTMENT - ®umpster o is v '"' Terr iter�xYeS � L��o a`ted a n. �i+r3 .t no Wit_ 4 t 12.4 Mai Street , r Fire Dpgepartment signature/da 3 y � t ,1d�l.. .t.y�y .J'!• N.,..:+.r�....tr..r.�Yw..-..r..�.a-+..-+_,..�„ ��y5 _ ZL?ZjT��"� t -yl � ;�.,Y� `5�.��s�T��r'PI��S�✓s�.Y�`�'si Y^i^'��MGSrq .�y+... Fay�+ � `l •COM ME IV TSS,:. if I s1; f 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.$10o-$1000 fine NOTES and DATA— (For department use) i I 44 I ❑ Notified for pickup Call Email Date Time Contact Name = Doc.Building Permit Revised 2014 Location � No. (N—)—) 2 — �C,.?E� Datel-2-z lit, . - TOWN OF NORTH ANDOVER 4", • Certificate of Occupancy $ ' Building/Frame Permit Fee $12 U x Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check 30648 Building inspector V Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 60,000.00 m $ - $ 720.00 Plumbing Fee $ 90.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 90.00 Total fees collected $ 1,000.00 35 Milton Street 072-2017 on 7/22/2016 Kitchen Remodel , Front Porch , replace Decking NORT1l own of 2 ? E ndover O y 0 (DIZ - 26ij ver Mass 4;t60 . 9 cocNic«ew�cr y1. �ds RATED HP��S U BOARD OF HEALTH Food/Kitchen PER LD Septic System ... �. .... BUILDING INSPECTOR THIS CERTIFIES THAT . ................ ............................ has permission to erect ................. buildings on .... ;.�,,,&................... Foundation . �..��it. ... .. .. 4r Rough to be occupied as .... .................... Chimney provided that the person accepting this permit shall in every respect co orm 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 MONTH§ ELECTRICAL INSPECTOR UNLESS CONS N Rough Service .. ...... ... ..... Final UILDING INSP TOR ' r 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. o NORTH TOWN OF NORTH ANDOVER ? ,,, . •`1 OFFICE OF 0 BUILDING DEPARTMENT 1600 Osgood Street Ruild-ing 20,Suite 2-36 o+4ren��` �* North Andover,Massachusetts 01845 c►+us�4 Gerald A.Brown Telephone(978)=688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER UCENSE_EXEW_T10N:- Please print DATE: 7 ZZ Za 6 joa_LoCA nom- 3 r *45 Num er Street Address Map/Lot HOMEOWNER A tkeuj k 4r Name Home Phone Work Phone PRESEN-TIMAE,ING ADDRESS- Z S Ill(1ln� S /1/hAn of ��nI�-�S City Town StateZip o�d T The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less R 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-Section-109.15.1-)- 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 structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsiTilrty for compliances with the State Building Code and0th47 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 an at he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 i 3 � t ON 3Ile 0 3 -- r° t 3 4 F g P � s 19, 91! The-Commonwealthof MawachuseMv- DiWii tmeent-af Industriateeiden S------ 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. T6 B"lLED-VdI`f-T13E-PER1bHTT1NG AlUTHORM. Auplicaret�aformation Pleasel�riieE=L�bh� Name(Business/Organization/Individual): A Address: �n/1, City/State/Zip: 4 AndoverAA, n i ge#: Are you an employer?Check the appropriate box: -TyVe.of-project 1.❑I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $.MRemodeling any capacity.[No workers'comp.insurance required.] 9. IEDemolition 3.FJ I am a homeowner doing all work myself.[No workers'comp.insurance required]t 10❑Building addition 4.,1-aat-a-homeownefand wi be- hhingsorrtractomtoconduct-all-wodcon-my-propergc-l"wi11=- ensure that allcontractorseither have-workers'compensation-insurance or are sole 11.Q Electrical repairs or additions pr°prietors with no employees. 12.E]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.insumnce.t 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other j 152,§1(4),and we have no employees.[No workers'comp.insurance required.] . *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information t'fkmneowners-who-rrbmk Ms-affidavit-indicating-they-are-doingall-workand-thenhire-eutsid conkastars-tnrisGsubinita-new-aff"rdaviFinndkdiiig-ssctf 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. If the sub-contractors have employees,they must provide their workers'comp.policy number. �I I am an employer that is providing ivorkers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Dame:_ 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 coverageas 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$25Q.00 ', day against the viol"ato-r.A copy of this statement-may be forwarded-to the Office of Investigations oftke DIA-for insurances., coverage verification. I do hereby certify undertl ains and penalties of perjury that the information provided above is true and correct Si ature: Date: 7— Z 2 Z-c ` E' Phone#• � �� 72` ��'Z-- Official use only. Do not write in this area,to be completed by city or town offrciaL City or Town: Permit/License# Issuing Authority(circle one): -C Other Contact Person: Phone#: c � f. ,perCz✓lre ((JrYr7a?7z��uu�.aCCf a��/��aQ�a�u�eCYQ- . -\ Ofi ce of Consumer Affairs c Bu:;ress Regulation y - — OME IMPROVEMENT CONTRAC. OR t.egistration: ;l25gc , r.a: :xpiratior: 17_; !ndniduai JAS%BWNCHIN&,�i) JASON BIANCHINO� _ ��' v 209 LINCOLN ST#3 (` /y� �rf REVERE, MA 02151 —'•— r l:ndersecretaiy .0 I'I