HomeMy WebLinkAboutBuilding Permit #463 - 350 ANDOVER STREET 2/27/2009BUILDING PERMIT
=- TOWN OF NORTH ANDOVER o�
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
��q.\7ED PPS .�5
�SSACHl1`��(
Date Issued: `8
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I ORTANT: Applicant must complete all items on this page
LOCATION 3`5T-0 v(kc) J -e r
PROPERTY OWNER 1 Print
Print
MAP NO: ZI PARCEL ZONING DISTRICT: Historic District ye
Machine Shop Village ye n
TYPE OF IMPROVEMENT
PROPOSED USE
Resi ential
Non- Residential
New Building
One family
ddition
Two or more family
Industrial
,.-,Alteration
No. of units:
Commercial
Repair, replacement
Assessory Bldg
Others:
Demolition
Other
Septic Well
Floodplain Wetlands
Watershed District
Water/Sewer
V rcpkace 5 hfet/x(f
d�entpifi!catig\Pl se Type or Print Clearly)
OWNER: Name:?TC Phone:
Address:
CONTRACTOR 'Name: Phone:
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone:
P. TSV,-.
joLn
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: $ �� FEE: $ 26
Check No.: o z 3 Receipt No.:
NOTE: Persons contracting wit nagister ion�i a�tors do not have access to the guaranty fund
/
Location S
No. i` Date ,v-z7d
HQRTry
TOWN OF NORTH ANDOVER
F 9
+ i
Certificate of Occupancy
$
t�
Building/Frame Permit Fee
$�`
CM
y
Foundation Permit Fee
$ .
Other Permit Fee
$"
TOTAL
$
Check # 12tf
2184.8
Building Inspector
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer
Tanning/MassageBody 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
COMMENTS
CONSERVATION
COMMENTS
DATE REJECTED DATE APPROVED
Reviewed on Signature
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
FIRE DEPARTMENT - Temp Dumpster on site
Located at 124 Main Street
Fire Department signature/date
COMMENTS.
Locatea 364 US ooa Street
yes -no
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
/v lex r a�
❑ Notified for pickup - Date
Doc.Building Permit Revised 2008
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/Crossection/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 Application
Revised 2.2008
NJ
MORTGAGE INSPECTION PLAN
A N'P o v E7 "F1', S -T -RS S'f
"-S r -AJ%'S SA$f r IV$ 4 !APE SUR`/EY %'NOT AN INSTRUMENT SL+R E1 Ul`'S TO Ftt ' "f ^ 142M W-WT;.AGE PURPOSES ONLY.
TV EREFOPC, THE OFFSETS AS SHOWN SHOULD NOT BE USED TO ESTABLISH PROPERTYU+FS
; 5SEX COUNTY
DEED REFERENCE: PLAN REFERENCE:
PL NO. 50 5,9
BK. 33 5(,o PG. / 04 PL.BK PL.
CERT. NO. BK. PG.
I hereby certify that the existing structures are located approximately as shown and
were not in violation of the zoning by laws at the time of construction, or are exempt
from violation enforcement action under, Chapter 40A Section 7 of the Mass.
General Laws. The structures are located in Zone-Caccording to the following
F.E.M.A. map. Note: Zone C represents areas of minimal flooding.
FLOOD HAZARD COMMUNITY NO 2-5022"B
BOUNDARY MAP NO. 000(oc- EFFECTIV 23JN9
9-7-98
DATE
PLAN OF LAND
IN
Noa.-t�-1 AtaS��v t
PREPARED FOR: .
f'gOPt-£5 Mom± Qs:
?M' L ?/ �AyrL11: PN-?PA5 — P f,�--
SCALE I IN.=SO FEET
BAILLIE & COMPANY
LAND SURVEYING & RESEARCH
33 HOWARD STREET
READING, MA. 01867
PHONE: (781) 944-2767
FAX: (781) 944-6112
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s The Commonwealth of Alassaehusetts
Department o
P
�/,�� f Industrial r4ccirients.
;~ .L Office of Investigations
` 600 Washington Street
Boston, MA 02111
Workers' Compensation Insurance.A�t Builders/Contract
oLcant Information ors/Eler-tridians/Plumhers
Name (Business/Organization/individual):
City/State/Zip:
Are you an employer? Check the appropriate box:
1. ❑ I am a employer with 4. ❑ I am a general c
employees (full and/or part-time).*
2. ❑ 1 am a sole proprietor or partner-
ship and have no employees
working for me in any capacity.
[No workers' comp. insurance
required.]
3 I am a homeowner doing all work
myself. [No workers' comp.
insurance required.] t
ontractor and I
have hired the sub -contractors
listed on the attached sheet I
The sub -contractors have
workers' comp. insurance.
❑ 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 re uir d
Type of project (required):
6•. ❑ New construction
7• ❑ Remodeiing .
8• ❑ Demolition
9. ❑ Building addition
10:0 Electrical repairs or additions
31.❑ Plumbing repairs or additions
110 Roof repairs
q e ] 13•7 Other
*Any appiizant.that checks box # I .must also fill out the section below showing their workers' compensation pobc} mmmration.
t Homeowners who submit -this aitdavii indicating tiiej' are duiie� irl cv;:
IConuactors that chec4; this box must attached an additional sheet showi 'u -n hire Outside contractors must submit n new ae`ndavit irdiwrh
reg the Name of the s tb cGrtlaetom and their workers' co S such.
m0. D011Cv lnmrmof:....
t am an employer that is providing workers' compensation insu
information rance for m3' employees.
Insurance Company Name:
Policy # or Self -.ins. Lic. #:
Below is the poficy and,job site
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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to 51,500.00 and/or one-year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA -if coverage verification.
I do hereb�, cert,
the information provided above is true and correct
Official use only. Do nor write in this area, to be completed by city or town ociaL
City or Town:
Permitli,icense #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Tow n
6. Other Clerk 4. Electrical Inspector 5. Plumbing Inspector
Contact Person:
Phone #
pORTM
TOWN OF NORTH ANDOVER
�''r ,•` OOL
OFFICE OF
p
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
lease pfipt
DATE:
JOB LOCATION: -t>5 Avtkve1r- Z
-7 6
Number Street Address Map/Lot
HOMEOWNER Pte Y(- 61-1 - CI2 I -2--790
Name Home Phone Work Phone
PRESENT MAMING 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 Section 108.3.5.1)
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 responsibility for compliances with the State Building Code and other
Applicable codes, by-laws, riles and regulations.
The undersigned "homeowner" certifies that he/sh rstands the Town of North Andover Building Department
minimum
inspection procedures and requ' and t she mP$' saidFrocedures and
requirements.
HOMEOWNERS SIGNATURE
APPROVAL, OF BUILDING OFFICIAL.
Revind 10.2005
Form Howwwom Ea mR*on
BOARD OF \PPF:\L S 6RP)541 CONSERV_MON 689-9530 HE\LAII (M-95.10 PL.LVNING 6kg X1535