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HomeMy WebLinkAboutBuilding Permit #630 - 350 BERRY STREET 4/28/2008BUILDING PERMIT TOWN OF NORTH ANDOVER /� APPLICATION FOR PLAN EXAMINATION (0 Permit NO: 30 Date Received Date Issued: IMPORTANT: Applicant must complete all items on this naee LOCATION ,Ver, A, 4- MAP NO: C— PARCEL: 00/b NING DISTRICT: Historic District yes to Machine Shop Villaae ves r nol TYPE OF IMPROVEMENT PROPOSED USE Residen ' Non- Residential New Building ne family Addition woor more family Industrial Alter No. of units: Commercial epair, ep ac Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: K�y''� ✓2 Q ' �s rcD 0 ` Gt S r� f _(`�i r''tR.�tA A n A y-�f� L4 (-q— Art Pda q.ArtPda l Ce F &If A f &C SAS day 7�r aev r go -yl "Ile ckeJ AI OWNER: Name: Address: 35-0 6 CONTRACTOR Name: Address: rel CJK rt`J-q �W' - Please Type or Print Clearly) RM f 4— © /ger S Supervisor's Construction License: Exp. Date: Home Improvement License: _ Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ Q 0, d 6 FEE: $ Check No.: Jll� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner T Signature of contractor 117 Locatlon,�5 N o. Date ila TOWN OF NORTH ANDOVER Certificate of Occupancy $ Permit "7d Building/Frame Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # /7-5 2 1 1 1 2 Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL PLANNING & DEVELOPMENT Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private (septic tank, etc. Permanent Dumpster on Site HEALTH Reviewed on THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature COMMENTS r 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 Dumpster on sit yes no Located at 124 Main Street ` Fire Department signature/date IAA 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 [M. 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 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: INSPECTIONAL SERVICES DEPARTMENTMFORM07 Revised 2.2008 rb cd x CO cn u A4 z z L� ro '0 x v C U w p a aC' w x � ?� w ►a 'Cao nC' u w a a ono u. r �i41. c4 z cn e cn D J z m s r CI ® - c ' H mm ,- o�m �3 CA p ' J H O N 1 m ® y m r � :• O Q N p,ct 0 0� 'm�Z c oti CL 0 Q H m C = O m r O d CO3 r A t r m LU W G A r cc r 1-..y dt A c O r O . cc •� CWS m p m : C N_ Q m� O� = cyv 0 y•O H t *0CL- E C43 to zoo (a C 7S CD CD L� C! c m 0 c) c N m IS IS O Z O O z O U CD O Qi • v CD z a O y � C W cm I O LA O O •r= CID CO �3 cc .0 O � i O d CL CMa 4-0 c C'ca0 C CD C CL V CA O C c— cc CO)CL W II� v/ W N 19 W LUW W CA QV W Z I Ncl, Q- z m s r CI ® - c ' H mm ,- o�m �3 CA p ' J H O N 1 m ® y m r � :• O Q N p,ct 0 0� 'm�Z c oti CL 0 Q H m C = O m r O d CO3 r A t r m LU W G A r cc r 1-..y dt A c O r O . cc •� CWS m p m : C N_ Q m� O� = cyv 0 y•O H t *0CL- E C43 to zoo (a C 7S CD CD L� C! c m 0 c) c N m IS IS O Z O O z O U CD O Qi • v CD z a O y � C W cm I O LA O O •r= CID CO �3 cc .0 O � i O d CL CMa 4-0 c C'ca0 C CD C CL V CA O C c— cc CO)CL W II� v/ W N 19 W LUW W CA The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street vW` Boston, MA 02111 www.mass.gov/dia ' Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ` Please Print Legibly Name (Business/Organization/Individual):--S:7c o-4- W rtta h t- Address:_3$Tj R City/State/Zip: 1IS6, C V&1-n1A Otm- Phone.#: 9;7Y-2Yy'1-fy'7 Areyou an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part e).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have w king forme in any capacity. o workers' comp. insurance required.] 3.0 I am a homeowner doing all work myself [No workers' comp. insurance required.] t employees and have workers' comp. insurance.$ 5. ❑ 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 reguired.l Type of project (required):, 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13. [1 Other RC2 roof' "`Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors 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 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. #:' 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 $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 I do hereby certify uAder the painA and penalties MUM use only. Do not write in this area, to City or Town: Issuing Authority (circle one): 1. Board of Health 2. Building Department 3 61., Other that the information provided above is true and correct. Date. I-IldY/08 or town officiaL Permit/License # City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector Contact. Person: Phone #: 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 Pleaw wWt DATE: a 8 D g JOB LOCATION: 3 S -D g aE �l D , �� Ax Number 9firet tAAddress 1vlap✓l of HOMEOWNER In��1� �l Name Phone Work Phone PRESENT MAILING ADDRESS .� 12e -(!at • a -r yh A+ o�sys- City Town State zip Code The convent 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 $action 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 morc that one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for c omplianom with the 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 BuildingM minimum inspection procedures and requirements and that helshe willcomQly with dpr�c�ures and reglriremerns. /?If HOMEOWNERS n APPROVAL OF BUILDING OFFICIAL :, xavind 10.2005 Form Homwwnma F-vmvtion BOARD OF \PPE:ILS 698-9541 CU.\SERN".VrIO\ 638-953x1 IIEAL111698-9540 PLANNING 698-9535