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Home My WebLink AboutBuilding Permit #841-11 - 354 MAIN STREET 6/10/2011s. TOWN OF NORTH ANDOVER LICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: i I D —,I l IIUPORTANT: Applicant must complete all items on this pane LOCATION TO k C4 Print MAP NO: �! .3 PARCEL: a ZONING DISTRICT: Historic District yes Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition Poo o ❑ Two or more family ❑ Industrial El Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: El Demolition ❑ Other OTSep he ,(]Wel '®►Floodpla'in�andsi E _ (]: Watershed District [] Water`/Sever � • - DESCRIPTION OF WORK Tn RF FFRFn'P?%A- n- rn ske, 1 l eve- u ra.. � a- Pool OWNER: Name: 1-16) Address:35-y Mc,,rh 5�- CONTRACTOR Name Address: Type or Print Clearly) �o S e-- CL Phone: Supervisor's Construction License: Home Improvement License: ARCHITECT/ENGINEER Exp. Date: Exp. Date: Phone: Address: Reg. N FEE SCHEDULE. BULDING PERMIT. $92.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ .P'da� o FEE: $ c Check No.: 1 Receipt No.: NOTE: Persons contracting Wth 6 unregistered contractors do not have access to the guaranty fund ,y FE s - Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan's ' Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL `j Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools— ; 1 : - ❑ k Well ❑ Tobacco Sales ❑ � ^ d Food Packaging/SalesEl Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMEN' CONSERVATION Reviewed on I Signature I CMHEALTH Reviewed on Siqnature COMMENTS - Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes �a Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124,Main Sfreet`- Fire Department -signature"Idate COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. it.: 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.$10041000 fine NUTES and DATA — (1 -or department use ® Notified for pickup - Date Doc:.Building Permit Revised 2008mi 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 a 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: Doc.Building Permit Revised 2008mi Location 9G�� No. 4w —//— Date Check # r: 24440 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building Inspector W W Cd ' 1w1 c' O� oz o a O w A Cd wa°' O w cn x O W a W I , w�' cn w a�' w W a w� cn Q cn o 'O C.3 L) ; O o m � Cq a0 CE 0 CL m � cn :gym O 1 c� �� o c m C 10�� y TZV vV i _ m4.4 CM p� ym� U? a �.L mom m P-4 :�•cjyZ c U ev c .:. c a o c Q.. coh-m c o = m H v1 m r � m L W • C �.='pct .. Go CL A C Z V OC.2 Go cm •v CD C+* o' o o '_v C CD So a� 0 E O �+ V O O Z a O CO) 0 C C CM cn 0 '� M E m m 0 co CD O.D Oca O L cc o a a- Cm Q ca C O cc Cc �O. O CD c Z CD V y O C C •— C cc CO2 The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): _J C1h k, 1n� Ad&ess:- City/State/Zip:#r An �p,) -e.c- Phone #: 1 7� )�__—%O y l Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I ployees (full and/or part-time).* have hired the sub -contractors am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. �1 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. F1 Plumbing repairs or additions 12.❑ Roof repairs 13BOther )�O-'. *Any applicant that checks box 41 must also fill out the section below showing their workers' compensation policy information. T Homeovrners 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 their workers' comp. policy information. lam 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. Lie. Job Site Address: Expiration Date: 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 ofthis statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certa(u�d4he pains andpenaldes ofperjury that the information provided above is true and correct. 20 (-1 use only. Do not writein this area, to be completed by city or town official City or Town: Permit/License # L i Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town CIerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone io't POO' ?- f IW A 411 ---fe4 ) W. bOUGIOUKAS Olt O°O� 'po MORTGAGE NSPECTOq PLAN LOCATED W o iR -r H A 0 r2ole MASSACHUSETTS I" OF DFORD ENGINEERING CO. 4 JAMES W. PO. BOX 1244 SWGIOUKASav«rhilf,Moss 018j, RLS j* cru 1 ISZ71 1 (3 TEL. ass ta.s MA -1 1905 SCALE 14-01 o%pTH TOWN OF NORTH ANDOVER 6``I °0 OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2=36 Dq'T1D pP �y - North Andover, Massachusetts 01845 Gerald A. Brown Telephone (978) 688-9545 Inspector of Buildings Fax (978) 688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please print DATE: JOB LOCATION: Number Street Address Map/Lot IJOMEOWNE o t4e� Name Home Phone Work Phone PRESENT MAILING ADDRESS 3 S �/ J�l'jg , -N4 A, .4 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 Qwns 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, rules and regulations. 11 The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements a that h /s will comply with,said procedures and requirements.. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535