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HomeMy WebLinkAboutBuilding Permit #702 - 36 LINDEN AVENUE 4/3/2012BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 0 Date Received ORTF�\ rro*0• f A tec.iwwewrtw , �' TYPE OF IMPROVEMENT ❑ New Building ❑ Addition ❑ Alteration "epair, replacement 0 Demolition PROPOSED USE Residential One family 0 Two or more family. No. of units: ❑ Assessory Bldg ❑ Other Non- Residential ❑ Industrial D Commercial ❑ Others: DESCRIPTION OF WORK TO BE PREFORMED: ) Gpc�& nJUC -s 21!�LLS Identification Please Type or Print Clearly) OWNER: Name. -Z-6 A-�7 C� - i�'1 ( ^) Phone:LA*aYK-4 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: $ 1© 000 FEE: $ Check No.: Receipt No.: NOTE: Persons contracting 4th u)registereld contractors do not have access to the guaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body 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 HEALTH COMMENTS R X 0 DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED ❑■ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Driveway Permit Located at 384 Osgood Street 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 Doc.Building Permit Revised 2007 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 DEPARTMENT:BPFORM07 Revised 2.2007 Location '26No. -7 -7 dZ Date Check # 25152 TOWN OF NORTH ANDOVER Certificate of Occupancy , $ Building/Frame Permit Fee $`� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 14 Building Inspector M Gerald A. Brown Inspector of Buildings TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 North Andover, Massachusetts 01845 Telephone (978) 688-9545 Fax (978) 688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please print DATE:LqL C� JOB LOCATION: I30MEOWNER Name PRESENT MAILING ADDRESS City Town Street Address Map/Lot Home Phone Ctwte . 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, rules and regulations. 11 The undersigned "homeowner" certifies minimum inspection procedures and req requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption the Town of North Andover Building Department e will comply with said procedures and BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Gf x The Commonwealth of Massachusetts Department of Industrial,Accidents Office of Investigations 600 Washington Street Boston, MA 0211.1 UF www.mass:govIdia Workers' Compensation Insuranee Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Tndividual): Address: City/State/Zip: b ����� Plaone 9_ — Are you an employer? Check the appropriate box: 1-1-111a am employer with 4. F]I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees 'These sub-contractoxs have working for me in any capacity. workers' comp. insurance. o orkers' comp. insurance 5. El We are a corporation and its quired.] ;1am. officers have exercised their 3. 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 I L[] Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *'Any applicant that checks box 41 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 anew 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. 1 -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 SeIf-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 ofup 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 insy6ance coverage verification. I do Hereby Phone #: and'penaldes ofperjury that the information provided above is true and'correct. Of 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 $ealth 2. Building Department 3. City/Town Clerk 4. EIectricaI Inspector 5. PIumbing Inspector 6. Other ContactPerson: Phone #: at.?— • O CQG v O w cntz Cal v cn U z W O w O -C U � C w" w a �'' O rz C w w W O c�; y cn G iw pWZ H a O w ro C w w G w cn o V) a p • � o as c c � o � c ` O N O �vV Q, c ev � o o : N � Ea c �t v Ec c u as m c o.:= E m m a 0 : m 3 y.. N cm C m O i :_ co N O0 N CD m o : CLU _N cmc m r � C :boa N m O O Ci H O j Z O `° O ..- ; CL Of c Q 0 = m F- CLO NoF- m m COD CcL •NCt H WE WL- c 0�CJ� Z CD Vi a = W ` N 70S CM 0 CL a p