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Home My WebLink AboutBuilding Permit #768 - 394 BOSTON STREET 6/24/2008BUILDING PERMIT o`tt, o "tio TOWN OF NORTH ANDOVER o? APPLICATION FOl[RPLrA-N`XAMINATION * _ Permit NO: 76Z DaLaReceived �SSgru6�/ Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION - Z. >t gin,., S+• A-1, a N --' -- Pant PROPERTY OWNER fayre G, l frocc t, p L Print ID MAP NO: 107b PARCEL: ZONING DISTRICT: -� Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE siden is Non- Residential in ne family_ Addition✓' Tv�i ore family Industrial No. of units: Commercial Repair, replacement Assessory Bldg Others: olition Other -Septic Well Floodplain Wetlands Watershed District r/Sewer DESCRIPTION OF WORK TO BE PREFORMED: - wee -v*% 610JA1 ( SutiNJ" Identification Please Type or Print Clearly) OWNER: Name: T ycr f ro ccl,,' Phone: 97 ft !o r-3 F 7f'-/ 1-1-10 Address: S y'f e° 3T°', s7Wt f , N• 1Ahc,(J u { " c _ CONTRACTOR Name: Phone: Address: Supervisor's Construction License: 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: $ 1:K1 FEE: $ ZI6?— Check No.: 16 1 f Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund signature of Agent/Owner Signature of contractor' w� 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS 0 CONSERVATION Reviewed o COMMENTS HEALTH. COMMENTS Reviewed on Signature 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 FIRE DEPARTMENT - Temp Dumpster on site yes no. Located at 124 Main Street Fire Department signature/date COMMENTS Street Location (,&iv \!:: No. Date ? r •/ NORTh TOWN OF NORTH ANDOVER •OOAL Certificate of Occupancy $ �ss•►cMusE< Building/Frame Permit Fee $— Foundation Permit Fee $ r Other Permit Fee $ TOTAL $ Check #_ 2 1 273 4Building Inspector 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 ❑ 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 o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products E: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Li Building Permit Application - o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses io Copy Of Contract Li Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o 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 li New Construction (Single and Two Family) ❑ Building Permit Application o Certified Proposed Plot Plan Li Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report Li Engineering Affidavits for Engineered products NO II : 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 thaw, the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording mu. be submitted with the building application Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 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 Applicatiom Li 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 2.2008 TOWN & COUNTRY CPNSTRUCTION P.O BOX 1516 BIDDEFORD, ME 04005 (207) 284-4681 Joyce & Paul Perocchi 394 Boston Street North Andover, MA 01845 5-13-08 Build Sun Room Build Per Plan *Roof Shingles to Match House *Clapboard Siding *Anderson Casement Windows *Hardwood Flooring * 1 Coat Primer - 2 Coats Paint * 1/2inch Dry Wall *Interior Casing to Match House *Footing with 4 foot Frost Wall *2/6 Walls with Insulation Materials - $12,450.00 Excavation - $35000.00 Foundation - $29000.00 Plumbing & Heating - $3,000.00 T&C Labor - $10,000.00 Flooring Allowance - $2,000.00 TOTAL - $399000.00 ! `.60a The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street ;`llr Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): �Iyce / f r0 cc . Address: Jf'Y S4, City/State/Zip: A— A 0 c.&y .0i- Phone #: 7 8 to £'3 q7 F Are you an employer? Check the appropriate box: 1. ❑ 1 am a employer with 4. ❑ 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. I 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 3.2"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. E]-i3"uilding addition 4-4#%eJ3-, 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box # 1 must also fill out the section below showing their workers' cdmpensation 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 their workers' comp. policy information. 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. #: 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 of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # —l7—coq` Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone Gerald A. Brown Inspector of Buildings Please print TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 North Andover, Massachusetts 01845 HOMEOWNER LICENSE EXEMPTION Telephone (978) 688-9545 Fax (978) 688-9542 DATE: 0 S. JOB LOCA'T'ION: .3 y'y'� �, ��-► S� ti . �y c% vimI , A'yc. u Number Street Address Map/Lot HOMEOWNER pro nc-4, f -I f 6 s 3 - i--7--y-- Home Phone work Phone PRESENT MAILING ADDRESS -7'7-;71 XO S7s w S,4 -'r jf - /V. al4djvo, A$1 CA. Ol g - %Y . 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, rules and regulations - The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building Departnu nt minimum inspection procedums and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE, APPROVAL OF BUILDING OFFICIAL izav ied 10.2005 Form Homeowners Exemption BOARD OF \PPE:ILS 699-9541 CONSERN'.MON 683-9530 TTE.1L111 08-95.30 PLANNING 6?8-9535 PgT7Z7RS �/qN 00 PROPOSED 1 STORY 54.88' C ADDITION h s� 4.95j ^� a 4802 STORY "o. 1 0394 1 �q 44.30' c 4 0 C6 c2 }LOT 4Lu c' (n z AREA=68,144 S.F. _ Q =1.56 AC. N Q M � Lt.. Z ��ts Z O J Q \ z O N O V 3 dog v W ~ � Z O (T► O ZZ v� c 0 r_ riot �zz F ��j► � 6' v92, PLAN OF LAND IN "I HEREBY CERTIFY THAT THE BUILDING IS LOCATED ON THE LOT AS SHOWN. NORTH ANDOVER, MASSACHUSETTS DRAWN FOR JOYCE PEROCCHI 394 BOSTON STREET NORTH ANDOVER, MASSACHUSETTS SCALE: 1"=50' DATE: JUNE 11, 2008 ASSESSORS TOWN MAP #107D TOWN LOT #4 0 25 50 100 150 6/11/08 MERRIMACK ENGINEERING SERVICES _ 66 PARK STREET DATE ANDOVER MASSACHUSETTS 01810