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HomeMy WebLinkAboutBuilding Permit #426 - 41 BEAR HILL ROAD 1/16/2009 BUILDING PERMIT poRr" q ttti'�� ib TOWN OF NORTH ANDOVER c - ~' 00 , APPLICATION FOR PLAN EXAMINATION 76 Permit NO: Date Received �SS/1CH�1`�E� Date Issued: IM ORTANT:Applicant must complete all items on thispage LOCATION nt - PROPERTYOWNER L t.U41 -�Xl n# ytP, �� Print MAP NO: "`Y, PARCEL: ZONINGDISTRICT. Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition 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 DESCRIPTION OF WORK TO BE PREFORMED: r Identification Please T e or Print Clearly) OWNER: Name: r_ri'C. one-S Phone: 4103 ' 9 q T b Address: CONTRACTOR Name: Phone: Address: 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: $ 1t/ aFEE: $ Check No.: Receipt No.: NOTE: Persons contractinw'h unregistered contractors do not have access to the guaranty fund Signature of AgentlOwner Signature of contractor Location No. /�� Date TOWN OF NORTH ANDOVER ` slow Certificate of Occupancy $ • i , , sA�NUSEt� Building/Frame Permit Fee $ Foundation Permit Fee $ , Other Hermit Fee $ .� TOTAL $ Check # Building Inspector 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 CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS 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 site yes no Located at 124 Main Street Fire Department signature/date 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 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 Pernut 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 Li 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 2.2008 NORTH Town of O 1 I '� to . n'Y No. 14 VOL LAKE OL dover, Mass., COCMICKEWICK RATE D BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.............��.c ................................... Foundation has permission to erect. bui Ings on....... I...... r......%l c.......ItA�...... Rough .... to be occupied as.......... wT.:....... . . . . ... .... . . . Chimney provided that the perso accepting this permit sha 1 in every respect conform to the terms of the application on file in Final this office, and to the-provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final N?? PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU TS Rough Service 7nBUILDIN INSPECTOR Final Occupancy Permit Required. to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. ' Materials Summary Job:Jones Updated: 29-Sep Qty Unit Cost 2/6 x 6/6 Hollow core door-RH 1 unit $104.00 310 x 6/6 Hollow core door-LH 1 unit $110.50 3/0 x 6/6 Hollow core door-RH 1 unit $110.50 - - 6/0 x 6/6 Solid Core-Double Door 1 unit $425.10 Total Invoice $750.10 2 x 4 x 8 KD Pine $346.58 2 x 4 x 16 KD Pine $89.44 2x4x16PT $86.11 1/2 sheetrock $327.52 Insulation $129.74 Vapor barrier $101.32 Nails,Screws $130.00 Joint compound,tape $130.00 Total Invoice $1,340.72 Total Materials $2,090.82 Frame 16 hours Rock 16 hours Hang Ceiling 32 hours Labor 64 hours $5,888.00 fA Total Quote $8,028.82 t( The above quotation does not include the following items-Mr.Handyman will be glad to provide the services and an additonal_ CCVJJ quote to perform these services once identified further. Addition of electrical recepticals or lighting Flooring Painting Ceiling materials/grid and tiles The Commonwealth of Massachusetts t Department of Industrial Accidents I i Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Iaformation C,, � Please Print Le�bly Name (Business/Organization/Individual): 1 (n(_ �./o Address: 4) 81, CAQ_ HILL &4D City/StatelZip; I�tO�4 �� ©� 4NOOd-4- �'9945 Are you an employer?Check the appropriate box: 1.7 I am a employer with 4. ❑ 1 am a general contractor and I Tye of project(required): employees(full and/or part-time).* have hired the sub-contractors 6 ❑New construction 2.❑ I am a sole proprietor or partner- listed on th.e attached sheet ? Remodeling. ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. workers' comp.insurance. [No workers' comp. insurance 5. ❑ We area corporation and its 9• ❑ Building addition required.] officers have exercised-their 10:❑ Electrical repairs or additions 3. I am a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions myself. [No workers'comp. c. 152, §1(4),and we have no insurance required.] t employees. [No_workers' 12.[] Roof repairs COMP- insurance required_] 13•❑ Other "Any applicant that checks box#I.must also fill out the section below showing their worke 'compensation policy information, + rs r iomevwners wlro submii.titis atirdavit htdicatitt;rite-arc dei:g ir`wr-,and ti en'riry outside eontraeioes muni submit a new am`uavit lConutactors that check this box must attached an additional sheet showing the name ofthe sub-contractors and their workers'corn oli y info mato c . p.p cY information. I am an employer that is providing workerscompensation insurance for n9i 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 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 for insurance coverage verification. 1 do hereby certify under the pai )�4 penalties ofperjury that the information provided above is true and correct Signature: Date: Phone#: Official 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 health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#• Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall.not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit-to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or.partners,are not required to carry workers'compensation insurance. If an_LLC or LLP does have_ employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the narnber.listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should writs"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA x2111 Tel. # 617-7274900 ext 406 or 1-8.77-MASSAFE Revised 5-26=05 Fax 4 617-727-7744 v^wu .mass.govidia f M0RT1f TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT f _+ 1600 Osgood Street Building 20, Suite 2-36 �►.;°�,.,• 'tc' North Andover,Massachusetts 01845 ss�cNuse Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please mint DATE: ,Q�v�2 15t Zop JOB LOCATION: 4gaL loll W Number Street Address MaplLot HOMEOWNER- t g�`�69 �603�23 -3303 Name Home Phone Work Phone PRESENT MAI m ADDRESS 41 S ai- 01u- It 648 1 o�� apo�ti� MA 005 City Tawe State Zip Code The current exemption for"home'owners"was extended to include owner-omWied 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 constricts 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 Department minimum inspection procedures and requirements and that will comply with said procedures and requirements. 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