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Home My WebLink AboutBuilding Permit #212 - 41 KINGSTON STREET 9/18/2009 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 7 v Date Received 2 6 < Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION C; �grazy–1 ilf ("L—"o Print PROPERTY OWNER ...-'„ Print MAP NO/6 5V PARCEL: &J ZONING DISTRICT: Historic District ye :no\�Machine Shop Village y TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration f No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed'District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: E CG Identification Ple se Type or Print Clearly) OWNER: Name: D rc /-,�icA Phone: �'��o�� Address: CONTRACTOR Name: Phone: Address: j i Supervisor's Construction License: Exp. Date: 'i Home Improvement License: Exp. Date: 1 i ARCHITECT/ENGINEER Phone: I 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: $ �oaa FEE: $ , 0- Check No.: Receipt No.: NOTE: Persons contr with unregistered contractors do not have access to the g aranty fund gnature of Agent/Owner Signature of contractor I __ _ Plans Submitted Plans Waive/ Certified Plot Plan Stamped Plans I TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales i 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 �� SignatureVJ U-- 11 J � COMMENTS 'L d,' W I HEALTH Reviewed on Si natu COMMENTS SYS 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: cy. 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.s100-s1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date i 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 PP 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 2008 A G --^^ i �SUO Ga/. -Sep U O O S La � qc s � w;,pew+»w+.n.rwu.wrmr.P'i�wM.:.Mw.+aM.w��wrr«..arnwwewirwwMm�aaYMamcw4'�++w.w+wu:.. u:„,rn»-...w�.w.rs...g4ssm..v....s»,.....-rrws�...»muw,mw.»raa.mvwrerv»r. »f l NORTH Town of s 4 L Andover O - , No. Z / Z w... _= A K E dover, Mass., COCMICMEWICK 0RA7E0 PPp\ �C �`S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System p BUILDING INSPECTOR THIS CERTIFIES THAT . .. ......... .. .................................................................... Foundation has permission to erect........................................ buildings on ... y .. .x....:64: .. , r............................ Rough to be occupied as............................................ ... -.... Chimney provided that the person accepting this permit shall 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 PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough ..................... ..' Service Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove F nagh No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. 33 r �S (4) t v 6S PEr�quo r/nTES. 2 X73 O 41710I to // 7NIS PL AN WAS PREPARED FOR �' �''✓ O ' �� PRESENTATION TO THF,NORTH AA N BOARD OF APPEALS TO OBTAIN A VARIANCE TO THE ZONING BY- LAA 2) VERTICAL DATUM IS BASED ON A/ ASSUMED ELEVATION OF /00.00 _ lO6 �r1 3) THIS PL AN BEING A SUED/VISION 6 8 r10 --� �. LOTS 9-A - 1 a 9 ro - 10 �� 5 47e 407 E t,112 ,. /08 510,9 16 o3 PlIS41C IV '7,9-- 261- 38" •'fid w.,'�+ Z W1'""'7 I E _.�' �`"` ... , 114 Gc. O n� 30'10 8 _ Opp � \0 116 ti 45) Me/ V' I - r � \ rfc i I rol sxs �4` 41 x 36 LING�; _ j ' / Qo „ r EM N� .+, ✓o �pWEL , ! ' !� pA� SUBDI VISION ,00 , E �N! �ET� PLAN OF AND 116- - ... 5� TONG U o 5IN X02 PRl�A1' UM,N 12- �. �C --� NIA SURVEY' INC .,+4IV& L /,3/ P, RI S T. N REAL?I'�'�' /�'AS. SCALE.' / " _ 40, DA T.E. FEB. 2, /988 / CERTi FY T/-IAT THIS PLAN HAS EEEN PRL-PARED /N r'�APH%iC SCAL E ACCORDANCRULE -5 WITH THE RULS .41VD /REGULATIONS `` p• ` � ` r ` O 4CC ` OF THE REGISTERS OF*DEEDS OF T/IE- «t - COMMONWEALTH Or MASS. '.-_.- 6C /I Information a nd In-§tructions Massachusetts General Laws.chapter I S2 requires all amp 3 oyars to provide workers' compensation for their employees. Pursuant to this statute,an m ployee is defined as"..:every person in the service of another under any contract of hire, express or implied,oral or writbm" An enpplayer is defined as"an individual partnership,amc:%6intion,corporation or other iegal entity,or any two or m on ofthe'formping engaged in a joint enterprise,and includii"g the legal representafives of a docessed employer,6r1he receiver ortimstrw-of an individual,partnership,associatiazn or other legal entity,employing employees. •Roweverthe owner•of a dwelling house having not more than thret apartments and who resides therein,or the occupant of du dwelling house of another who employs persons to do maintenance,construction orrepay work on such dwellinghouse or on the grounds or building appurtenant th=tn shall not b-.. use of such employment be deemed to be an employer." MGL chapter 152,g25C(6)also states that"every state o.;-local Geensin,agency slinE withhold the issaeanceor renewal of a ric ew or permit to operate a baseness or *o construct buildings in the commonwealth for any applicant who has not produced acceptable evidenm ok coaaprsance with thein umuce'covemge,required." Addid a lly, MOL chapter 152, §25C(7)states"Mcither t is commonwealth nor any of its political subdivisions shall enter into any contract for the per of public wane unt -accaptaiile avid„-nce of compliance with the insurance requirernwds.of this diapter have bean pre=ftd to the cmTit acting authority." Applicnuts Please,fill out the workers'compensation.affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply subrcontrmlor(s)name;(addrzss(es):arid phone numbers)along with their certificaie(s)of insurance. Limited'Liability Companies(LLC)or Limited Liability Pwtnmsliips(LLP)with no employees otherthan the members or partners,are notrequbmllto canyworkds'cc>Tnpensmion insa au= Ifan LLC or-LLP does have empioyees,a policy is required. Be advised that this afi4at*h may be submitted to The Depsriment of Industrial Acciderris for confirmation of insurance coverage. Also lbe sure to sign and date the affidavit The zffidavit should bur returned to the city or town that the application far the paimit or license is being requested,notthe Department of Industrial Accidents. Should you have any questions regua-clang the law or if you are required to obtain a workers` camper ban policy,picaercarl the Department at the-nurwiber.listad bolow, Self-insured companies should entertheir Sett-iFrSraFncc1icanse number on file z3ppro�t nate lire. City or Town Officials Please be sure tient the affidavit is complete and printed legibly. The Department hes provided a space at the boimm of the affidavit for you to fill out in tiro event the.Office of Investigations has to can=you regarding the applicant. Please be sum to fill in the permit/license number which W-ill be user!as a reference number. In addition,an applicant that must submit multiple permit/licm=applications in any given year,need only submit one affidavit indicating-current policy information(if necessary)and under"Job Site Address"th:applicant should write"all i=ations in (city or town). A copy ofthe affidavit that has bezn,officially stumped or marked the or town m be provided to the by city s QY appii=it as proof that a valid affidavit is on n"ie for futom permits or licenses. A new affidavit must be iced out each year. Where a home avvrier or citizen is obtaining a license or permit not reiatmd to any business or commercial venture (i.c. a dog license or permit to bum leaves ate.)said porson is NOT'.re paired to•eompietc this aftrdaviL The WE=of Investigations would filen to thank you in advance for your cooperation and should you have any questions, please do not,hesitate to give us a call. Tim Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of lm ustrW Accidents Qffice ofIr Envestiv " 600'Washington Strict Basion, ISA 02111 TeL f 617-7274900 i. t 406 or 1-g.77-MASSAFE Fax n 61 7-727-7741 Revisals-26-QS www.masq gav{dis nP C;omRwnweakk of Mmachusefis ' tt Department of Industrial Accidents ��e o esttd Ij� 'Q.f afions . 600 Nfrrshircgion Street Boston, MA 02111 Workers' Compeatioasiuranee r»assgrru/din , A 'cant Wormation. idavi builders/Contractors0eatriciatos/Pintmbers Please Print Leeibf aMe. (Business/Drganj=fioMndividuW): ( C�. r.__C Address: � , 46, elaz CityLState/ ; • FF1'j emPloyerl Qmk.the appropriate box: empioyer with 4. ❑ I am a Type of ProJi (r a'general contractor and I eq �' yees(fun and/or parttm1e).* have hared tltc sub- 6. ❑Now constructionSC .proPnetor ar P me- iistnd on the attached sheet 3 7• [�Rernodeiiag nd have no employees . 'I'h :forme in S -cO �haveg 8 Q Demolition orers coin �'��n' wor�c� comp.insurance.p rastnance 5• � We awe a cotporafion and tts9• ❑Btulding addition ej�un-�] o friC� have exercised their 10.0�e^hicalhomeowner doing all work right impairs or additions of exemption per MOL I I.[]Plumb rnyt:el£[No•w.orl�rs'comp. .e, t52, §I(4j,'and•wc have no m$npairsoraddifions insurance.required.].t ..omployr-mL(info work=' I2•(]Roof Mpairs �P. insurance uired M.M.pm7 ticar,t fel ��a � l cErecks t��f mune also ttl out the section below mho 1 F;omeownen;who submit this uMzb vh inn' �B tharcvarken;'isotbpees .Potny;nfommt;oa _ �Cantratwnrs that check ►Ming Choy are&Ding an waste end then hoe Dorsi fhta box rmur t}e can naetan okr d an adct.�f;onal sheet aw,rng.the imma dr6m sub. mast auimttt a new Affidavit iadiaetiag such,' I arst an enloyer tita7 csornurottttg►no��' GOD`s and finis woridrs' on mf0mladam mpenvioe.: Below tr ffic r Pavy orad jai.cite . Insttancc Company Name: Poficy#or Self-in& Lie. #: - Job Site A�ddross. Expiration Date: Attach a copy of the workers'�com CitylState �' pensalaon policy decF$rg�Q Page(showing the pones,number and e fine u e m se=*e-coverage as required under Section 25A of . xpis�fion date] . fine uP to$1,5DO.t)0 and/or one-year imprisonm MOL c. 152 can lead to the ititposition of criminal penalties of a of up to$250.00 a e�as wen as civrl penalties in the form of a Mp WORK 0Rpena turd a fine �3 the violator. Be advised that a copy of this st�cnent may be forwarded to the Office of Investigations of the DIA for insurance coverage verin"�on: I w hereby c under the pains and penalties afPerJWy tlfiat the utfnrmation m —� P viafed above is bue and correct Si burr . Phone#: Official use only. Do not write ia.this area,lb be contplet'dafty or town ofjtew( C-tty or Tows: IssuingAatbotify(circle one): Permit/Limmse 1. Board of Beattb Z %ilditrg Department 3.Cityy/Towvn Clerk 4. Eiectrical Inspector $. Plumbic ins 6.Other inspector b Contact Person: .. . Phone#: NORTH TOWN OF NORTH ANDOVER OFFICE OF A BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 pA ttp�4P �S North Andover,Massachusetts 01845 9SSACHU5�4 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:--/ <--5 0,2-nyy Number Street Address Map/Lot HOMEOWNER 'I)69U e / Gos �3 _ ' Name "Horie Phone Work Phone PRESENT MAILING ADDRESS- caCar 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 Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNAT A C��eSI APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Foran Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 s `r Location 1_ 4, 'j No. Dated AORT#q TOWN OF NORTH ANDOVER _ _ O F ~ Certificate of Occupancy $ Building/Frame Permit Fee $ �— :s ACMUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # r � • 2241. 4 -�- Building Inspector