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Home My WebLink AboutBuilding Permit #184-11 - 41 MOUNT VERNON STREET 9/1/2010 1 BUILDING PERMIT NORTH O�tt6ID /dT �O TOWN OF N TH ANDOVER �� -,. ,° o APPLICAI OR PLAN EXAMINATION ' ..y Permit N0: Date Received 4q •y7' 'trap 41 ® \ Date Issued: r (� ACHUS IMPORTANT A phcant must complete all items on this page $ 1(�� i _ T'a10A'i'�.14 st�� t2 ;" ai�J;'# 4 '� ,A�'�*� RE fYKM } �� 1r y"Y'' '�-`, •N -�'"'�w'�3 r4.rC'�`�'4'�,x,�,�,�Y- � w �.w� 1 a,� 'f a.a _ H .f�` -�`it� �s�-.e :�*:: ar:,�.'�-�;,.tL'k,..�,,,;f'r ,T 1 va'...� F`•.r°.�'g. ''.S.r' �t 3 . 7 50 PONT.;� • xy s ,'u �5'-,`arAy`s € . x��;lt ,x ��7� y y� �n 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 �l� �,��"z's�asM.�r . � s�r '�u v a '�r`�"{�_.z,... ° u `% �s �� a r•,. ;%.moi'� w a wr- `Yci- �*Y.w_ ��`"- er ;l s-rr4* �aaW ` {�"' .' a ��la ,�, 'x tae ` j a� r14� " ..,._..... ,`_ h .r..,..r''z rr?.A..,. DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone• 270 ';? b 8818 Address: �°+ x r.� .: �"F ��; --as- 01 a �'�> .� 'qa� '# � -� .r•i Hca x�Fr rt i � _ �� ;.'gin.- _._ "Gk3>��s '�rm .* i � r+k"k �+�' •"U ��-'�, Pr,• 6'F^ vi�Y�:'��.til`i' /� �j`a..i,�+e-T ;.- .�� ,. C��d -. 3%r��Y�•''3-2�-��''�•*�.� xt'fi7Y HIM ,. He ,_..x.rr Y....._.•n ...-.>xuf.. :�- ,..�.. fiFa.—.,.>._.. .I^i.... .1.G».... .�.'K1 L�_a� 1 �'.{J upv"� tY 4as't'.`.P f > .tµy .�" 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: $ r �' '— — FEE: $ Check No.: t Receipt No.: � NOTE: Persons contracting with unregistered ntractors do not have access to the guaranty.fund Saturn of X�tgent0aruner Sfgn°aturejfcon` ractor 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 I INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING DEVELOPMENT COMMENTS CONSERVATION Reviewed on---0 3l'7 Siqhature�"/—'-- 0 I n � COMMENT 5 _ , l + HEALTH Reviewed on � Si nature � COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments i Conservation Decision: Comments Water $ Sewer Connection/S4nature& Date Driveway Permit DPW Town Engineer: Signature: Located 384"Os ood Street .: Loca#edt ��llairafreet t t 3 s �� iearret � r�ara�e m _ �t `-r- '� L t M NTC 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 i DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department epartment use i ❑ Notified for pickup - Date Doc.Building Permit Revised 2010 i i Building Department l The following is a list of the required forms to be filled out for the appropriate permit to be obtained. i Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application I ❑ 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 f ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler I P p kler 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 i 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 S Doc.Building Permit Revised 2008 f Location l F(�,f No. Date �f MORTIy , TOWN OF NORTH ANDOVER O.t1`.O '••ti0 A � > ; . Certificate of Occupancy $ Buildin /Frame Permit"Fee $ s�cMuse 9 "�— Foundation Permit Fee $ Other Permit Fee $ TOTAL $ F Check # 2331' Building Inspector F NpRTH , TONM ® 1 overf o dower, Mass., !2 COC KIC EWIC K 7�S f?ATED pP�`,�� BOARD OF HEALTH Food/Kitchen P-E R M IT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......!!.K.4..1.. . 1-.........................1..` !��1... /1�.................................................................... Foundation has permission to erect.........:.....•......................... buildings on ..I`'�T......0.4..CA-(.LT..... ...................... Rough to be occupied as.... — �1/�1 .. . .�....... .........4.. ....e.(R ...... 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 30 . PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTiI �T ELECTRICAL INSPECTOR Rough ................................... ..................... Service .. ... BUILDING 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 S 1 D E Smoke Det. NORTH ® Andover .ONM No. LAKE 41- - -oW dower, Mass., to COCHIC EWICK �t C ORATED �l BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......!!..A..1..4. . r 1-......... .......1..` !��1... /.1�. .................................................................... Foundation has permission to erect..................:...................... buildings on ..(.q.T.......�m...C(i4.4LT...... Rough to be occupied.as....... .�1�''� .. Y�.......al.N...... .. .............. .... �'�... .. ... °r®............. +- c Chimney provided that the person accepting this permit shall in every respect conform to tNe 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 30 - PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC ART Rough ..._ Service BUILDING 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. OARS 0 li L HVER/ 9T G y / \NC So, e-tJT • T. Fora. �N St.. 53.78' =IIt-47 �xtsT. Fvt�i. 5.3 171.22 O 1.9 Y fz or RL.4--oV 3 u I!,o I b DWI.'ro T r,VE'=DT't_:, n tacorEa a c/ TyEcaT.�s s��+-•v.gvo r.�iToaes cavFa�,,! y,V �7E1••O,PO/.tom,' SETdIC.!'S fz'GGM S STZErT f!pT tiv s �11c 'r Fvc7we'r czmwy X vw1r.MAf F p.T . _ lr vaT �•, +L'rl-� Q int 4W ,.tZ t`-A Z444r,W/W rvE FEQEt.RG ftGioo AWZACp .4.PFi4. Ple-410 =ale ,SyawAe 0,V fe�.w-t �'a.�...��..��ry P,4.v« 250098 a7r5 C-DA-rLD 1 u N$2, 199 3 PJa a-m E-tT t � 4 A Z�, 3 d� a/ fit/, V/ Lv HOFMANN t Hf:2QIr�G'Z ��.Ya11Jt;Y 2t Ufa '�EQ1/ILc"S iG. 'b9 iK36381 '�3o SUaV P R o_Pp`,E b E 5 a L C A IL T" see c-Ltd L A-g bm � '�� 9 k� past i W'GOl"Y C,YGt� i fovti r,�s ,StfJ�RW�9 1 P � jw d 2.- 2.k �b'S tl LK t C, i IX-1 _ Z � ca1xZ t, Tl i i <7I-)( -� F NORTH TOWN OF NORTH ANDOVER 0 �t4eo sE'S1• OFFICE OF 00 BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 North Andover., Massachusetts 01845 Sac►+us� Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978) 688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please print DATE: ( 1 L) JOB LOCATION: y' 0+j C�, Vf (,v Number Street Address Map/Lot HOMEOWNER UR I C .11tfu;MeV) 9-70° X55 �5(6 Name Home Phone Work Phone PRESENT MAILING ADDRESS I '� 4I� City Tovm Sta-te 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 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 The Commonwealth of Massachusetts Department o f.tndustrial Accidents Office OfLnvestia atuin e S ..600 W _ asha baton Street Bostorz, MA 0 111 N'N'►+'-m4ssgovidia Workers' Compensation Ins urance Affidavit: guildersontractors/Electricians/PIu An licant Information /Ctubers Please Print Legibly Name (Business/Organiza6on/Individual): r�a 1 ,' �i Address: - +j �d City/State/Zip: N. -vv� • Phone#: -'c'- ,� �v� Are you an employer?Check the appropriate boa: 1.❑ I am a employer with 4. ❑ I am a 7DRemodeling ect(required): =eneral contractor and I 2.❑ employees(full and/or part-time). have hired onstruction I am a sole proprietor or partner_ listed on the sub-contractors the attached sheet I ship and have no employees Thesesul�- working for me in any capacity. workers' ccontractors have . Demolition INC)workers' °mP•insurance. corninsurance 5. P• 9. ❑ We are a corporation and its ❑Building addition required) officers have exercised their 10•❑Electrical 3. I am a homeowner doing all work right of ex repairsor additions myself. [No workers' comp. c. 152 'exemption per MGL 11.❑Plumbing repairs or additions insurance required.] t '§1(4),and we have no q employees. [No workers' 12•❑Roof repairs comp.insurance required.) I13 0 Other `•=-ay ap it taut that checks box:�i Must 'Homeowners s so iYu out f^.c se-on ceiaa• ^.`+ ' ers wao summit&is affidavit indicating thea'a=de g aL'wc;b and —=- a•�� cow^ r 'Contractors that cbWk this box must a � outside coat_cte s i;.submit x new at3rdavif indicating such. ttachcd an additional sheet showing.the t name of the sub-contractors and their workers' I am an employer that is providing workers'compensation insurance or m e comp.Dory information. information, f y employees' Below is the policy and job site Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: Attach a copy of the workers' compensation policy declaration pa_ (showing City/State/Zip• Failure to secure c the policy number,and an coverage as required under Section 25A of MGL c. 152 can lead to the. d expo afion date). fine up to$1,500.00 and/or one-year imprisonment as well as civil imposition of criminal penalties of a Of up to $250.00 a day against the violator. Bea penalties in the form of a STOP WORK dvrsed that a co ORDER and a fine Investigations of the DIA for insurance coverage verification. Py of this ��ent may be forwarded to the Office of Ido hereby cerci �under a and penalties o er .fP .%ury dirzt the information provided above is true and correct Sisnature: -- Date Phone#. Official use only. Do not write in thi area, to be completed by cit),or town off�curl City or Town: P ermitUcense# Issuing Authority(circle one): I: Board of Health 2. Building,Department 3. City/Town Clerk 4. Electrical Inspector 5.PIumbinR 6. Other a Inspector Contact Person: Phone#. Information ant d Instructions Massachusetts General Laws chapter 152 requires all employs 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,associattion,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including t3ae legal representatives of a deceased employer, or the recti ver or trustee of an individual,partnership, association ox-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 mainte3aance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not be cause 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 c anstruct buildings in the commonwealth for any applicant who has not produced acceptable evidence of co3mpfimce 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 un:7til acceptable evidence of compliance with the insurawe requirements of this chapter have beta 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' comp emation in�ce. 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 stare to sign and date the affidavit The affidavit should be.mturned to the city or town ih.—,the a plica 6 for the pP t or Ece:nse LS beingrequested,not the.Deparrament.of Industrial Accidents. Should you have any questions regardin=._+fit�v;or u you are;��i;ired to obtain a workers' compensation policy,please call the Department at the number=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 p=nit/licrnse 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 cmT=t policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stampe=d or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future penarits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or pemiit 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 hke 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.,fammumber _ T'he Commonwmltbz of Massachusetts Department of lrtdustrial Accidents Office of Inrestig, 600 Washing-ton Streit Barton,MA 0.2111 Tel. # 617-72.7-4900 =4.06 or 1-8 77-1VLA3SAFE Fax � 617-72.7-7 749 Revised 51-26-05 vrvm,.I7mass._aov/dla.