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Home My WebLink AboutBuilding Permit #016-14 - 415 MASSACHUSETTS AVENUE 7/3/2013 _ TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ` < Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION - a_ '� Prints rr-- L PROPERTY OWNER��5�°UV1 Tc - r y __ Print f `wb'year;. Sfr'ucture — yess no . MAP'NO: -� Machihe_,Shop Village yes ARGEL: ZONING DISTRICT: Historic District- yes. no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition El Two or more family El Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ DemolitionEl Other _ El Septics ❑tlNelli El Floodplaini o Wetlands. ❑ WatershedlDistrict 0 Water/Sewer; DESCRIPTION OF WORK TO BE PERFORMED: V�5+r.\1 ,ne-� -c �\-?\n a—� Identification ,,((Pse�sa Type or Print Clearly) OWNER: Name: � S,P�� YR`C IC Phone: �� 7/ { Address: l�v -�'� A N�o V-e r � �5 � �c � t CONS jRACTOR' Name: Phone. Address•: - - Supervlsor's,Construcflon License;. Expo, Date . - _ - - r LNome,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: $ F. FEE: $ Check No.: '�� 4 V/0 Receipt No.: cP J 0 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature:'of Agent/Owner`; :Sig �,aturefof contractor _ W Plans Submitted ❑ Plans aived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Building Department artment The fol;wving is'a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits u Building Permit Application u Workers Comp Affidavit u Photo Copy Of H.I.C. And/Or C.S.L. Licenses u Copy of Contract u Floor Plan Or Proposed Interior Work u Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks u Building Permit Application u Certified Surveyed Plot Plan u Workers Comp Affidavit u Photo Copy of H.I.C. And C.S.L. Licenses Li Copy Of Contract u Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Li Mass check Energy Compliance Report (if Applicable) Li 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) u Building Permit Application u Certified Proposed Plot Plan u Photo of H.I.C. And C.S.L. Licenses u Workers Comp Affidavit u Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) u Copy of Contract u Mass check Energy Compliance Report Li 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 app-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Building Permit Revised 2012 1 I ' I 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 4 1 1 COMMENTS 1 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Si nature c Date Driveway Permit DPW Tow;! Engineer: Signature: Located 384 Osgood Street FIRE DEPARfM,ENT - Temp Dumpster on site yes no ---] Located at 124 Mair Street Fire ®epartmert signatureldate P COMMENTS." Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions.__ Total land area, sq. ft.: 4 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 I NOTES and DATA — (For department use) I I I I I I I U Notified for pickup - Date � I ----------------- ( I ' Doc,Building Permit Revised 2010 i I i �j Location No. Date - 3 • - TOWN OF NORTH ANDOVER • O-E Certificate of Occupancy $ Building/Frame Permit Fee _ Foundation Permit Fee $ saOther Permit Fee $ TOTAL $ Che ck/# Q U 26585 Building Inspector Enter construction cost for fee cal - North Andover Fee Caku/ation Construction Cost $ - $ 180.00 Plumbing Fee $ 22.50 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 22.50 Total fees collected $ 325.00 Foundation 100 415 Massachusetts Ave. 016-14 on 7/3/2013 Remodel Kitchen and Bath ill i a4 TL TH TO"OF NORT F[ANDovFR ° OFFICE OF BUILDING DEPAPTMENT • ��i.^",� '1600 Osgood Street$ wilding 20,-Suite 236 S9Cuu North Andovex s� ,Massachusetts 01845 yds" 4"� Gerald A.Brown Inspector of Buildings Telephone - 88-9545 HOMEOWI\MR'LICENSE BXEIVIpTION Fax (978)688-9542 BUIDINO PFRIVI T APPLICATION Please mint DATE: ' JOB LOCATION: Number Street Address -- ' . Map/Lot 1SOMEOWNER 5� C.k5 Q - ( - 0171 c Name. Home Phone Work phone PRESENT MAILING ADDRESS C'3i�i Tn�m �v�V �� Q •y� Zip Code The current exemption for"homeowners"was extended to inchide owner-occupied dwellings to i�vo units or less and to allow such homeo�,.ners to engage an �dividual.for hire Who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OFHOMEOWNER PerSOn(s)who Awns a parcel of land on which he/she resides or intends to reside,on which there is,oris intended to be,a one or two family structures. A person who constructs more that one home in a which there Orio-d shall not e considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code .Applicable codes,by-laws,rules andregulations, � and other The undersigned"homeownez"certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requir ants 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 688-9531 IIS The Commonwealth of Massachusetts Department of IndustriqlAccidihts Office of Investigations to 600 Washington Street Boston,MA 02111 www.mass gov/ilia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers _Applicant Information /_ Alt Please Print LegibName(Business/Organization/Individual): G (/1 i Address: z�-14 55 A_QrCP. r City/State/Zip:_ 0/f/. A;tAf ff Phone#: -7 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time)." have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. �• El Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.El Electrical repairs or additions required.] officers have exercised their 3.XI am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roofrepairs insurance required.]t employees.[No workers' comp.insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they ate 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. I am an employer that is providing workerscompensation insurance for my employees. Below is thepolicy anal 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 requiredunder 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 u er Aepains and pen alfies ofperjury that the information provided a ve is true and correct. - Si k C Date: 7/�/3 Phone#: ( CS, 7 Official use only. Do not write in this area,to he 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.PIumbing Inspector 6.Other - - - Contact Person: Phone#: Information and ffnstructions 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-contractors)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 maybe 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 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 Departmerifhas provided a space at the boftom 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 write"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 bum 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 CQmMonwealth ofMassachusett$ Department of lndu$trial Accidents Office of Iavestigatlona 600 Washington Street Boston,MA 0.2111 Tel,#617-727-4900 ext 406 or 1-877,MASS.A,FE Revised 5-26-05 FaY,4 617-727-7749 _ ww�v.rxtass,govlcl�a. pORTH Town of tAndover h ," ver, Mass, O LAKE .I. COC MICNl WICK V A�OATED ►PP,`�(5 S V BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT ,�.� ... BUILDING INSPECTOR ... Foundation has permission to erect .......................... buildings on ........q1.T ....� ..... ...w.......... Rough to be occupied as ........N.�...J.....14L. ....�..... .� .... ................. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6AM� TTLeHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIkRough Service ............... ...................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. SEE REVERSE SIDE 7/3/13 IKEA Home Manner kitchen remodel Final - Plan View 0000-4704-0098 2201 n 83 M 33 103 518 � _- 11 12 L13 Ki �' 1f1 CO O CO O � � s (0 ZZ CD r ko CO a ZZ O 14 17 Q1 W 7' sS 47 1 140 133/4 1 66 314 I f it 314 183 314 I 140 I 801 Q I I All measurement in inches kitchenplanner.ikea.com/US/UI/PagesNPUI.htm 6/13 7/3/13 IKEA Home Planner kitchen remodel Final - North Wall 0000-4704-0098 357/823 718 20 f8 213/1 22 718 171 /1 6 70 314 u er9 611 6 (0 3 ZZ C C - CO 367M6 24314 1 21 2915/16 1 207/8 11U 24518 1 51315/16 367/16 24314 1 193/8 1 33 103518 All measurement in inches kitchenplanner.ikea.com/US/UI/Pages/VPUI.htm 5/13 7/3/13 IKEA Home Planner kitchen remodel Final - West/South Wall 0000-4704-0098 1915116 1 2915M6 1 2915116 1715116Ci 213116 2613/16 12 Ird )11 ti r� 14 T �I M CO I.I m N ED 7 $ LO Ln 0 1715/16 2913116 RI 2915116 1715M 6 1 35 All measurement in inches I kitchenplanner.ikea.com/USfUI/PagesNPUI.htm 3/13