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HomeMy WebLinkAboutBuilding Permit #041-16 - 43 BRIGHTWOOD AVENUE 7/8/2016 k��� `` NORTt� 1`� I BUILDING PERMIT Qc�TLED 161 6 6 TOWN OF NORTH ANDOVER i,�' hy;: • APPLICATION FOR PLAN EXAMINATION Received � � „TED •c Permit No#.• Date �SSgCH►1`��� Date Issued: I ORTANT:Applicantmust complete all items on this page LOCATION 43 Print PROPERTY OWNER Z&t//( /10 5Z Print 100 Year Structure mL no MAP 0(4,(tv _PARCEL: ZONING DISTRICT:_ 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 p Septic 0 Well ❑ Floodplain Wetlantls '1Nal:ershed Distract 1.1-11 O Water/Sewer_, - - DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: .6 vel AZl-44UP=,YAL Phone: e1 7 9-- Address:' -`-� Contractor Name: Phone: Email ---- Address: Supervisor's Construction License: Exp. Date: Home Improvement License. �— Exp. Date:-- ARCH ITECT/ENG I NEER ate:ARCHITECT/ENGINEER S'. L.� Phone: Address: 5 A-Lxf 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: $ FEE: $ Check No.. l0 Receipt No.: NOTE: r`ons contYactang with unregisteYed contYactors do not have access to the guar my fund z ,- i Location No. �2 C� Date w . - TOWN OF NORTH ANDOVER . �D46` . Certificate of Occupancy $ Building/Frame Permit Fee s, Foundation Permit Fee N ` Other Permit Fee $ F TOTAL $ Check#Z, ' Building Inspector Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped !Tans ❑ 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on1Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes f anning Board Decision: Comments Conservation Decision: Comments Wafter& Sewer Connection/signature ®ate Driveway Permit DPW Town Engineer: Signature:, z Located 384 Osgood Street t;L•rocateci at12;4)VIin�St� 'F rme�'�Depattttment��gr�at%rE�/date `' .`�. '{.. - . COMMENTS • i 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 lies No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) 6e— Ll Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 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 OTE: 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/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) 4. Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products OTE: 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 ;rF Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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:Building Permit Revised 2014 NORTH Town of t E ndover 0 '� M No. _! b ,� oh ver, Mass, cocNUNewrcw y1• A044TED I.p�`�.�5 S tl BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT BUILDING INSPECTOR � aQ�,j�_1 Foundation ................. buildings on �� �-,1f�ii 11 �SJJ �t��'' has permission to erect ......... ..... . ...... /.+......v . ....a. ..�................... .�. ...YCA.01 4 .. Rough to be occupied as 4 Chimney ..... .. ..... .............................................. provided that the person accepting is 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR r3� UNLESS CONSTRUCTI STTS Rough 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. TOW OF-NORM AND O Y M OFFICE OF ' y�naRbc .�i•6y :'1600 Osgood StxeetBuffdjug20,-Si&f,-236 7 �R3Ttp�4j [5 • •NbithAudovex Massach-amtt.-0I$45 fu Gerald A.Brown � - r—-- � Teleplione(979)689-9:5.45 Ins.pector-ofBuildings Fax (97-8)688-9542 ` M OWNER-LICENSE=A/h?TION ' - � r PRAT A-PPLICATION �leaseprint DATE: BOE LOCAT. DN.- �f3 ' • .�e JG- WT a ©-b ,4v"g-- Number StreetAddressilap/Lot . ' IX02VEOWNER DA-(..,Ib l(IA45-6u . Dame. �J.ome l'l�.oneJ . Workl?hone -P E,SENT HANG ADDIMS . .. dip Cods The current exemption for aomeo)vners"teas exte-aced to i.ojude owiler~ocotipied dwa iugg to two unifs or;�s5 a�?d a cts as ss as Busuoh�?Dmeoz+uerS t4 engage an�civid-,xal•for hire-mho does notposses8 a license,pxovidod that the owner apervisor). gfateD ilding (CodeSectiou DEFMII'ION OFROMEO•W,hl R . Persons)who gWns aparcel oflan(I on vrhich helsheresides or intends to reside,on which there is,oris infended to be,aoneortWofann ysfructuzes. Apersoawkocor imotsmore,that-one home%ratylayearperiodslta7lnothe eonsidered ahomeowner. The Mdersigned"lzomeowzzez°'assumeszesponszbilityfoz compliances wifh the State Buildiug Code and other .A.pplicable,codes,by-law.;xi&s and-iegulations, The,undersigned"hoMOoWner°'cerftfzes that l chfie imderstands the Town ofpori h Andover73nilding D of mfruent minimum iuspecfion procedures and requirements and that helshD will comply with.,said procedures and xequirenneuts., .. . -UOMEOWN:BRS SIGI?T.E3.'z M f ' APPROVAL OF BUMD)NG OFFICIAL Revised 7.2009 _ - x'orm Flomeozvners Exemption - 30A D OF'APPEAM-688-9541 OONSERVA'RON 688-9534 BEALT11688-9540 PIANMNf v aszA;4q The Commonwealth of Massachusetts f Department o De artIndustrial Accidents � p rr. d 1 Congress Street, Suite 100 e Boston,MA 02114-2017 r ;�� www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print LeZibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7. El New construction 2.[�r^fam a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition XIE� am a homeowner doing all work myself.[No workers'comp.insurance required.]t 0 ama homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.E]Roof repairs These sub-contractors have employees and have workers'comp.insurance.# 6.Q We are a corporation and its officers have exercised their right of'exemption per MGL c. 14.❑Other 152,§1(4),and we have no,employees.[No workers'comp.insurance required.] *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 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workerscompensation insurance for my employees.•Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: ------ 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 MGL c. 152,§25A is a criminal violation punishable by 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.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 thepains and penalties of perjury that the information provided above is true an/d�correct Signature Date: Phone#• Of 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#: 43 Bdghtwood Ave Deck Plan July 7,2015 12'-82" 2-2-x1o^ 12"SONOTUBES BEAM CONCRETE POUR 3PL MAX HEIGHT-j5" FROM GROUND TO $ POSTS BOTTOM OF JOIST TS 3PL 1 ' STAIRS ■ 2"x10' CONSTRUCTION 9'-102" TYPICAL EXISTING DECK North Andover MIMAP June 25, 2015 E t, a a ' :6 pl u � r Interstates —I —SR Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, --Roads Meters Data Sources:The data for this map was produced by Merrimack NORTii Valley Planning Commission(MVPC)using data provided by the Town of t Easements Of tt�ac re q�'C North Andover.Additional data provided by the Executive Office of 0 MVPC Boundary ? 6a *s O Environmental Affairs/MassGIS.The information depicted on this map is I Parcels3 L for planning purposes only.It may not be adequate for legal boundary O -- 9definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER 16. MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING ♦ * THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY # s ^ OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT • o�q r • ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION SSACHUS� 1"=38ft ^�°