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Home My WebLink AboutBuilding Permit #476 - 44 MARIAN DRIVE 12/13/2011Permit N0: —ak— Date TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ANT: Applicant must Print Date Received ` Print MAP NO: PARCEL: ZONING DISTRICT: TYPE OF IMPROVEMENT ❑ New Building Addition ❑ Alteration ❑ Repair, replacement ❑ Demolition PROPOSED USE Residential ❑ One family ❑ Two or more family No. of units: ❑ Assessory Bldg ❑ Other all items on this Historic District yes <Z ) Machine Shop Village yes (0� 100 year-old structure yes Non- Residential ❑ Industrial ❑ Commercial ❑ Others: s DESCRIPTION OF WORK TO BE PERFORMED: `II` (Identification Please Type or Print Clearly) OWNER: Name: n A -A Address: R CONTRACTOR Name: �ia�,�� y},J Phone: Address: S,9 r,t,G. Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No FEE SCHEDULE: BULDING PERMIT. $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COSTii BAS N $925.00 PER S.F. Total Project Cost: $ ��c�0• D D FEE: $ _ 1 Check No.: �' �� Receipt No.: %2- NOTE: Persons contracting with unregistered contractors do not have access to theuaran g ty fund 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 Permit Application 2j Certified Surveyed Plot Plan `A Nl> s'�`N ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract -a—Fige /erm-ection/Elevation Plan Of Proposed Work With Sprinkler Plan And elffi yp ulations (If Applicable) umM-a-s§ a k- E- nergy=CoIpliance Report (If Applicable) � n-gi-nee-in@494av is 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 2008mi 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 PLANNING & DEVELOPMENT ❑ COMMENTS DATEPROVED ❑ �v CONSERVATION ''Reviewed on I S nature S CONS ^�� F1', �r1 COMMENTS HEALTft COMMENTS (-J) k � M, Reviewed Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comm Water & Sewer ConneCtionlSignature & 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` �ATA(For department use) v v' �A/ 17C �N �J) � S Wins w °f' [c— 12 v 0-nre . ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi r— Location�1 No. Date Id -113-111 NORTh TOWN OF NORTH ANDOVER Cit�ao .•,�O 10 R F Certificate of Occupancy $ s'Building/Frame Permit Fee $ CMUSEc�•' Foundation Permit Fee $ of" Other Permit Fee $ TOTAL $ Check # + 1 q 24883 Building Inspector F ,,tleTp 0 �N TOWN OF NORTH ANDOVER t14eo ° °0 OFFICE OF BUILDING DEPARTMENT �.4L�o�� 1a * 1600 Osgood Street Building 20, Suite 2-36 Ay�sSgTNus�North Andover, Massachusetts 01845 `{Jerald A. Brown Telephone (978) 688-9545 Inspector of Buildings Fax (978) 688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION . Please print DATE: JOB LOCATION: Number Street Address i IW Name Home Phone PRESENT MAILING ADDRESS Esq Map/Lot Work Phone City Tovm State . . Zip Cede 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. 11 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 SIGN APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 'I,? d;�, pok._ -zm 4L The Commonwealth of lVlassachusetts Department of Industrial.Accid'ents Office of Investigations 600 Washington Street Boston, IIIA. 02111 www.mass go-P1dia Workers' Compensation lnsuranceAffidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: 1. ❑ Iam a employer with 4. F1 am. a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp, insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3.] I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] i employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling . 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.R9 Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. 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 their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. Insurance Company Policy # or SeIf-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 WORD ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement xray be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert"nder the pains andpenaldes ofperjury that the information provided above is true andcorrect. / �4 Ja / Official use only. Do not write in this area, to be completed by city or town official. City or Town: PermitUcense Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other C ontact Person: Phone #: at.1- N m m m X U) m It 4� W F M: n H C 0 CD O m O _ _ m O C _ A CD 42O VJ O O. CA H C EAco 7. -� _O, y :9. my C0 .'�.' m O m C..) 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N/F [3A In O 2W MARIAN DRIVE ZONING DISTRICT: RESIDENTIAL DIST. 2 "1 H',8Y �'F,,RTIFY.• THE DWELLIhI 1S"7;77ICATED OAr,THE ,LOT AS SHOWN AND ThfAT Ifi DOES COIV ORM:_:WLTH THE T0' OF NORTH AMDOVER ZONING REGULATIONS REGARDI*G SETBACKS FROM STREETS S. " "I FURTHER C HIS DWELLING IS NOT LO CAT - FF��,�' t 00D HAZARD AREA SHOWN ON FE ITl 'AAN 250098 0008 C DATED JUNE 2, JAMES KLOPO OSKI, P.L.S. DATE THIS PLAN Fiff'7RT" ICA E 'P�RPOS "S—NOT FOR BOUNDARY DETERMINATION. BOUNDARY INFORMATION TAKEN FROM EXISTING RECORDS. PLOT PLAN IN NORTH ANDOVER, MA. DRAWN FOR IOU BOWAB 44 MARIAN DRIVE SCALE: 1"=40' DATE: DECEMBER 6, 2011 IMERRIMACK ENGINEERING SERVICES 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 .! ��•* THIS PLAN & CERTIFICATION IS NOT A WARRANTY OF THE SUBSURFACE DISPOSAL SYSTEM. IT IS A RECORD OF THE LOCATION AND ELEVATION OF THE EXISTING SYSTEM COMPONENTS: Pw tFJ1CH MWY!/ 43 NH. "Im d1A16BFR8 r two ON. Q0. PUMP TAW ItWO CAL 7M; 107C SEPIC TAW *BM.u. / A (44,180 &F.+} 1 ' ( II r Vkl$T. ' 66fis4, ,� i Pt v (( ' Zil MARIAN DRIVE ARDS TOWN OF NORTH ANDOVER HEALTH DEPARTMENT VLADIMiS L. 2 NEMCHEN0tC o 4ge r :`dv.4�8a': AS, BUILT PLAN ppIrs` Y� � OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN NORTH ANDOVER, MASS. / 44 MARIAN ?RIVE AS PREPARED FOR IDU BOWABTM: 107C T i ry11P7 A n in