HomeMy WebLinkAboutBuilding Permit #831-13 - 440 BOSTON STREET 6/3/2013TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
PermitNO: 13� �—j� Date Received
Date Issued:
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
0 New Building
VOne family
11 Addition
0 Two or more family
11 Industrial
11 Alteration
No. of units:
El Commercial
0 Repair, replacement
D Assessory Bldg
El Others:
El Demolition
El Other
I, I 6:qo W 1 S
p.a!n) t and
ater-9hed Disffibli
DESCRIPTION OF WORK Y E PERFORMED:
'413
Ro z>yn i-- 4k ;;a---
Identificati nt Clearly)
o Rea vpe or Pri
T
OWNER: Name: - A-'? Phone:92,F-/e/-&g�7Y
Address:A-5tv Ss-,�14--V�- !&�'evaevft4,5-
Cc _Q N JT1 RAO I
J TOR, N bt 'e-�.
Me Ptlone-�
Add
p
n 0 -.-qns-al Ex
PQry
!.Hib iE� rrqp
M yqvqmeirtPL-qqnge-.,, p 0'a
te*f
ARCH ITECT/ENGI NEER Phone:
Address: Reg. No.
FEE SCHEDULE.-BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASED ON $125.00 PER S.F.
'Total Project Cost: $ !t FEE:
Check No.:
Receipt No.:
NOTE: Persons contract* W registered contractors do not have access to the guarantyfund
n ure.of
bnt1.OWh6t
Plans Submitted D Plans Waived F1 Certified Plot Plan Stamped Plans F]
Locatior
d
No. Date
1-75
Check #
26467
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee / $
Other Permit Fee
TOTAL
Building Inspector
Plans Submitted [I Plans Waived 11 Certified Plot Plan [I Stamped Plans 11
TYPE.-OF-SEWERAGEDISPOSAL
Public Sewer
Tanning/MAssrgi4c�d; Art
Swimming Pools
Well
Tobacco Sales
Food Packaging/Sales
Private (septic ta* etc.
Permanent Dumpster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATEAPPROVED
PLANNING & DEVELOPMENT T1
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH
COMMENTS
I
Reviewed on Signature
4;
Zoning Board of Appeals: Variance, Petition No: 7oning Decisionlreceipt submitted yes -,-
Planning Board Decision:
Comme
Conservation Decision: Comm
Sewer Connection/ rmit
DPW Tow;! Engineer: Signature:
Located 384 Osgood Street
FIRE DE*PA1R'TM'E'j"T* - Te'mp' Dump�teir on site no
Yes
�b.cated at'l 24 Main" Strdet
Fire Dep,a'r'ti-he*f'it.s�ig"ii'a'tij'rb/dito
COMMENTS
� Dimension
i Number of Stories: Total square feet of floor area, based on Exterior dimensions.
I Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
I Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21 A —F and G min.$100-$1000 fine
Doe.Building Permit Revised 20 10
Building Depprtment.
ThefolCowin� is a -list of the required forms to be filled out for the appropriate.permit to be obtai' ed.
9 n -
Roofing, Siding, Interior Rehabilitation Permits
Building Permit Application
Workers Comp Affidavit
Photo Copy Of H.I.C. And/Or C.S.L.- Licenses
Copy of Contract
• Floor Plan Or Proposed Interior Work
• Engineering Affidavits for Engineered products
SOTE: All clumpster.permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
u Building Permit Application
u Certified Surveyed Plot Plan
o Workers Comp Affidavit
Li Photo Copy of H.I.C. And C.S.L. Licenses
• Copy Of Contract
• Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
• Mass check Energy Compliance Report (If Applicable)
• Engineering Affidavits for Engineered products
10TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
• Building Permit Application
• Certified Proposed Plot Plan
• Photo of H.I.C. And C.S.L. Licenses
• Workers Comp Affidavit
• Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (if Applicable)
• Copy of Contract
• Mass check Energy Compliance Report
• Engineering Affidavits for Engineered products
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the apj)�al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
rnust be subm'-fted with the building application
Doe: Doc.BuillingPeunit Revised 2012
-7
Enter construction cost for fee cal -
North Andover Fee Calculation
Construction Cost
4�000.00
m
-$
$ -
$
48.00
Plumbing Fee
$
6.00
Gas Fee 100 comm.
$
100.00
Electrical Fee
$
6.00
Total fees collected
$
160.00
440 Boston Street
831-13 on 6/3/2013
Finish Bathroom on Second Floor
10 0
r
L
LA.
0
0
co
a)
u
0
0
LL
(U
>.
Ln
CL
0)
V)
0
z
Q
z
CIO
.2
m
0
LL
D
0
0::
r_
E
U
LL
(A
z
z
-C
to
=
o
—
m
S
LL
0
z
—j
LU
txo
:3
0
W
a)
u
cu
Lr)
S
U-
0
uj
CL
IA
z
to
0
7;
z
LLI
LU
L&I
5
m
co
6
z
V)
4-;
cu
-IC
0
E
V)
dr,
0 m
0
WN
CL (L)
0.2
E CL
'to 0
0
0 r
0 4)
U L-
IT4 A�. U)
0 ***
—d
CD
Co
CD
>
0 (D >
-0 0
U) 0-0
0) cc
(D
E %6 0
z
cn
r
0
m.2
m
> 0
T
TJ 0- CD
CL
cc 0
4, cn
c .0 CD
0 c S
12 cc -0
0 CD.2
*.. cc
cn r_
LLJ 0
S? cn a
CL :E. .2
u1i - L = �w b.
LW E CJ -0 r 0
Ll 0 a).— =
L) 0 -0 4)
cx U)
U) 0 4— C
am FE cc o " a 0
4- CL 0 C-)
0
w
Z
C/)
C/)
z
C)
Cl)
LLI
0
>
x
.2 UJ 0
cn
uj -J,
a- :z
=3
0
0)
0
0
z
0
0
E2
0
E
0
0
z CL
0
IM
0
.— E CD
0 CD
Cc
0
in 0
0 CL
0-0
(n Z
0 QL
0 w
cc
LLI
a
7A
LLI
CA
19
LLI
LLI
I%
LLI
LU
U)
Lz�-�
TO" OF NORTH ANDOVER
OFFICE OF
]BUILDING DEPARTMENT
-1600 Oskood Street Building 20,.Sllite 2-36
North Andover, Massachusett8 01845
Gerald A. Brown Telephone (97�) 689-954.5
Impactor of Buildings
-F�x. (978) 688-9542
110NEOWNER-LICENSEEXEYiPTION
BL11EDING PERYHT APPLICATION
Ejease prin
DATE:-
: JOB LOCATIbN:._
INNumber Street Addiess Mapf�ot
ljoymcmrNER 00�wz t -3104P
Home Phone
WorkRone
-PRESENT MAILING ADDRESS
A
WIN
zip code
Tile Current exemption for "homeown
was Cxtaliaod to include owner-occ6pied dwellings to two units -or less and
to allow Bubb -bom P'"'Mars to engage an indivi dual-f�r hire -Who do as not p ossess a license, provided that the owner
acts as SUPOMsor). State Building (Code Section 108.3.5. 7)
DEFINITION OF HMMOWNER
Person(s) who _9wns a parcel of land on which halslic, resi aes or intends t6 residq, on which there is, or . is intended to
be, a one or two fam ily structures. A person who constructs more that jone home in a two-year perio*d sh'all not be
Considered a homeowner.
The undersigned "homeciwncTI, assumes responsibility for Compliances with the State Building Code, and other
Applicable codes, by-laws, rules and -regulations. k
Tile undersigned "homeownee, cajt�fies that he/she U*ndarstands the Town oMorth Ando . ver Building Department
minimum inspection procedures and require ts d that he/she, will comply with,said procedures and
a C, Ulat
,L,U,r,
j,U r
requirements,
HOMEOWNERS SIGNATURE
APPROVAL OF BULDING OFFICIAL
Revised 7.2009
Form IiOmeowners Exemption
)3()AR*D OF APPBALS- 688-9541 CONSERN"AnON 688-9530
DEALTE1 698-9540
PUNNING688-9535
The Commonwealth ofMassachusetts
Department ofindustriqlAccidints
Office ofInvestigations
600 Washington Street
Boston, MA 02111
vwwmass.g;ov1d1a
Workers' Compensation Insurance Affidavit: BnUdersfContractorsfElectriciansfjpl-umbers
,"I - - - - T -M.1,
/05-PhoneV:
Are you an employer? Check the appropriate box: -
1. 1 am a employer with
4 . El lam a general contractor and I
_
employees (RM and/or part-tim.c).*
have hireathe sub-cofitractors
listed the attached shoot. T
2. 1 am a soleproprietor orpartner-
on
ship and'have no employees
These sub -contractors have
working for me, in any capacity.
Po workers, comp. insurance
workers' comp. insurance.
5. We are a corporation and its
.
officers have exercised their
3. Arequired.]
I am a homeownBr'doing allwork'
right of exemption per MOL
myself. [No workers' comp.
c. 152, § 1(4), and wo have no
insurance required.] t
employees. [No workers'
comv. insurance requiredJ
Typ f project (required),:
6 1� ction
-OL
Now c
7' JRemode:g
8. E] emolition
9. El Building addition
10-0 E lectrical repairs or addition's
11. F,-1 Plumbing repairs or additions
12.[] Roofrepairs
13.jj'Oth��!V 14400 All-
irworkere com.
Lthe section belft sho'Wingthel pensation policy information.
1*%nyapplioarit�ha' checks box #1 must also fill out davit indicating such.
, nomeow"'s who submit this affidavit indicating theY Ere doing all work and then hire outside contractors inust submit a new affl.
TContractors that check this b ox must attached an additional sheet showing the name of the sub -contractors and their workers' conip. policy information.
am an emp loy er th a t Is p ro Wing W arkers ' c om plo
.pensation insuranceformyein yeeN. Below is ihep011cy anlliOb site
information.
Insurance Company
Policy-* or Solf-ins. Lic. #: � . Explrati.oq Date:
Job Site Address: Pity/ltate/Zip:
Attach a copy of the workers' compensation -p ollcyileclaration page (showing thepolleymimber and expiration date).
Failure to secure coverage as requiredunder Section 25A ofMGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,50 0.00 and/or on& -year imprisonment, as wellas civil penalties in the form of a STOP. WORK ORDER and a:fme
ofup to $250.00 a day against the violator. Be advised that a copy of this -statement maybe forwarded to the Office of
Investigations of the, DIA for insurance, coverage verification.
epains andpenaldes ofperjury thatthe informationprovided above is frueandcorrect.
e"e IV! /T. A - - . X — 2 — 0) Al ,�
— /I Y / /
Official use only. Do not vjrlte in is area, toheC0mP7etedbYc1(P0Tt0Wn Official
City or Town:
rermit/lAcense
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. CitylTown Clerk 4. Electrical inspector 5. Plumbing Inspector
6. Other