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Home My WebLink AboutBuilding Permit #012-14 - 47 EAST WATER STREET 7/2/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION C-4ST (NdT6A S i _ Pring. PROPERTY OWNER � J Print 100 Year Old Structure yes QD MAP NO: �PARCEU.� /ONING DISTRICT: Historic District yes Machine Shop Village yes pio 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: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: 71?"t)*0-7 Identification Please'Type or Print Clearly) OWNER: Name: I�a 1e ' F c °f Phone: q -77--Q Address: '—� rI ��l s i �.s �Te ati Imo► U CONTRACTOR Name: Phone: J Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: 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.: �� d' Receipt No.: 5�� NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund �� j' i �afure of contractor ;Signature of Agent/Ovvner g:_ . Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Location N . Date • • TOWN OF NORTH ANDOVER Certificate of Occupancy $�'� • Building/Frame Permit Fee Foundation Permit Fee _ $ r ` Other Permit Fee y $ TOTAL $ Check# t r; Building Inspector 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 i OMMENTS Zoning . Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments � 1 Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit � DPW Town ]Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT Tem Dum ster o Temp n site es p no Y Located at 124 Mair Street Fire Department signatureldate p COMMENTS Dimension Num er of Stories: Total square feet of floor area, based on Exterior dimensions- Tota imensions_Tota land area, sq. ft.: ELECTRICAL Movement of Meter location, mast or service drop requires approval of Elec rical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL hapter 166 Section 21A-F and G min.$100-$1000 fine NOTIES and DATA — For department use i El Notified for pickup - Date E Doc Building Permit Revised 2010 Building Department The fol;'owing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofivg, 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 ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ 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 N TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building pp 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 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 a4 O T aero TOWN OF NORTH ANDOVER 0 6E t R••a fi O.L'cL'10E OF BUILDING DEPARTMENT ' Osgood Street Building 20,-Suite 2-36 North.Andover,Massachusetts 01845 �AFHus�. Gerald A.Brown Telephone(978)C88-9545 Inspector of Buildings Fax (978)688-9542 • HOMEOWNER-LICENSE EXEMPTION R ING PERMIT APPLICATION Please print DATE: .TU '�f 20 3 JOB LOCATION: - — r Trs _n Number Street Address r Map/Lot IXOMEOWNER Aye i -� -� Z C�I Name Home Phone Work Rhone PRESENT MAILING ADDRESS S+a+w. Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units-or less a-nd to aI1ow suob home"%Wers 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 OFHOAMOWNER Persons)who awns 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 farrfily structures. A person who constructs more thatone home in a two-year 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 Forth.Andover Building Department minimum nts,specfion procedures and re requirements, and that he/she will comply with,said procedures and HOMEOWNERS SIGNATURE v� • G APPROVAL OF BUMDING OFFICIAL Revised 7.2009 Form Homeowners Exemption k BOARD OF APPEALS 686-9541 CONSERVATION 686-9530 HEALTH 688-9540 PLANNING 688-9535 i The Commonwealth of Massachusetts Department of IndustriqlAcci6nts Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov1dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name usiness/Or anization/Individual : ` G t 2 C (B g ) � � � � � Address: -c—n S t t••, E C\, City/State/Zip:_ (tel d t jd 0 Phone#: 7 Are you an employer?Check the appropriate box: Type of project(required): L❑ I am a employer with 4. ❑ I am a general contractor and T 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2111 am a sole proprietor or partner- listed on the attached sheet. ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑DemoIition working for me in any capacity. workers'comp.insurance. 9 [J Building addition [No workers' comp.insurance 5. El We are a corporation and its equired.] officers have exercised their ME]Electrical repairs or additions 3. I 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.❑ repairs re airs insurance required.]i 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. Homeowners who submit this affidavit indicating they ace 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. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: Ci /State/Zi tY p. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requnredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine u to$1 500.00 and/or one= ear imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine P � Y p of up 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 DTA for insurance coverage verification. Ido hereby' c�erti undQer thepains andpenalties ofperjury that the information provided above is true and correct. Signature: �( Of'i�' �C:�f-1 p� Date T/2 2Q /3 Phone#: / 7 0 dS�F `� s Official 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#: Information and Instruction's 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 employd 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 Iegal 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-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'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 retumed 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 -P-lease be sure that-the affidavit is-complete-and printed legibly. The Deparhnent has provided a spac6a f 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 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 burn 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 GornmonwealthofMassarhv..sPtts Departmeat of Jadwtda .1 Accidents Office ofInyestigatioxta 6.00 Washington St=,t Boston,MA,02111 Tel,#617-727-4900 ext 406 or 1:-877-MASSAFF, Revised 5-26-05 Fax#617-727-7749 wwt�.z><?tass,gov/dia t%ORTH Town of _ t E ndover 0 No. ® _ _ - �AµF h ," ver, Mass, ' • a • C OCKIC"IWICK �d A0R�TED S V BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT ......... Q� ......, BUILDING INSPECTOR has permission to erect .. ....................... buildings on ....0...... .�..... .. ............ Foundation � Rough to be occupied as ..... . ?..!......:.. .� '�..�. .(�...... . .. .�...... Chimney provided that the person accepting this pe it shall in every respect c form to the terms f 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 OA PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU N4111emumn TS ARough 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. SEE REVERSE SIDE Smoke Det. North Andover MIMAP July 2,2013 e c , t dyA N� T \\ "X f L A� t P rx a�zQ iN Yrastfes Interstate- Maier Roaft Hoizzat al Datum YA SWeplam Cow&We system DaWm NAD83, Roads Meters Data Sources The data for In map was produced by Mertima it Ti5mrs, Valley Planning CWVPC)using data provided by Ire Town of Easementspf 4"%D ,6 qh brih Andover.AdAwned data Vanded by the Ennui a OI&e of O MVPC Douday ? 66 s�� Enviomrentat MaisWassGIS.The erformation depicted on live map a Parcels for planig puposes only.I may not be adequate for Iegal ti—day _— ."• - is ddWm ar regulaory sterpretatim THE TOWN OF NORTH ANDOVER MADS NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING t 401qpmw ♦ THE ACCURACY,COMPLETENESS.RELIABILITY.OR SU TABLNY ♦ "s ,^, {� OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT oma+ �' • ASSUME ANY LIABLITY ASSOCIATED WITH THE USE OR MISUSE OF t THIS INFORMATION �1SSACXUS 1'=39 ft r