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HomeMy WebLinkAboutBuilding Permit #168 - 47 HUCKLEBERRY LANE 9/1/2009 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: ' L D IMPORTANT:Applicant must complete all items on this page LOCATION 4,7. 14,e,kle�e mu 4-f- r Print PROPERTY OWNER y h 61& ,', Print MAP NO: ��- --PARCEL: ZONING DISTRICT: Historic istrict yes (no Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building_ s!L,1 /c;02, One family Addition Two or more family 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: � io SCI Identification Please Type or Print Clearly) OWNER: Name: Gita 2 F yhvePl7►u Phone: Address: -"17 Act/err Z CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home 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: $ Z�U FEE: Check No.: I �s Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund signature of A ent/Owner _. _g.� _Signature of contractor Plans Submitted Plans Waived Certified Plot Plan Stamped Plans 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 ❑ 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 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 2008 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 and DATA— For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2008 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 S U Si nature , ' l t COMMENTS W Pl� 4 iewed on Si, ure COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& 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 Location�7 ITyl �(� No. Dateof U NORTN TOWN OF NORTH ANDOVER 3: i • O F 9 ' Certificate of Occupancy $ s i • ;�s'•CHus •t<�' Building/Frame Permit Fee $ s�cN Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Lj 01-- Check # / 2LJ / ;J Building Inspector NORTH TOWN OF NORTH ANDOVER a �r°�`,"`� k`•a"°L OFFICE OF BUILDING DEPARTMENT �o 1600 Osgood Street Building 20, Suite 2-36 b4`�N,rQ,�pPy�y North Andover,Massachusetts 01845 �SSAGHUSES Gerald 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 Addr ss Map/Lot HOMEOWNER Mw.-h!j `/A-6t6 //d-1 4/7- '140-yney N61 Home Phone Work Phone PRESENT MAILING ADDRESS 4 7 Ackk / Ali A4owl M,4 S City Town State Zip Code 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. The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and t t 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 688-9535 VIOR PI �� 1. �� � �_���" RE. r��rq, �s+�;j � saw. � s ti-{�•., _ $`;1.d>'�'��� Y..s:�. .Y Jr 5r�z✓.`-`mom �."...'H"a ��.• -' PLAN-..R Z: v if- '. ��'��"-r'� �n"„✓�+'� tea.+ - d j i t U i it f s � j i r� ! v`,s pfin�;Ilpr�o by mac 'oblw t:h,@ v6ld rn Agin PN- �l ern. IU#3Ba n s.s —d W:,,k 13� err.lags ra ?air A �M F t1th�. �S f .QY avv r3 Cr,_, �;�ro•�ri7�'t.... .} }*^ ��- prcip`�" Information a nd Ing§tructions Mass,achusettc General Laws chapter I S2 mquirets all amp Ioyers to provide workers' compensation for their employees. Pursuant to this statuste,an enplayer is defined as"..:Query person in the service of another under any contract Air, ,- express or implied,oral or written," ; An ernplayer is defined as"an individua> partnership,msc:%din6on,corporation or other legal entity,or any two amore of the'famgoing engaged in a joint enterprise,and includi"g the legal representatives of a d==ELsed employer,arthe receiver ort mstce•of an individual,pmtnc76ip,associatio zn or other legal entity,a toWng entpioyem 'However the owner..of a dwelling house having not more than three apa rtmerrts and who resides therein, or the occupant of du dwelling house of another who employs persons to do me-Intr:mance,construction or repair work m such dwelfthouse or on the grounds or building appurL-riant thereto shaU nol- b===of such Qmployment be d—„-toed to be an amployer." MGL chapter 152,§25C(6)also states that"every state o.nr-local Bcensing ageacy shall withhold the issmanceor renewal of a license or permit to operate a business or too constrme t buildings in the commonwealth for any applicant who has not produced acceptable cvidence.oir eomp➢'iance with tbe..insarance'coverage required." Additionaliy,MOL chapter 152, §25C(7)stains"Neither t be commonwealth nor any of its politicgl subdivisions shall enter i=any eomaet for the perfarnmee ofpubiic wmie until-a=cpfaole evidence of oomplisnce with the insu me e requarcments.of this chapter have been presented to-the aizrcts-acivug authority." Appficenta .. Please fill out the workers'compensation.a£idavit compientely,by checking the boxes that appiy to your situation and,if necessary,suppls'sub-contrector(s)rtsrne(sj,addr Ke9):and phone number(s)along with their eartificata(s)of insurzn= Limited'Liability Companies(LLC)ar Limited Umbility.Partnerships(LLP)with no-employees othexthan the memb=or partria.m,are not rogrmrd,to nary work='ani,-Ttrp=wdion insurance. Van LLC or UP do=have emth employees,a policy is required. Be advised at this affidavit may be submitted to the Department of Industrial Accidents far conf rmatian of insurance coverage. Ake Ese sure to sign and date the affidavit The afzrdavit should bee,returned to the city ar town that the application for the permit or Beans:is being requested,notthe Dopar mer t of Industrial Accidents. Should you have any questions rO9ftr% ng the haw or if you art rmpimd to obtain a workers` ooiglaensation policy,please-call the Departrnent atthe-nurnber.listed below. Self-insured corriprnies slreuld enter their salfirrsrannee'HCMMc numbW on t6t'approf—ij— Trot. City or Towle Officais Please be sure that the affidavit is campleft and printed l gaNy. 'rhe Departrnmt has provided a space at the bottom of the affidavit for you to fill out in.the event the Office or Invesfi 'ons has to contact you din $iQ Iic ertt _ Y rugw g Please be mr:to fill in the perrntt/license number which w-ill be used as a reference number. In addition,an applicant that must mrbmit multiple parmit/iicense applications in any givesn year,need only submit one affidavit indicatingeurrerit policy:information(if necessary)and under"Job Site Addr-ass"tl.=applicant should write"all locations in (city or t Dwn)."A eaPY of-the affidavit that has boen.officia{ly stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit mast be filled out each year. When a home owner or citizen is obtaining a licensor or permit not related to any business or commercial venture (i.e. a clog license or permit to bum leaves etc.)said person is NCnT.reguirtd to.complefz this affidavit The Ofnce of lnvesfi.W ions would lilm to thank you in advance for your cooperation and should you have any questions, please do not.hesitate to give us a call Tir,Department's address,telephone and fax number: The Commonwealth of Nfassaciitisetts Dzpart meztf of Imidustaal Aceidcats officeof Lnvestics ions 600 Wad i.ngton Str--t Basion, MA 02111 TeL 4 617-727-49010 i=406 or 1-877-MASSA Fax:9 617-727-7744 R vised 5-2b-(?5 www.ma govidia (:omrnonrneOM of1V=achusetts 1 J. D F nt of Industritrl Accidents lll",, Q07ce of Im►estigafiorrs 640 T�rashirigtan Street Boston MA 8.2.111 Workers' Cam emaiioa Iasitranee �y "2=S gov/dia , Applicant Inform at-ian. Mdav' Ruilders/Coat mr-tors/Eleetricians/Plambers Please Print Legibi Nam E ($+sislOrgRoiTafion/Individusl)' rnc/✓/l Address: y� �1c/c�C��ii City/stawZig: /1/ 414 Phone Fern employer?Cheek.the aPProPriste.bu= employer with 4. ❑ I am a Type°{Pr+.I�(required): yees(fug and/or * contractor and Ipart time), have hired the suf�-corttracto6• ❑'New construction.soie proprietor or partner. iis�dnd have no employees' Thome on the attached seet 3 7. Q Remodelingg forme ar St1I' ��rs haveffiry capacity workers, comp.insurance. 8. (]Demtiiitionorkers' comp• iasra� ee5- [] we, art a corporationanditsBWIciing addition d offiaess have exercised theirhomeowner tiaing all work right10'[].Biectrical repairs or additions rnysel£[No•wark�'co of exemption per MCL 11.1]Mumb' c, t 52, §14 ,'.and-we have no '�TeP or additions msrtrarrce.regnired.]:t .ompltaye e-L[No work=? 12.0 Roof repairs ;Amy aPPlic=thet doinS STP. hisurencorrquim&j c&RU boil of mutt etao fill outtht==don below showing theirworkad'coriM=Ntion Policy information Fiomeowner�who atibmit this aGidevk indicating th am Contractors that check this box"I=amu*l d an add•itioasl,,r end then hie outside conm,_Wrs mrist submit anew of?davit indica* L showing.the name orthe aub•coumtotors and their ' su I arsr.crrt enrpioyer that rsia'ravur�arrg;worN� 'ter.-r �rfsarmreejor � °C :ic; on. infnrnralion. '' m1'eotpluve°c; ���cru,.g•�L,� r .. Faau and jot'size Insurance Company Name: Policy#or S,W-in&Lie. #: ------------ F.ipiration Lute: Job Site,Address Attach a copy of the workers' cont CitylStatelZrp peasation Policy deeEar atioo page(showing the policy number aid e Failure to se=*e coverage as r�equimd under Section 25A of MOIL c. 152 can lead to the imposition a criminal iratioa da*4 fine up fa$1,500.00 an one-year im of uP to$250.00 a 1�0 �'as wen civr'I penatfies in the farm of a MP WORK ORDr^_R andpenalties a fine invest? > i nsu violator. Be advised that a copy of this staternent j be forwarded to the OfDE of gations of the DIA for insrusrrce coverage verin"wticyn. I do Ite�ebg,certify dere and penalties of pedrrry trimc in fnrmalioR provided above is arae and Qo Si twr:. reset Date: zs/moi Phone#: tC1Qj We Onfy Do not write in thio ax,¢,m he comptete•d by or town.a�irrp[ Cray or Town: Issuing Antho 'rrPermit/Licaase# ty(circle one): I. Board of health Z Buildiog Department 3.C' /Tow CL Otber City/Town Clerk 4. Electrical inspector 5. Plumbing Inspector Contact Person: Phone#: I I NORTH Town of And LA o L�. dover, Mass., COC MICMEWICK ORATED F'P? C` S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ....... ...:rV ... .......... ...................... ........................ ............ Foundation has permission to erect........................................ buildings on Rough ....Y.?...... ........G Ato be occupied as.........(AY-UL........S. ... ..............................:...................................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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 UNLESS. CONSTRUCTI ARTS Rough ...... ........................................ Service B I OFC-CTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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.