Loading...
HomeMy WebLinkAboutBuilding Permit #1195-2016 - 47 MOODY STREET 5/16/2016 BUILDING PERMIT NORrH q TOWN OF NORTH ANDOVER 3 - - APPLICATION FOR PLAN EXAM INATIGR`._.; * M � Z m Permit No#: Date Received: 1 ' �gSsgcHusE��y Date Issued: IMPORTANT: Applicant must complete all items on-&�—&page LOCATION V\AC>04 Print PROPERTY OWNER Gr V,V, ^� Print 100 Year Structure yes no MAP U 1 PARCEL: ZONING DISTRICT: Historic District yes no Machine Shap Village yes no TYPE OF IMPROVEMENT PROPOSED USE Re idential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well El Floodplain ❑Wetlands ❑ Watershed District 0.Water-/Sewer- DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Tyne or Print Clearly OWNER: Name: r1ro- Phone: p ,,�,,, 1 Address: �� �A&o0 s � '"`" av °- Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp.. Date: Home Improvement License: Exp:..D.ate:::. ARCHITECT/ENGINEER Phone: Address: Reg. _ q. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED OAST'>SA,SEEF0ff•$125.00 PER S.F. Total Project Cost: $ .S FEE. $ Check No.: cZ �O Q Receipt No NOTE: Persons contracting with unregistered contractors do not have access-,to,,,the guaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWER-AGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ rimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales 0 Private(septic tank, etc. ❑ permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM LANNING DEVELOPMENT Reviewed On r Signature O"A COMMENTS Iy I XCO NSERVATION Reviewed on J 7 Si nature, COMMENTS Cs� L HEALTH Reviewed on Si nature COMMENTS c aZoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments �l Conservation Decision: Comments Water& Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE at-PA IZ�TMENT � TemoiDumjost_er,•�on site. ,yeses [nog I r Located at•i1234�Main,�Street F Fire�Departrnent�signature/date COMMENTS, - Sr. Dimension Number of Stories: Total square feet of floor area, baseif-aw-Bderior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop-r! ices approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No 5. MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department ease) ® Notified for pickup Call Email Date Time Contact Name Doc.Building Pernvt 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 i 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) 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 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 Doe:Building Permit Revised 2014 Location , tV Oxy 9� 11g --20i No. Date L-;' • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ bo Foundation Permit Fee $ Other Permit Fee $ TOTAL $ - Check#Z -. Building Inspector NORTH f Town of �� _ Andover 0 0 h ver, Mass, cochic«ew�c« RATED 5 V BOARD OF HEALTH PERMLIT T LD Food/Kitchen Septic System �.�.1 ., d dr 0 THIS CERTIFIES THAT ........ BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ..... �......... ................. ....�......... ........... ................. Rough to be occupied as ....... . . I4Ji.�f� ....�.. ................................................................ Chimney provided that the person accepting this permit1hall in every res ect 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS 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. 00 Iq P r, 8ove M 55 H 30/ CO( 10 COX 37 PAVe-( WA(Kwly 1vl\oo h 00 � s P W 4-vOv -)V >Pao ©f s �� � ac►�1?S v� zoo 7 CaDd s F?Go 1/7 5� I� rig buos Y� i �'VI'J_1210 �o ' w New O Q,A Ik U p RC(YN\p Hc)use- Ian C-.q 12- 7--To-7 pec v, e5 o --------------- noc Nolve slit/ Sud �ccc, �iqm� u. FI u55 Thi-�5ko 00 v �• , ., Arl to New ClQCK q7 M;Oojjfit J W ULV-CK �- ( ��'1 �1 t � An8ovec MA 1 Ing Qo 15 C ) CAC)B 1 F ThrovjA f3o I T O v Q � 0, G �t NIV Pt 3_ x10 , 3e a Cyl Bea rvl l o x t 9(2aM rJ rr Ox l rpt �Ixy„�� pr �x x 8 { JD)-,f e42artin J z� q � gl3S io " 5orvq wilh posf bra( ke f q�4 104 Pbs- Bol+e-d Oxy TOP ( tAp 6r\d c4�is t24 (jecL/t� Wiled w� � S d ��n C-41 vrn�ze� ����5, poi' BeCA Poc ,ro' 0nccTube Tvl-�—> ID"Sz)nQ Tobe w TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 9_ 1600 Osgood Street,Building 20, Suite 2035 +� North Andover,Massachusetts 01845 Gerald A. Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION DIJIDING PERMIT APPLICATION Please prin DATE: S- -I II)► JOB LOCATION: Number Street Address Map/Lot HOMEOW /� NER l�1�-e-v"" V-0O 1 f 7�'31oQ Io$d Name Home Phone Work Phone PRESENT MAILING ADDRESS City Town State Zip Code The current exemption for"homeowners"was extended to include owner occupied dwellings of one or two family dwellings and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. 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 dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner.(780 CMR Section 110.R5.1.2) The undersigned"homeowner"assumes responsibility for compliance with 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 that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE cj�z__ �n \ APPROVAL OF BUILDING OFFICIAL Revised 8.2015 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANd ING 688-9535 � The Commonwealth ofMasscrchusetts A , Department of lndustrialAccidents X Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Elecixicians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aipplicaut Information t Please Print Legib Name(Business/Organization/Iridividual): A ���v�•� ��� `� Address: City/State/Zip: /y. w A-r— W-*— 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, F]New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. []Remodeling ny capacity.[No workers'comp.insurance required.] 9. E!Demolition am a homeowner doing all work myself[No workers'compAusurance required.]t 10 []Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 1 l.❑Electrical repairs or additions proprietors with no employees. E]Plumbing repairs or additions 5. 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ g, t 13.❑Roof cepa These sub-contractors have employees and have workers'comp.insurance. • � '\ 6.F]We are a corporation and its,officers have exercised their right of exemption per MGL c. 14.[�Other � 152,§1(4),and we have na.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. 1 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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 ine sub-contractors fiave employees,they%must provide their workers'comp.policy.r,..v nbei. 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 S elf-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 DTA for insurance coverage verification. Y do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. R_Si afore: „ Date: S'�� `" Phone#• 7S — 3 (®r b �� Official use only. Do not write in this area,to he 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.PIumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions ' 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 employer 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 legal 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 bd 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 may be submitted to the Department of Industrial Accidents foi•confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned 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 Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.#617-727-4900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia L North Andover MIMAP May 11, 2016 0811.0 008. 081.0:-0010 elo-\ 08,1.070Q01, !�p)c,. LjGAT--E-,C-fR-- 081.0;-0064 s�i mPOY'ST 081* :-0010 081.0-0004 S T 062JMQOQC�Y'!�T M 125 081.0-0003 0;0025, 49 MOODYIST 6e r F4SAVE; t14 •10 tt k 041'.%00012. Ln' t 09:10=0018; tF 40'MtQ-Q bXSIT, If 091 0;-0029` 081.0=00.27' 41 M0,67D. 'y 081.0-00,17 00 S T A C-Y'D R 081.0-00.15' 13 mvpc Bo Zoning Overlay Zoning 63 Municipal Boundary 13 Adult Entertainment Distric, Businei s 1 District 0 Machine Shop Village Ove C Busine!s 2 District Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, —Rail Line 0 Watershed Protection Dist :Busine!s 3 District MeteData Sources:The data for this map was produced by Merrimack rs Inteates 13 Historic Mill Area Meters Busine!S 4 District j40RT#j Valley Planning Commission(MVPC)using data provided by the To"of I El Medical Marijuana a Genera Business District North Andover.Additional data provided by the Executive Office of SR Q Downtown Overlay District 13Planne� Commercial Dev 6 Environmental Affairs/MassGIS.The information depicted on this map is Roads 0 Historic District :;Carrico Development Dist for planning purposes only.It may not be adequate for legal boundary U Osgood Smart Growth(40 K3 Corrido Development Dist 0 definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER 6 Easements C Hydrographic Features 0 Corrido Development Dist MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING :nd stri :�1 District • THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY 0 Parcels Streams ndustri 2 District u Wetlands El Indus ,3 District OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT 0 lndus�Hd 11 S District ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF c THIS INFORMATION Exempt Lands Residej a 1 Distnet Arfo Reside i ce 2 District Reside-ce 3 District SSACMUSEt de cc 4 District ce V=52 ft �de 5 Dis dct Ede ce't District ge esidential District PHOME CALL A.M. FOR e r/Z DATE ( TIME P.M. M t3 0 UcX PHONEDOF J-7 1 E]FAX J Y (�V� �QLJR N�L C]MOBILE PHONE MOBILE l O YqET CALL AREA CODE NUMBER EXTENSION ASF=CALL': MESSAGE WILL, L � �J S �� AGAIN I CAME TO. SES YOU I M WANTS TO yr ` SEE YOU, SIGNED SECONDNATURETM RECYCLED COPS. FORM 74620