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Home My WebLink AboutBuilding Permit #193-2016 - 48 WAVERLY ROAD 8/13/2015 BUILDING PERMIT I* NORTFr q 1�'� IJP --�� 1 t4LED 6 •p TOWN OF NORTH ANDOVER 3? yEl •_'0,46 O APPLICATION FOR PLAN EXAMINATION - Permit No#: I Date Received /9A�Rw7EDFWV gSSACHUS Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION /�� not Cn PROPERTY OWNER I V � f4-1 I Print 100 Year Structure yes MAPPARCEL: ZONING DISTRICT: Historic District yesMachine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ew Building 11 One family Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other o Septic ❑Well ❑ Floodplain 0 Wetlands ❑ Waterihgdl District 0 Water/Sewer boXDESCI�I�N OF WORK TO BE PERFORMED: Tom-!,,// Id ti ation- Please Type or Print Clearly OWNER: me: Phone: azw Address: LwRSV Contractor Name:6 E J h lQ P�W O-)Rhone: Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PECOOOO.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ y FEE: $ �a Check No.: JC1 � 1 Receipt No.: NOTE: Persons contracts with unregistered contractors do not have acces the gugranty fund 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS � Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes � k Planning Board Decision: Comments i Conservation Decision: Comments Water& Sewer ConnectioniSignature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street ILEA �" ..a .� 31,x." - �F;IRE D40 .41 --�NtT� Temp ®umpster onsite+j,�y�es i Located at`1 4 Main Std e %-.r ` • ,,- +�t+t -'*^"+" 0 may++ '�G.„�,... Feire D�epartm$ensign„ fu:re/date 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 foricku Call p p Email Date Time Contact Name Doe.Building Pemnit 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 Addition Or Decks 4. Building Permit Application :r< Certified Surveyed Plot Plan 4 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) 4 Building Permit Application 4, 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 I ECC 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 Doc:Building Permit Revised 2014 i a Location �\\ a No. — l Date • • TOWN OF NORTH ANDOVER k Certificate of Occupancy $ Building/Frame Permit Fee o'J Foundation Permit Fee $ � A- y" Other Permit Fee TOTAL $ Check# � 2 or- 2 0 � Building In 1p`�ctor f r '1 AORTH w: s E . ., Andover o h ver, Mass 115o «. > > co"t «twit« �'►• x,45 RATED r'P�,`,�y U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System G� BUILDING INSPECTOR THIS CERTIFIES THAT ................................ ....�.......................�....... .................................... has permission to erect .. ........... buildings on .... �. ooveAe � Foundation Rough to be occupied as ......... .....�... c�M ..... !.....�Q�N►wl.......... .. y"'1.. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the pplication 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT ARARTS Rough Service ...........�:.... ... .... ....f q-►....................... 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. all mj�opuff Ir.17 TOWN ANDom 0 OIT`ICE OF - - z . ,u�y`c. QR �•"*o.xa4b" By :1600 O9g0Dd ytreat 13uffdyg 20 L,S'S.!ljj..`ftl.I.p`{2-3. 6 r 7 S� u5 �5 'NoithAndmx,Mamaabusdtq 01845 Pg £reMEL Brom � Telepltorte(978}6$8 9�45 InspeetorofBuildings _ (978)688-9542 D@YM4WNER LICENSE X EMPTION . )MOM pE CT A'PUCATION DATE- , J'OB LOCATION.- l .` ' i- VI . -Numbez �xeetAddress ll�Iap/Lot . Name. L16 6 k Home one �1ozk 'hone -PRESENT MAUU NG ADDRESL � • � - . , . . ell dip Cods The eurrent exemption for 110meownere,was extenclod to?�olnde owner❑cctipied dfYe�1�,gs to iro units qr gess an t $6allo�,v9u hholoco„versLoengageanL'-- Cz'Vaduax•forhire,VAGdoesaotpossessalicense,providednat owner acts as supervisor). 9f teBuizdiug (Code Section 108,3.5.x) - bEMIMON OYNOMEO"NNER Persons)who was aparcel of land on which Tre/she reslices or htfeuds to reside,on which fhere or zs intended to ' boneortwo familystzuctams. ApersonwhaconstructsmoretliatonelxonzeinatwaysarperlorishaTZnctbe consideredaboz�teownez; , The mdersigned"lzottteowner"assumeszesponsibxlityforcompliances with the StateBuilding Codeand other Applicable codes,by laws,zules andxegulatiom. la uude imved`�iomeoedure c lie sheMderstauds the Town ofl`0iffiAadoverBuildingDe�axf Gut ""n——dm�?m inspeoiion proeeduzes a�' e is and that belsh,e will comply with said procedures and zecluizerneztts, { 1 j HOAMOWNERS SIGN.A.TM APPROVAL AL OP BDMDMG OFKC1AL ' levised 7.2009 ' ?ozml-lomeowners£exemption OARIT?OFAPPBA7 S 688-9541 CONTSFRVAUON 688-9534 1iEALTH688-950 Prd'�7i�Ti�,Tr3 tur nrnr The Commonwealth of Massachusetts F Department of IndustrialAceldents 1 . r 1 Congress Street,Suite 100 Boston,MA.02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legib Name(Business/Organizationadividual): t/�Y i AR(. Address: W K� City/State/Zip: OWN ( Phone 05 N6 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. Q New construction 2.E]I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 9. Demolition 4. I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10[Building addition r ensure that all contractors either have workers'compensation insurance or are sole 11.E]Electrical repairs or additions proprietors with no.employees. 12.b Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 1.3.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.# 6.Q We area corporation and its officers have exercised their right of exemption per MGL c. 14.EJ Other 152,§1(4),and we have no 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. i Homeowners who submit#tris 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 state whether or not those entities have employees. If the sub-contractors fiave employees,they,must provide their workers'comp.policy number.' p ail an employer that is p/'oviding 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: 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 DIA for insurance coverage verific " ' X do hereby e rfy nder tl epains andpenalties ofpetjury that the information provided above is true and correct. Date . —PO/ Si afore: � : V Phone#: IA, 41 Of 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#: