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HomeMy WebLinkAboutBuilding Permit #227-11 - 48 WAVERLY ROAD 9/16/2010 BUILDING PERMIT of N°pTti TOWN OF NORTH ANDOVER 3� 6'`.a' •..,6.6"0 APPLICATION FOR PLAN EXAMINATION ° Permit N0:__D;� Date Receivedran Date Issued: v/ (� US IMPORTANT Applicant must com Tete all items on this page 51f '�r 7 - 7 7.7 g � 744 ^'b����sG} 3" 04 # TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family A Two or more family y Industrial lterati No. of units: Commercial air, replacement Assessory Bldg Demolition Others: r �3 'y � x-i �. �� c '±Px .... -.' ��,,.r,/,N,M.�v Is.K�+1-4;.&��N,s;s'Cr!'a'r� R m"�ti` xZ+�+:.x��%�'!r'+�-'�'�u�,oR��� �'` ..�'�����r��'"�''W�5""'"`��',�y k�!-�`�' --[1"��S� �S��� k� �•4 DESCRIPTION OF WORK TO BE PREFORMED• ��� L ( � W Identification PIease Type or Print Clearly) OWNER: Name: V11ti Phone �'7�7S Z Address: ix M �bx r'fW.2-s -"�"a_ z�r�'`',�. •y,:N_t Mr. 01 r d rn y..„ # ,=a, t-'4'a 3, a. r+ 4 W Igo i ', .a,'1` - ,z z` ,.,a z r. r -! °5.� .r�'{b' ,�"' r+ - -u.• rf u 3�.s�_ ARCHITECT/ENGINEER hD 1 j�S_SZ6� �e p Phone:_ �- Address: Reg. No. �5at� FEE SCHEDULE.BULDING PERMIT.•$12.00 PER$.1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. AQ Total Project Cost: $ LN FEE: $ � •®� Check No.: ,f Receipt No.: NOTE: Persons con racti ith unregistered contractors do not t have access to the guarantj�fund Slna#ire�of�X�� ent/��r✓ner =� - _ ,�„ ; lgnature of con.tactor Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer /j 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 C7 Signature COMMENTS 'A cl/Ul b� HEALTH Reviewed on Signature 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 RE 0E , ► T �erDrpsror� rt eyes bacate dot 24WE n�Str-eef r S 7 - � re a as aaataisiz na ve'' a-e ti} T t YC0 �1a1TS _: 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 I DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A-F and G min.$100-$1000 fine NOTES and DATA— For department use i 1 L �II I ❑ Notified for pickup - Date Doc.Building Permit Revised 2010 - r— Building Department The following is a fist 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 yl ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior or 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:Building Permit Revised 2008 Location No. aa Date dd NORTIy TOWN OF NORTH ANDOVER 10 A Certificate of Occupancy $ Building/Frame Permit Fee $ "us Foundation Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # E 7 NJBuilding Inspector Of µORTH TOWN OF NORTH ANDOVER 20�tt4eo NO b- o� OFFICE OF BUILDING DEPARTMENT *� 1600 Osgood Street Building 20, Suite 2-36 North Andover,Massachusetts 01845 SACNUS� Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978) 688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please Print DATE: S-eP`� 16 0`10111 JOB LOCATION: ,;- A� Number Street Ad dre s Map/Lot HOMEOWNER 1 tis, 75 r o ,s' Name Home Phone Wo r Phone PRESENT MAILING ADDRESS (J(:NVk0 Pl"A City To,%>'n Stw*.e l .a� 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 that 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 685'-9530 HEALTH 688-9540 PLANNING 688-9535 The Commonwealth of Massachusetts Department o f Industrial accidents Office of investigations 600 Washing ton Street Boston, MA 02111 Workers' An Compensation www.massg licant Infonna6on isurance oda it: Buoiv/ddeiras /Contractors/Electricians/Plumbers PIease Print Le6ibl Name (Business/organizaiion/tndividual):1 r I C Y Address: City/State/Zip: Phone#: Are you an employer? Ch eels the appropriate boa: L❑ I am a employer with 4. ❑ I am a Q Type of project(required): . — =eneral contractor and I employees(full and/or part-tim.ej.* have hired the sub-contractors 6. New co ❑ nstruction 2 ❑ I am a sole proprietor or pat•tBer_ ship and have no employees listed on ehe attached sheet 1 7• ❑Remodeling These sul>_ contractors have 8. E]Demolition working forme in any capacity workers' comp.insurance. [No workers'comp. insurance 5. ❑ We are a corporation and ., 9. ❑Building addition equired] officers have exercits ised their 10 El Electrical r �tkm am a homeowner doing all work right of ex epairs or additions yself [No workers'comp. c. 152 1 emption per MGL .11.[]Plumbing repairs or additions srequired_] t insurance , (4),and we have no q employees. [No workers 12.[]Roof repairs r o r comp.insurance required.) I3.❑ other :A 'arP.t-_n.th--cheel. t Romeo box Must aso sue cu!the sere^^eeiov warms who submit triis affidavit indica -^oY� w�� 'con^� s`ee =fc o ff'am dc.;.E aL'iJGib anQ r Y......� ..:--m +Contractors that check,this box m= chEd ab additional sheet showine the men hire outsidE contaactaa 4W.sabMit a new affidavit mdi sting such. name of the sub-conusctots and their workers'co I a n an em g p mP•Pommy information. employer Hurt Prm' in workers'com ensation insurance for my employees, Below is the policy and job site informaSon. Insurance Company Name: Policy#or Self-ins.Lic.#: .Expiration Date: Job Site Address: Attach a copy of the workers' compensation policy declaration pane(showing thhetpolic p, Failure to secure coverage as required under Section 2 w2ng` Policy number.and expiration date). fine up to$1,500.00 and/or one-year imprisonment,as well 152 can lead to the imposition of criminal Of up to$250.00 a da agaicivilnst penalties in the form of a STOP Wpm{ORDER pines of a Y tamst the violator. Be advised that a co and a nine Investigations of the DIA for insurance coverage verification. FY of statement may be.forwarded to the Office of I do hereby un er the pains and penalties of perjury th¢t or f mation provided above is true and correct Si C: Date. G-�OC��U Phone#: 2 Official use only. Do not write in this area, to be completed by city or town official City or Town: 1°ermitucense# Issuing Authority(circle one): L Board of Health Z. Building Department 3. City/Town Clerk 4.Electrical Inspector 5 6. Other P Plumbing Inspector Contact Person: Phone'#: Information an- d 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 pt✓rson 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 otherlegal entity, or any two or more of the foregoing engaged in a joint enterprise,and including t1ae It gal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association ox.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 maintennance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not bescause 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 c-instruct buildings in the commonwealth for any applicant who has not produced acceptable evidence of c03Mpliance 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 un til 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'comp emsafion 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 for confirmation of insurance coverage. Also be shire to sign and date the affidavit. The affidavit should be a ctum d to the city or town tha',the app ca ion for the^ li ,emitor license:s being requested,not the.D--nar�:ent.of Industrial Accidents. Should von have any questions regardir b the law or if you=i,.."i;*Ito ob-ain a workers' compensation policy,please call the Department at the numberr 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 siamne:d or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for fut=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 Iicemse or permit to burn leaves etc.)said person is NOT required to complete this affidavit- The ffidavitThe Office oflnvestigations would I&e to than 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..fagnumber.._... The Commonwealtb. of MassachusetEs. Department OfIndustHal Accidents Office of Inrestieai ass 600 wasbiut_tcrn Street Barton,MA 0.2111 Tel. 4 617-72.7-4900 ext 406 or 1-97/ -MASSAFE Revised 5-26-05 Fay. 61".-72.7-774 9 v MM7.mass._gov/iiia ORTH ToVM of �_ No. �O _ - L A K E -� dover, Mass.,tL- �o a COCKICKEWICK !�ADRATED P?at�5 S ` BOARD OF HEALTH PERM IT� T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT....... ...... .a.. .. ..................................... .. .fir✓ ........................................................ Foundation A has permission to erect..............:..:...................... buildings on ..................... Rough .... .� ...... to be occupied as................. kUP.......invwnA......`I . . r�.................................................... hymn y C e 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 94 • PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC N TARTS Rough ........... ... .......... ............................................................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocmpy Building _ GAS INSPECTOR Display in a Conspicuous Place on the- Rough 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.