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HomeMy WebLinkAboutBuilding Permit #433 - 49 PADDOCK LANE 7/30/2009 BUILDING PERMIT yORTF� o� �,�o ,6Ati TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Receivedogwrn ACHUS�� Date Issued:/-30- ssued: _3v- IMPORTANT: Applicant must complete all items on this page LOCATION 4'� PADc)oc- < tQ cX--rm A,\,(:)©\j a AA X o\,R 4S Print PROPERTY OWNER Mi? . S M QS C1-\f,STo &9-2 , Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential 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 Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: w Nt-L- SToe A-G �.�.. p ,l� �:i,y %S\,V0 �AS�-�.f NT . AG Identification Please TXpe or Print Clearly) OWNER: Name: 1\&12. 33 t^aS CVACSTori-tE4 Moog-s--) Phone: C%'l $-2S$- S"3 Address: Z4-q PA-000c-L- 1--ANC , N aTk A/vSDoJia k$ 4-5 CONTRACTOR Name: ,naar�4- Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER 1,Jarv4- . 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: $ 0 - FEE: $ �3 0 -- - Check No.: KReceipt No.: g2?1 F/ 0 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner_ C _ Signature of contractor 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 r ' 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 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) 7 ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 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:INSPECTIONAL SERVICES DEPARTMENTMFORM07 Revised 2.2008 Location No. Date A7A• O 0.1 HORTp TOWN OF NORTH ANDOVER 41 9 Certificate of Occupancy $ Building/Frame Permit Fee $ 30 At Mus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # � 218 , 0 Building Inspector NORTH c 0 of And ?,o o dover, Mass./V-0 O /�.11 COCMICMEWICK y^ RATED S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT.....� 0" j sa BUILDING INSPECTOR .....,,.. ...."""" Foundation has permission to erect...................... buildings on5......... .... ..�� . . �..... ..��.......... Rough 101& to be occupied as........ .....I.A!.). ............ ► .... ...... �I -....... Chimney provided that the person accepting this permit shall in every respdff 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 NT OHS ELECTRICAL INSPECTOR UNLESS CONS Rough J ......... ..................................................................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough 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. t IL y I .YR';Kl�, R<' �Y _ y } I;' s Wa a:. 329 176 Pad � � �� SSS 02. JAZ 24.50 110 37 66 rl Information E.nd 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 includi-n-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 agar-tTnents and who resides therein, or the occupant of the dwelling house.of another who employs persons to do maint.-nance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall nc>-t because of such employment be deerned to be an employer." MGL chapter 152, §25C(6)also states that"every state a r local Iicensing agency shall withhold the issuance or renewal of a license or permitto 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 contractingauthority." Applicants Please fill out the workers' compensation affidavit compZ-etely,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 cerrificate(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 afiica.vit maybe submitted to the Department of Industrial Accidents for confirmation of insw^ance 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 Deparment of Industrial Accidents. Should you have.any questions regi rding the lav, or if you are required to obtain a worker' compensation policy,please call the Department at the nxT_nbes.lis+wd below. Self- sured companies should enter their self-insurance license number on the ap„ropratut line. City or Town Officials Please be sura that the'affidavit is complete and printed leQibiv. 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 pennit/iieense applications in ariy given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations inc 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 Iicenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a licenses 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 Commonwealth of Massachusetts Department Of Indust ial Accidents Office of Lavesfigations 600 WashLinmon Street Boston, MA 02111 Te1, 4 617-727-4900 C=406 or 1-87-MASS.4FE Revised 5-26=05 Fax# 617-727-7749 vt WW-mass.gov/dia gORTM TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT = + 1600 Osgood Street Building 20 Suite 2-36 '� '••,..e +'`� North Andover Massachusetts 01845 1sswcwus'�t Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please PdLt DATE: 3� SArJ 2csa� JOB LOCATION: Oct l A-0 U ocL-- LANE. Number Street Address map/Lot HOMEOWNER me-84S CV%AS MC0LS-0+J Ct-7F-2Sf'-S�-(--'s Name Home Phone Work Phone PRESENT MAILING ADDRESS 4-Ci PA O UOOC.Lc LA rJ 6- "OeT Hkrj O o V�;k vk P 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 constricts 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 1teviwd 10.2005 Form Homwv mm E=mption ROAR.n OF \PPFAI S 6890541 CONSERVNrION 688-9530 ITEALTIT 688-9540 PLANNING 698-9535