The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #601-16 - 5 MAPLE AVENUE 11/17/2015 S eta-V11lIrD f NORTH q BUILDING PERMIT 3r �,9 TOWN OF NORTH ANDOVER ° ¢ APPLICATION FOR PLAN EXAMINATION s -y Permit NO: 1 Date Received 04 •� I=0 Argo +` Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION l ' a p�P_ IAVf- I ' rmt PROPERTY OWNER/IIAlo �iS � Print MAP NO: PARCEL: / ZONING DISTRICT: Historic District yes n t Machine Shop Village yen s TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition O'Two or more family ❑ Industrial ` ❑ Iteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑ Water/Sewer e Identification Please Type or Print Clearly) i OWNER: Name: �Gy V�� JYN� Phone: 6f 2e L-0-3 ��o� Address: / oc + cmk VN AkCA" CONTRACTOR Name: Phone: i Address: i 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: $ 1000 FEE: $ Check No.: Receipt No.: c NOTE: Pers s 'ontracting with registered contractors do not have acce o ua •anty ' fund Si ure of Agent/Owner __, Ignature of contractor Plans Submitted ❑ Plans Waived.❑ Certified Plot Plan ❑ Stamped Plans ❑ r F SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennanent Dmnpster 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 HILALTH Reviewed on Si anature COMMENTS -,Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes s Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer:_Signature: Located 384 Osgood Street FIRE'DEPARTMENTT Temp U;umpster on site yes m no toeated;at 124 Main Street Fire Department signature/da'to CQMMENTIT S 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 Call Email Date Time Contact Name Doc.Building Pennit 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 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 a Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic y 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 a Photo of H.I.C. And C.S.L. Licenses ti ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract a Mass check Energy Compliance Report o 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 2014 a NO t RTH town ofE ., Andover o —+L AK h ver, Mass, COCMICNtWKn �i9s RATED ►4p,��(5 U BOARD OF HEALTH P E Food/Kitchen RMIT T LD Septic System THIS CERTIFIES THAT ......... .� .I�.r.r�,�► BUILDING INSPECTOR .. .......... -�.......... Foundation has permission to erect .......................... buil4nson .., ..... ........��. ,.,.....,,,,,,,,,,,,,,,,,,, Rough to be occupied as ... .1.. ....... .. . .. . . � .. .. 4/.'L.................... Chimney provided that the person accepting this permit shall in every respect 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI ST TS Rough Service .............. ...... ............................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. I of NORTH , TOWN OF NORTH ANDOVER ,ARD , Q b�, °oma OFFICE OF } A BUILDING DEPARTMENT o b + 1600 Osgood Street,Building 20, Suite 2035 North Andover,Massachusetts 01845 SSACHUSE Gerald A. Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please print DATE: 1 . JOB LOCATION: -._ IP Ay Num,lbe"r__1 - Str et Address Map/Lot HOMEOWNERkjYG1�z� Name Home Phone Work Phone PRESENT MAILING ADDRESS ��, �� -� 'RYto\ 1`O 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 I IO.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 a t he/she comply with said procedures and requirements. HOMEOWNERS SIGNAT APPROVAL OF BUILDING OFFICIAL Revised 8.2015 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 The Commonwealth of Massachusetts Department of IndustrialAceidents I 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. Annlicant Information \ \, Please Print Legibly Name (Business/Organization/Individual): N' �V o\a S ��"`�.1 Address: &1f(fC\_ Qa)a 2A City/State/Zip TMp f` Ar&' VCF Phone#: `f ,3 3 Are you an employer?Check the appropriate box: Type of project(required): I.❑I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.�J I am a sole proprietor or partnership and have no employees working for me in 8. [v�Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 E]Building addition 4.d 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 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.E]I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.ERoof repairs These sub-contractors have employees and have workers'comp.insurance. 6.❑we are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑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. t Homeowners who submit this 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 have employees,they must provide their workers'comp.policy number. I am an employer that is providing 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 verification. I do hereby certify u re pais enaltt of perjury that the information provided above!is,true and correct Si afar . Date: I I I �(� is— Phone#: Cl?I Official 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#: Location No. Date {r . - TOWN OF NORTH ANDOVR Sf . w Certificate of Occupancy $ .' Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 29677 uildi g Inspector