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HomeMy WebLinkAboutBuilding Permit #301-2017 - 50 WOODLEA ROAD 9/20/2016 BUILDING PERMIT NORT!{ E D 'tv O��. . TOWN OF NORTH ANDOVER o� APPLICATION FOR PLAN EXAMINATION 1 19 _ * [•D µ c•' 301- 2017 Date Received �� Permit No#. R'°DR..rED�P"`•c5 ��SSACHU`�E� Date Issued:4�1.9 Z®04 IMPORTANT: Applicant must complete all items on this page LOCATION 6D004 1-L /t Print -' PROPERTY OWNER �f ! � ��z 11-V S &� Print 100 Year Structure yes MAP PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes 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 < TT ®IFI'oo lain fl lNefland -.-. Sepfic� ❑1 Well �p W�a sherd Dis#rs 3 __ t e � W,ater/Sewers - _ DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER- Name: S Phone: Address. �.ts� Phone: Contractor Name. �i� � �--�-- Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BUL DING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 561 0 4w— FEE: $ Check No.: Receipt No.: 30 / 2,3 NOTE: Persons coning wi unre istered contractors do not have access to the guaranty fund = �. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Sw"` g 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 CQMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes I Planning Board Decision: Comments Consenation Decision: Comments !Water & Sewer Connection%Signature& Date Driveway Permit DPW Town ]Engineer: Signature: Located 384 Osgood Street FIREDEP,4R�TMENT ,Tem Dum ster onsite ' �'." r:- � , tit p {p; yes, t _. :�►,o ,: Located ato124 NIaintStr"eet,I ' ti x f {, „�� �_ 2 t r r , ;. Fire D`epahm�_e'nt-'signature COMMENTS` "�O' 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) i ® 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 OTE: 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/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 I Location ,9 4 No.y lam'!- Date 05) w A� • - TOWN OF NORTH ANDOVER �r Certificate of Occupancy $ Building/Frame Permit Fee $� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# �,9 3 Building Inspector f w � �,/ Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 20,000.00 m $ - $ 240.00 Plumbing Fee $ 30.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 30.00 Total fees collected $ 400.00 50 Woodlea Road 301-2017 on 9/20/2016 finish basement with bath N0RT1i Town of ?_ ... e ndover O No. Y o h ver, Mass, �D LAKO COCN.C.2-1c" 1. s V BOARD OF HEALTH ER P MIT T D Food/Kitchen Septic System ou. E THIS CERTIFIES THAT BUILDING INSPECTOR ......... go...........Vis.�............... ll..........�'.1,/..............: has permission to erect . buildings on .... W 00�„�. ,J ......................... Foundation to be occupied as ,!h �...... A A!1 l�Il 0:1!40 IV, Rough p' ........ ...... .....................................................'!�i1 M 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 CONST TI Rough Service .. .. .. ........ ........... ........ Final UIL G INSP CTOR 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. �. n8 Common veca7th ofMass chuse#s s. Department of.XndustrtalAcctderats Y _ .1 coligress steeet,Suite 100 Rogtoa,.A 021142017 www rmass govfi zrz ' sY �c��kexs'CompeazsatzonTnsurance.A�da�t:J3�Iders/Coyt�ac�oxslEleeixzciaxislP�bexs. TO BE MLXD MM T9E PERMM-JNG AVMORITY. ApIieaut Information Please Print I,e�bly Name(Business/DrganizationlCndividtaT): Address: 60 city/state%Zip: Ale &b®(la"x, IVs" © (A�'Phone Arayou an employer?checlitiie app'ropxiale box: Type of project(rgCS[axed): I. l am a employer�rtb. employees(f2land/orpartiime)•* 7: Q ew cozisLxuction n 2.0 lam a sole pmpdob:o or parinerSWP and have no employees workiog forme in 8. KRemo deag .any capacity.[No wo±ers'comp_insurance required] 9. ❑Demolition 3"Q lam.a homeawnerdaing all workmysel;ENO Workers'comp. Usmace required] 10 E Building addition �4_V�LahomeogM_TandwMbehiTkgconfmtorstoconductall-WOkonmyproperfy Iwil1 1 ElectClcalTe 2irsoz�ddi#Iortsensure tib A contractors either have-Workers'compensation in cutanea or are sole Q p proprietors wig no e6p10yees. 12:Q Plumbing repairs or additions 5_F-I I am a general confractar and Ihaye _,dthe sub-eonitactars listzd enthe attached sheer 13_[j R,6 xepaiTs 'These sub-comractorshave employees and have worlmrs'comp-42st,rM0e-- 14.[(Qther 6-El we are acozporai�nn?ndiEs,ocersbave enercised 7ieiizlght ofemprionperMUZ a. 162,§1(4),andwefiavena.employees.jNoworkers'comp.,r,�„ranreragnired.] , : yapplicanttbatehecl�sbax lestalsoirIloutthesec onbelowshawingfiheswnrkers'compensationpolicyi�ormauon. Y Someowners s,*ho sidi�;4��daWitindi"caimgihey are doing allYvorkandthenhi=e outside contractorsmust si7hmit anepv a£$daWr'iindicating such ?Coniractois�at check this b mush a�agfierl an addi[ionzl sheet showing the name ofthe strb contaccom and s�whefilier ormt-rhose eniides Dave employees. Tfthesub-coiacforshaveemployVs. �heymustpravideflseirworkers'comp.policynumber. I ai,2 are erriplayet t1x at zsBr0I;!diig7va keys'compensation insuranceforY�y e �byees 'BeZoiu zs thepolicy acid job site infoiynatiar2. " Insurance Company 2iame: ]?olicy##or Self-ins.Ii G. ExpiratzonDate: R4 0/o Job Site Addxass-so A/0'm City/State/gyp:/ � �D JCn . Attacbacopyoftb v�o &exs' coangex�saitortpolicydeclaration.Page(showing the polzeynumb exandexpirkt~nondate). Failure to secure coverage as require under MCL G. 152, §25A is a criminal violation punishable by a foie up to$1,500.00 and/or one-year liuprisonrn ant,as weI(as civil p enalties in the fozm of a STOP WOR g ORDEFC and a fine of up to$20.0 0 a day against the-violator- A,copy of this s-tatementmay be fozwardedto the Ofnce ofluvesttgatzons of the DIA for insurance coverage verification-- Idahexeb c fyti riepainsandperzaitiesofperj �ytTaatthezjorrrtaiiortgtovzdedabo;�eis te�WCOT�ect Si afore: Date: I Phone#: -7 Official rise onry. Do riot-wxzte in this area,to be corrz_Fleted by city at toiz offiezaz City or Town.• PexmitlLieense# Issuing Authoxity (circle one): 1.Board of Healtll 2.BuildingDepartment 3.Czty/Tovm Clerk �.Electrical Inspector _Plumbing Tns ectoz 6.Other Co)atact Person: Phone#�: taformation and Instructions Massachusetts General Laws chapter X52 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an empkyee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." Au•employer is.defined as"an individual,partnership,associafion,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enferprhe,and including the legal representatives of a deceased employer,ox the receiver'or trustee of ail individual,partnership,also ciation or other legal entity,employing employees. However the owner of a dwelling house having not more than tbree apartments and who resides therein,or-Ehe occupant ofthe 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 be deemed to be an employer_" MGL chapter 152,§25C(6)also states that"every state or to cal licensing agency shall withhold the issuance or renewal of a license or pexmit to operate a busirLess or to cousixuct buildings iu the con Mo-nweaM for any appucaut-RO lias not produced acceptable evidence of compliance-with the msuxanee coverage required." Additionally,MGL chapter 152,§25C(7)states`Neifter the commonwealth nor any ofits 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 beenpresented to the contracting authority." Applicants Please 1111,out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub=couftactoi(s)name(s),addresses)and-phone numb er(s)along with their certif[cate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Pattaerships(LLP)withno employees'o-therthan the members orpartaers,are notrequiredto caaryworkers' compensation insurance. IfaaTLC or LLP doeshave employees,apolicyisrequired- Be advised that this affidavit may besubmitted tothe Departmentof-Ifrdustdal Accidence for confmration ofinsurance coverage_ Also be sure to sign and date the affidavit. The ofCzdavit should be retarn:ed 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 ox if you•are xequired to obtain a workers' comp ensatioA policy,please call the Department.at the number listed below. Self-in=6d companies should'enter their self-insuranoe license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department haoprovided 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. I'Iease be sure to fill in'�he penuit/license numb er which wall be used as areference number. In addition,an applicant that must submit multiple,p ermit/license applications in any given year,need only submit one affidavit indicating current poli6y information(ifnecessary)and under"lob 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 maybe provided to the applicant as proof that a valid affidavit is on file fox future permits or licenses. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit notrelated to any business or commercial venture (i.e.a dog license or permit to bum 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 TOW, N'OF NORTH ANDOVER mcr :._ OFFICE OF 1600 Osgood Street,Building 20, Suite 2035 +L North Andover,Massachusetts 01845 Gerald A. Brown Telephone(978)688-9545 Inspector of Buildings, Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPUCATtON Please print DATE: 2-0 -2-016 JOB LOCATION: 50 Ge�j - 4Cd1jt Numbers� Street Address Map/Lot HOMEOWNER '-(-4 /� 4 k4AA'7_N/ '?7F 0GSIR'/aRV f Name Home Phone Work Phone PRESENT MAILING ADDRESS O �V&64,e-* I&M 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 su erp visor. 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 r ements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL &A Revised 8.2015 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 683-9535 6-8" Sewer Ra sa n e n Notes: �. Doors - 36" _.......:----.__.. New 32" Entry door % Utility access doors for sewer and pump Proposed New stair railings to be decided Bath - Ejection Flooring to be decided 43 pump NEW /3'0"► Sprinkler Head - Electric r Storage Area Panel co b Louvered Door Area M - 2 8 __... ..__ Sprinkler Heads i O H2O In Ceiling Height 93" (84"where forced air duct is) - - H'Wb ,i NEW j Qolumn -- N Sprinkler Head _.__.. Fz�Qon UFurnace ' O Sprinkler Sys 44'4"k r Finished Ceiling Height 88" b F14' Sprinkler Head Play Area O — Sprinkler Head "/ �- (Ceiling well.........__.. ..................... , � for door Air swing) — aD 0 a0 (Box out around r -- 12'8"►- b Duct : --- - air dud 83"finish) ! o --@WSt-udy (Add 18x 4 j ��Ii I 1�3 0 ► slide win ) ------ 128'8"► _............- Window