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Home My WebLink AboutBuilding Permit #297-15 - 51 BRIGHTWOOD AVENUE 9/24/2014 NORTH BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION �0 �7 Permit No#: Date Received � gDRA7ED gSSAGHUS�� i Date Issued: Iq kPORTANT: Applicant must complete all items on this page 9,ie-1 M . LOCATION d I _ Pin _ 1 PROPERTY OWNER �arj) n tint 100.Year Structure yes no � MAP� PARCEL: y 1a 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 PERFORMED: c Identification ase Type or Print Clearly OWNER: Name: Phone: ZAQ Z=0 Address: • Contractor Name: _ _ Phone: Address:. vv 1,J Supervisor's Construction License: Exp. Date: _. Home Improvement License: Exp. Date: I 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: $ FEE: $ Check No.: Receipt No.: 2! to (P NOTE: Persons contracth g with unregistered contractors do not have access to the guaranty fund Signature of Agent/Own _ Signature of contractor Location No. [—l Date c-bq • - TOWN OF NORTH ANDOVER • Sib r��' • • Certificate of Occupancy $ Building/Frame Permit Fee s:55o Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# O( n All uv :3J t `� Building Inspector Plans Submitted ❑ Plans Waived 0 Certified Plot Plan ❑ Stamped Plans ❑ TYPE"OF SEWERAGE DISPOSAL Public Sewer ❑ Swimming Pools ❑ Tanning/Massage/Body Art ❑ 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 t 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) i ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit 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 o 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/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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o ❑ 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 thea appeal period is over. The applicant must then et this recorded at the Registry of Deeds. One copy and proof of recording PP P PP g g Y P must be submitted with the building application Doe:Building Permit Revised 2014 *211274450* 10/22/2014 NSF NSF _ 000000743677136 0 *211274450s This is a LEGAL COPY of your —0 ru 10/08/2014 check.You can use it the same O 000000703346001 C3 E*TRADE 1006 way you would use the original Lr)"0 ru JEANNE C.DONOVAN C O M P L 6T E rnien.i--ftfayov —0 Qu 51BRIGHfW000AVE Check. CQ11-1 w2y y You on,w ft miom l rl� VA 01816 1e-7767/IW NORTH ANDOVER, 01 woy you wouk uw tl»alpYrl c0 ' RETURN REASON (A) p �C3 -a 7 "�� NOT .yUFFICIENT FUNDS �,� NOT S�FFICEI °N (A) Lqa pay -0 ENT FUNDS 'n Order run Cash Letter 1 of 1 r%--F9i �L tW 1.1' Ln. r Dollen 8 l Bundle 1 of 1 O tnuww y W~4 ve 18 Item 1 of 1 o o o ED M O'er arU O 0 ru trot _C3 r=1 " 1:0560735?31: 62?2?436 M _,.. ... _.. _.. 0 d 41:0560735731:627274361' 006 o'0000003000r1' 40:0560 ? 35 ? 31:6 2 ? 2 ?Le36ne X006 It'000000300011' 074909962 10/20/2014 000008670192178 06MO0146 10/20/2014 000002382005301 t 056073573 10/21/2014 _ 000002382005301 061000146 10/22/2014 — 000002418642737 *211274450* 10/22/2014 0000007436771360 074909962 10/06/2014 000009980368939 061000146 10/06/2014 000002142903730 056073573 10/07/2014 000002142903730 061000146 10/08/2014 000002184646598 08 *211274450* 10/ /2014 000000703346001 0 n N f0 N�p C'4 ,.. gRTH rl Roi.Pc!gt5T ONLY .OW Tf I ANDOVEF 0 ccou f 0 o 0 c+> rn N M pr N U) c >03120 < 10/16/2 14 00E MV..r.�D485O.6 . *>21127� $ 10/16/ 014 >oN 9MP6 0 q8816 *>2112�11 /02/2014 0 jorg5558816 ~ 0 #3 Bank ACCT# 8245912840 DATE: 10/22/2014 America's Most Convenient Bank® 800-747-7000 TD BANK NA P O BOX 1377 1Q LEWISTON,ME 04243-1377 TOWN OF NORTH ANDOVER ,CI C k ' L/ DEPOSITORY ACCOUNT �`t �V�y� cS 120 MAIN ST NORTH ANDOVER MA 01845 THE FOLLOWING ITEMS)THAT WERE DEPOSIT N RNED UNPAID. WE HAVE DEBITED YOUR ACCOUNT '.S WILL BE REFLECTED ON YOUR MONTHLY ANALYSIS :)R CONCERNS,PLEASE CONTACT US AT THE NUMI CHECK# DEPOSIT DATE CHECK AMOUNT REFERENCE# RETURN REASON 1006 10/16/2014 30.00 726048506 NON SUFFICIENT FUNDS TOTAL ITEMS 1 TOTAL AMOUNT $30.00 G— l I f n 99 #3 Bank ACCT# 8245912840 DATE: 10/22/2014 America's Most Convenient Bank® 800-747-7000 TD BANK NA P O BOX 1377 LEWISTON,ME 04243-1377 TOWN OF NORTH ANDOVER DEPOSITORY ACCOUNT 120 MAIN ST NORTH ANDOVER MA 01845 THE FOLLOWING ITEM(S)THAT WERE DEPOSITED INTO ACCT#8245912840 HAVE BEEN RETURNED UNPAID. WE HAVE DEBITED YOUR ACCOUNT AS INDICATED BELOW. THE ASSOCIATED FEES WILL BE REFLECTED ON YOUR MONTHLY ANALYSIS STATEMENT. IF YOU HAVE ANY QUESTIONS OR CONCERNS,PLEASE CONTACT US AT THE NUMBER LISTED ABOVE. CHECK# DEPOSIT DATE CHECK AMOUNT REFERENCE# RETURN REASON 1006 10/16/2014 30.00 726048506 NON SUFFICIENT FUNDS O { TOTAL ITEM(S) 1 TOTAL AMOUNT $30.00 n 99 De, r offlee of-WesiigafeonY 00 Waskinet?.11 aSYreed Hoytov.,AM 02111 www-muss go-v1did Worckex$i C-fo)npensatiou bsurance Afflawit:J u c er�,�f�o c oxo lEXc� reiczan l 'a ie c, tj aaut hformflon Please,VrlutLo 'fix Nagle(Bushlossforga9zagona.(Rvid,zai): 040 - _ Address: � A eyouanemployer?Ckteel the appropriateraoxr Typo of project(regmlred): . Jam a general confractor and S 1.Q I am a ex3nployerwith � �_____. 6. [j Xew c6nsfrtzc6oiz employees(ialla�c7lox a fitne}T h.avenedthe mb-confxactoms r 7. ��-emodeTing 2.Q S an-1..a solo proprietor orpa lAU" listed on aftached shaef� ship annaveno.employces These mb-covtraetors have 8. �[Demolzfion woriung forme is anycapacity, workers'comp.insurance. g, []Building addition PTO worl<-erS' �camp'insurance S. Q we axe a coxpora[ion anclits 10. Bleofricp alxe airs ox adcliflons cictired.� o�tcemleave exereised.thelr ,., work rdght OIL exemption perMGli 1. [Plumbing xepairs ox additions 3.{�.l am a homeowner�o�tg a11 myself.UTO workerscomp. c.1.52,§1(4),andwehaveno 12.pPoofxepairs insrzranc�zeed.�i employees.[Nb workers' 13.0 other comp.insnranco mquired l •� sEalsof711ouifbesecfionbeldwshowingthearwbrkers'compensatioupolicy'informatiou. ' 'ean�Chas checks box�1 mu • a Iz ►-r- meovrners�vho submiftbisafddaviEindreating�ey�'redoing altvrorT�andfbenbueoursidecontractors ruustsubmfanewaffidapitindicaffigs'uch. xConiracforsiha�cbeckfhisboxmusGaffacbedauaddifienalskeershov�ingfbenameofthesuh-eonfracforsandtheirorkers'comp.policyinfarmazion. r text ern day �dial igprovIdIng Workers,corptpet2satiar�insr��araea fo��-y er�Ioyees,, �3o w ISAgvalie w9job life irZ•faa�raaatiorx. lummee CompanyName:. Policy it or sel imylic.#: ExpirafionDate: lob Site,Addraw CityfSfate/dip: ttaeSx a copy oz t�ewoxke&compensationTolicy declaration page(showing•the policy'nmahor and q*atloo elate). `silure to secures coverage as xegrdrec�under Section of MOL c.152 can.leadto the imposNon ofcximinall3enalfzes of :be. to 50fl.00andraxone-yearimpxiso nert xaswell-aschlpenarhesintheforteofaSTOP OR1 ORDER andafzne : P 1 $ of-ep to$25Q.OD a day agaiv 9tfzeviolatoz: 13e advised that a copynfthb sfatem.en-tmay'be fawardedto the 0frtce oz• hVesdgatgolm of: o DIA.fox fi'=ame coverage veriffcafion, xtfo iie.�eby fy zr�ide inn a. rl ve7 alfles af.pe.�T IV triattria ire,�onaftam provided a7oYe is true a d eo��ect. i Sz atare. Date. 'hone# WSJ ��2�C7 O�ciaZ tt��o�rry. 11a r2o�W�iie in tries a�e[�,to tie co�reted riy cies o.�taruxz o�eiai I City or Tonin: Berxnztl�icenso# l f8m)ag.Autlxor1tg'(circle oja*- 1.Board of ealtlr 2,BuiSc7z�agJ�eparfinexrt �.�zlyf7Cowa clerk ButnbingInspector- f.Other Information and Instructions . . Massachusetts GeneralLaws chapter 152—requires an employers topxovideworkexs'comp ensationfoxEokamployees, Pursnaat to this statate,an errs,070yee is defined es",.,every person i the service of another under any contract of hire; • express onim�lied,oral orwxitten:' . Auer roy?ris deizned as"an-individual,paxinexship,association,corporation or otherlogal entity,ox apy-, oxznoxe, ofthe foxagoing engaged in anoint enterprise,and including tho legal xepxesentatives of a'deceased elnplo�ex,.or tha xedeivex ortCristee ofanhtdividual,partnership,associaflon or other legal entity,employ ng employees. 5owevexiha owneroi a dwelkghowehavingnot7noxethmthtea apartments audwhoxeszdes tihere4 orthe occupantofgo dwelt�g house o;another who employs,persons to da anaintenance,consft�zction oxxepaix work on such,dwelling house or onthogrounds orbui&g appuxtenantthereto shallnot because,of such employm.entbe deemedto be an employer;" MQL chaptex 152,§25C(6)also states that"every state or Weal lic-ening agency shall withitold the issuance or renewal of a license ox permit to operate a husMess or to construct hodiugs in the commonwealth for any aplrlic"t who lias not pro duced.acceptable evidence of cornp7iaxtee With the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"N'either the commonwealth nor any of its political subdivisions shall enter into any contract for ilia performance ofpublic workunQ acceptable evidence of coxnplianca with the insurance, xequiremenfs ofthis chaptexhave beenpresentedta the cortfxacting authority .c�ppucattts Pleas:M out the workers'compensation affidavit completely,by chor ft the boxes that apply to Yom situation and,if necessary,supply sub-contractox(s)name(s),addresses)and�ltonenumbex(s)alangwitb.their cexti�cafe(s)of insurance, .LimitedVablkCompanies(LLC)or Limited LiabilityPartnerships(up)with no employees other thm10 members or partners,are notxequiredto can7workers'compensati.cuh suxance. an LLC or LLP doeshave employees,apolloyisxequired. Be advisedtliatifiis afdavitrnaybe submifiedto theDepartment of Industrial Accidentf for conf5xmation of insurance eovexage. .Also be sura to sign and date the afdavz. the amdavit should bexetumadto the GiV or town.thatthe applicatignr"oxthepemiit orlicense isbeingregaoited,snotteDe�axtment of .l'trdustrialAccidenfs. Shouldyouhave.any VasUonsregarding the law orifyou axexecfuiied to obtaia•ay,0Aors' compensationpolicy,Please call thaDgpartmentatftmunber listed below. Saf&iuguradcompaniesshould entextheix seli~insurance license number on the appxopxiafe ling. City or Tom Officials Measebesuxethatiheafzdav%tiscomplete andpxintecllegibly. T$eDepa�tmenthas�pxovicledaspaeeattlzehofto�n ox the,al clavzt f'ox yon to�Il out xn.tTia evenE the Office oflitvestigatlons has to cantactyou regarding the ap�lZcant: - f'lease beluxe to z"+Ilinihepennxf/ficextsenumbex whielzwill be used as a zefexencenumber, k addition,an applicant fheL:I oust submit-multiple pemit/.ficense applicat10ns:h any given year,treed only submit one affydavit indicating current policy information(ic�'necessaxy)and under"hb Site Address"the applicant shouldwxito"all locations in (city ox aowh)"A copyo£tlieaitidavi4thathasbeOnoificiallysziainpedoxmarkedbytheeityortovvnmaybepxovidedtoto applicantasprflo thatavalidafitdavit1soni7le orrLifuepennitsorlicenses. Anew aztxdavitmustbeffiledouteaclt year:Where ahome owner orcitizen is obtaining a license ox,pemtitnotxelatedto anybusiams or commercial venture (i.e.a cloglicense orpetmitto bum leaves etc)saidperson is NOTxequiradto complete the afi"zdavii. The Office of JnWstlga&ns would Me,to thank you in advance fox youx coop exation and sb ould yotr have any questions, please do no i hesitate to give us a call. . The Department's address,telephone ahc1faxnumbex: The CQ 011wGam ofmaw—a rd-wPtW �t�pa .e��Q��?1��t �a�,Q.cc�c�e�.t� • 64[ 4b1-ngtQ:a xe :Rostm, 02111 TO,, 617-72&49,00 W406 Qr 1-$77-MM Rovised526-05 ft617"M"7749 TOWN f N VFi,'I V.LS.TH AND OVjp . �°� 011TICE OF - BUiI IDI NG DE-'AR.TAWNT • ' �•"y :'1.600DBkoodStreet$tlifft20,•Surte2-36 North Andover,Massachusetts 01 845 S R�Nus� , GexaldA.Brown Telephone(978)698-9545 Inspeeforof$uildings - fax (978)688-9542 x(DyMQV-MR 1QENSEtXENjPTION 13MING PEWWW•P'1'LICAT.I ON Please print DATE: q SOB LO CA.TtN•: Y 1� Number Sfreet ddress MapJLot 208 t� Name. Rome Phone Workphone 'RESENT MAILING ADDRESSM,Tmm- . .. ------------ dip Codp- 'Ihe current exernpiion foz"homeowners"was extended to inchideowper--occupied dZyel�r gs go i�vo units-DY-11 ems,and to aI1o� su,h homPo;risers to engage anindividual•forbire,who does notpossess add VoE,provided unts oems,a acts as supeztrisor). StateBuilding (Code Seeuon I)MMITION OFHO,iAMC)WNER, Persons)who Awns aparcel ofland on which he/she resides or .one home i into to reside,on which there is,oris intended to + b�-'a one or two Family stmctares. A person.who constructs more tliatn a twoycarpmiod shall not be considered ahomeowner. The undersigned"hontedwnex"assumes responsibility forcompHances with the State Building Code and other Applicable codes,by Iaws,rules andxegvlalaons. c Tho undersigned"bomeowne 'Corti fies at he/sheunderstauds the TownofNorthAndoverBuildingDearfinent n'n;m inspection pzocedures and req ements and that Ire/she will comply withtsaid procedures and requirements, HOAMDW ERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 7.200.9 Fomn Romeowners Exmn2tion SOARl]OFAPPBATS 688-9541r r COITSBRV AMN 688-9530 DEALTH 688-9540 • pLANNING 689-953i