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HomeMy WebLinkAboutBuilding Permit #56-16 - 512 MASSACHUSETTS AVENUE 7/13/2015 BUILDING PERMIT NORTH +O _ O��SLE D'h6 1 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION � �j Date Received A°R�reD�Pay�y Permit No#: v � "VSs s�4 ACHU Date Issued: �1 I f s 1IMPORTANT: Applicant must complete all items on this page LOCATION f `S S !q Ve Print PROPERTY OWNERC int 100 Year Structure yes o' MAP (D "� PARCEI_06! ZONING DISTRICT: Historic District yes Machine Shop Village yes n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building v6ne family ❑Addition ❑Two or more family ❑ Industrial MAlteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg. ❑ Others: ❑ Demolition ❑ Other _ D Septic ❑�1Nell ❑+FI'o�odplatrt Weflands' ❑ 4UVatershed iDistnct z ❑`Wate_r•/Sewer„ DESCRIPTION OF WORK TO BE PERFORMED: -j q f x ' cvnG Identification- flease Type or Print Clearly OWNER: Name: 5'-kvQ a exi l Phone: 17d Address: GJ o2 M Cl S-S PV1, Contractor Na : Geo ' Rkv 10 Phone: -1 7 o q OCA41 Email: 1 Address: 1�Q 1`Gil A �21,�- 1�a03 -S'14 3 Supervisor's Construction License: CS OFq 962 Exp. Date: (Q OL Home Improvement License: 30�`"l I q Exp. Date:(0 — ! -1 —d o ARCHITECT/ENGINEER Phone: Address: Reg. No. ON$125.00 PER S.F. FEE SCHEDULE:BULDING PERMIT.,1L$12.00 PER$101000.00 OF THE TOTAL ESTIMATED COST BASED Total Project Cost: $ La bar Re- i 0©Q ,D6 FEE: $ Check No.: e-Z> Receipt No.: diol NOTE: Persons contracting with unregistered contractors do not have acc ss to the guaranty and d n — — ,� _� 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 i vit ot--- Photo Copy H.I.0 And/Or C.S.L. Licenses Copy of Contrac 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 _l New Construction (Single and Two Family) Building Pp Permit Application 4 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 II I I Doc:Building Permit Revised 2014 I i Dimension Number of Stories: Totals square feet of floor area based on Exterior q dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, avast 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-$1000 fine NOTES and DATA— (For department use) ® Notified for pickup Call Email { Date Time Contact Name l Doc.Building Permit Revised 2014 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ ' TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMEN"T"S CONSERVATION Reviewed on Signature � COMMENTS WEALTH Reviewed on Signature COMMENTS i Zoninn Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit ]DPW'gown Engineer: Signature: Located 384 Osgood Street SFIRED � Iil1EN r: , - 4 ;� e�; :. . ;.: E ,. EPARTT TempDumpsteraon site, }y n� _ y ono � • A if KtLtocated a1�24 Main)Street9 ,,# r. •+�R��/''e.s'•,-�"�At;l is •$�'`� 'aw 4 5tt`-.i 3 s�t''.�j;+�w �YL yY' _ x . _ FireDepartme"n" signature/date° 4Y yf •� � oar �+{f4 4� 9R ftft- m, �•tp,.,,,,Yv �4r>I.t`.:.t ILA,2.wr.•t!. •..-.ti.�•+.� c- �; t� `f�,�/; i c. ;�.� "S Z k �l� x i„ f a� :, r';�. r, -t, S 7 j,' � Location tea, No.41, Date y . - TOWN OF NORTH ANDOVER x o i 9c` Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ 1 IN '"' Other Permit Fee $ TOTAL :. $ Check# Building Inspector F NORT N own of . � E ndover - to No. ��—���j * �� - soh ver, Mass, A_ cocmlc"Imc. ' 7�A�RATEO p. 5 S V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THATN.�i... 4�'. BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ......... . i11A 49..JAV.!t.R. . ....... .. . ........ Rough to be occupied as .... ....... .....� .. .... . ..1.. . ....... .. Pl ................ Chimney provided that the person actpting this permits all 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 M S ELECTRICAL INSPECTOR UNLESS CONSTRUCT T Rough Service ............... ... ........ Final BUILDING INSPECTOR 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. JOB CONTRACT Company Name Contractor: &"4r4l m olrp Owner Address: I Address: i s V Cv� o� � S Ave Phone: (0(4,41Phone#: Email 9� T-490 q - E-mail q77' S93 �7-7y : i l " ( cbrvy LABOR u r +l %'�I0 � 0'n r CL _7 ®Sr V 0A CL lAn o S pd-vii 606d ` s MCL Q k Gd CbMi0le4e, eel w,` .r`. t h � �•� a card 0 o S;. . r -S di c 9 v Ja So + C w Vii `kl s l ^ Q ; f TOTAL Owner agrees and obligates him/herself to pay Contractor the sum of! Total amount shall be paid to Contractor from Owner letionproject. immediately upon on conip of A DEPOSIT of$.That leaves a balance of$to be paid when Contract is Completed. Property debris and surplus material creted by the operation will be removed by Contractor. Materials 4'111be supplied by 1-by)y dW 54eye uq XL4K�1 X Contractor &"Ura 1my r r k� OWNER Company Name North Andover MIMAP June 8, 2015 ,,T*s' M t ..w , .•t. ,psi a .�� "Wil 7 T F, . Be a 0 , c q venue Bay °n A *# r: 1. ." c Interstates - —SR Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, ' --Roads - Meters Data Sources:The data for this map was produced by Merrimack NORTH Valley Planning Commission(MVPC)using data provided by the Town of %7,Easements Of t rs q� North Andover.Additional data provided by the Executive Office of E3 MVPC Boundary 2b b� +6 CO - Environmental Affairs/MassGIS.The information depicted on this map is ❑Parcelsf p for planning purposes only.It may not be adequate for legal boundary - definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING 11 ; THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY • s + { OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT oma+ r ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF �l,' o+•+bo��,�4g THIS INFORMATION SSAC14US� 1"=44ft ^� F S 3 •�'s rr ai � { +Ilk`'r � � �"t i/J ���,,,yy ''�+�e`'`��� ;jlt i .�� � f a �., �4 � ��Pr „ 144 ''.'w a".� T r�' .. < ,�A _x � �, y� F✓,s?'�4`r � y�'a s! y�«�>~ ;�r,�tita �," { i s x ,. �` 1},r s r_.. � .� v-. *4 s�� �w�7 fi �.#,� Y ''/.. � Ak � - ,f Y % ,•Y*,.! , - 44. 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" y ; North Andover MIMAP June 8, 2015 I645�G=0052; 045�.G o005;Ij. _- (045B 00'60 �� .145 BEACO HILL B V y 404§190059't 141 1155 BEACON HILL Mp) 1�3 6ea°on�1i11 Do 99' _ 174' "��lJ :045�:6 0055 ti�'40 BEACON HILL BL Oy5.„ B: oo575� MASS'ACIUSETTS i4VE 045E OOOe3; Mas ` 01, nue 6a�°n Ave ��Q�O e !-0745 BB OQ35 X33 1514 NI�ASSAG, SE�T��11AVE s' X505 M�ASSAC�U�E55��S�AUE 65' gaY State R°ad Rail Line Wetlands Zoning Interstates O Exempt Lands G Busine s t DistncI sine s 2 Distract Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, SR C Busine s 3 Dislnct - Meters Data Sources:The data for this map was produced by Merrimack c Busine s 4 Distract HQRTM Valley Planning Commission(MVPC)using data provided by the Town of Roads C Gene Business District Of �`�a 9� North Andover.Additional data provided by the Executive Office of C�Easements O Planne Commercial Dev. ? 0*4 re�e 00 - Environmental Affairs/MassGIS.The information depicted on this map is 4'A Corrido Development Dist 3 L for planning purposes only.It may not be adequate for legal bounds MVPC Boundary 12 Corrido Development Dist O in _ N y 4 g boundary definition NO TOWNOFD,NORTH CONCRNIN(; Q Municipal Boundary O Corrido Development Dist �' .• 9 MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING ?G:Industn I 1 District Zoning Overlay • * THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY TE Industri 12 District ,n i OF THESE DATA,THE TOWN OF NORTH ANDOVER DOES NOT 8 Adult Entertainment • s d Industri I3 District ❑Downtown Overlay District •.o Myr �� i ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF ©Historic District d Industri I S District • 0 Water Protection Reside ce 1 District THIS INFORMATION ii Reside ce 2 Distract SSA�NUS� ❑Parcels a Reside ce 3 District B Hydrographic Features de ce 4 District —Streams ”=44 ft de ce 5 Distncl tde ce 6 District ".g.Zesid.nitzl District AV 2 a { q jfyt s dF . I p t The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/L+lectricians/Plumbers. TO BE FILED WITH THE PERNHTTING AUTHORITY. please Print LegjhLY A licant Information �,-n ' Name(Business/Organization/Individual): T' Address: e- zv KH , Phone#: 0 ✓ Q a "' _l City/State/Zip: We, Are you an employer?Check the appropriate box: Type of project(required); to Rill and/or part-time).* 7. 0 New'construction 1.Q I am a employer with em P Yees( 2.V1 am a sole proprietor or partnership and have no employees working for me in 8. []Remodeling any capacity.[No workers'comp.insurance required.] 9. 0 Demolition 3.0 I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 0 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.0 Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole , proprietors with no.employe6s. 1Z.E]Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 110 R06f repairs 1 These sub-contractors have employees and have workers'comp.insuranceJ 14.1C]Other E_b l"r' _, `_ 6.F]We are a corporation and its,officers have exercised their right of'exemption per MGL c. 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: Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. sheet showing the name of the sub-contractors and state whether or not those entities,have $Contractors that check this box must attached an additional employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. Yam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Expiration Date:. Policy#or Self-ins.Lic.#: City/State/Zip: Job Site Address: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ift up to Failure to secure coverage as required under MGL c• 152,tiWOand a fine of up to $250.00 a violation RK ORDER punishable and/or one-year imprisonment,as well as civil penalties in the form of as STOP day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. Ido hereby certify u er the ains and penalties of perjury that the information provided above is true anorrect. Date: (1 Signature: Phone#: vnn t 0 q 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 Phone#• Contact Person: i Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their empl`o`yees. 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 d'efiried as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including 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 apartments and who resides therein,or the occupant of the 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 local licensing agency shall withhold the issuance or renewal of a license or permit to 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 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 certificates)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 affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance 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 Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number 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 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 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 license or permit to burn 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 Massachusetts -Department of Public Safety Board of Building Regulations ulations and Standards Construction Supervisor -License: CS-108482 GEOFFREY MURPHY y, 2 FELICIA DRIVE Zn Newton NH 03859 y l f I i _ f' y� Expiration Commissioner 06/08/2018 � �' ,tee C��ae�pooy�yzoa2usea�f�o���cxv�ac�iccueG� i -\ Office of Consumer Affairs&Business Regulation 1 _ OME IMPROVEMENT CONTRACTOR egistrationt182419 Type: Expiration ti/19/2017Individual i GEOFFREY R.MURPHYs:, i GEOFFREY MURPHY 2 FELICIA DRI VE `;i, ,�.>�� oil '4:-c -��'.•�,��_—�_ a NEWTON,NH 03858 Undersecretary S i