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Home My WebLink AboutBuilding Permit #378 - 52 RIDGE WAY 10/27/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0:�� Date Received Date Issued: v f IMP TANT:Applicant must complete all items on this page LOCATION Z Wy Print PROPERTY OWNER Unit# Print MAP NO. b PARCEL:ZONING DISTRICT: Historic District yes nN Machine Shop Village yes 'No 100 year-old structure yes `moo TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building kOne family ❑Addition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic ell D oodplain ®We lands a ers ed +istrict Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: )(Identification P ase Tyke or Print Clearly) OWNER: Name: ( (/V Phone ��S�r3U Address: Cj z tbC?(-z &VA�-y CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �� FEE: $ Check No.: Receipt No.: a NOTE: Person contraing with �reg&tered 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 ❑ 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 COMMENTS i Zoning Boardcof 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 iI 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.$10041000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date L Doc:.Building Permit Revised 2011 June/mi 1 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 Li 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: Doc.Building Permit Revised 2008mi Location 6 —_No. Date a _ ` MpRTM TOWN OF NORTH ANDOVER f P i � } ° Certificate of Occupancy $ IT �cMus 6 Building/Frame Permit Fee $ � J Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 24769 Building Inspector NORTH 0 Of ov e r qq O .;vim, No. 3 70 _ o , �` lover, Mass., if0 LAKE •♦l COCAKE HICHEWICK y�. % 4 A?ATED p'P \1.1 Cl `S U BOARD OF HEALTH } Food/Kitchen Septic System PERMIT T DBUILDING INSPECTOR THIS CERTIFIES THAT......' .!J�h.................... .. w..R.��...... .................................................... Foundation has permission to erect........................................ buildings on ..... ......... .. AS... 0..................... Rough c .. .... .... ... .......M. 1..:... '-�....... Chimney to be occupied as......... .....1.eA.t..... ............ ...........��................ . . provided that the person accepting this permit shall in every respect conform to the terms o 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 IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU ST Rough ........... ............ .... .......................... .................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. The Commonwealth of Massachusetts Department o �dustrial�Iccidents Off e oflnvestigations 60 Washington Street Boston,ALL 02111 'Y www.`mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pdmbrs A licant InformationPlease Prin Name(Business/Organization/Individual): PA-VIAI Address: City/State/Zip: D/l i 1/✓170//' Phone [31 an employer?Check the appropriate bo a employer with 4. am a general contractor d e of project(required): loyees(full and/or part-time).* have hired the sub-contract ❑New construction a sole proprietor or partner- listed onfhe attached sheet 7• RRem.odeling and have no employeesThese sub-contractors ha 8. ❑Demoliti ing for me in any capacity. workers'comp,ins c�workers'comp.insurance 5. ❑ We are a corpor 'onan s9 g addition red.] .officers have ercise 1 •' Electrical repairs or additions a homeowner doing all work right of mption pe NIG 11.❑Plumbing repairs or additions lf. [No workers'comp. c.l §1 4 and wno ance required.]s ployees.)[No ers' 12.❑Roofrepairs comp,incurce required.] 13.❑Other *Any applicant that checks box#1 must also fill out the s tion below s ing their workers'compensation policy information. T Homeowners who submit this affidavit indicating th are doin work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an ad tion bet showing the name of the sub-contractors and their workers'comp,policy information. I am an employer that is providing w' ers'compensation insurance for my employees. Below is the policy and job site infopmation. Insurance Company Name: Policy#or Self-ins.Lie.#: 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1•do hereby cer under thepains and enaldes o ` e P P fperjury that the information provided above is true and correct 3i nature: or Date: 0(_ r-z 'hone#: t [coj FOf only. Donot writein this area,to be completed by city or town official n: 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#: F }1°RTH 4. TOWN OF NORTH ANDOVER Ot�1�no 0 °� OFFICE OF BUILDING DEPARTMENT a . ,P^* .;1600 Osgood Street Building 20,-Suite 2-36 North Andover,Massachusetts 01845 gC►+us Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER-LICENSE EXEMPTION BUIDING PERYHT APPLICATION Please print DATE: JOB LOCATION: S'Z. �.(12 Iz-: Number Street Address Map/Lot HOMEOWNER 0,4VIIV 1,16A,7 G,e Cl 74 Name Home Phone Work Phone PRESENT MAILING ADDRESS - City Towp lip Code The current exemption for"homeowners"was extended to include owner-occtipied dwellings to two units or less and to allow such homeoj=,mers 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 Awns 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 constructs 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 Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530f HEALTH 688-9540 PUNNING 688-9535 a Alt A•73.-f. .94 24-va All A1?--N YP 9P F-I O