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Home My WebLink AboutBuilding Permit #178 - 55 MILK STREET 9/2/2006 yORTF1 BUILDING PERMIT 0 q%Ao 06 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: / / Date Received SSwCH►15� Date Issued: -2 IMPORTANT: Applicant must complete all items on this page LOCATION 57- Milk nffe-e_t Print PROPERTY OWNER_ I'` 0,-t he.c'1rW_ Low CQYCL Print MAP NO:, PARCEL: ,3 I-ZONING DISTRICT: Historic District yes no !Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New BuildingOne famiI 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 PREFORMED: _ 7Q_ e_ c1=n 0- 3 +boi- non-cue irax f be ri (1k)(1 0 ukth n e 1 D oth CQ Q i'sS o S , Re - shl na lo- Ot y-n ] _ riof Identification Please Type or Print Clearly) OWNER: Name: 6afftbrg�_ Cram Phone: q79- Address: SSLJIJk St 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$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ADD —)—FEE: $ ,EO Check No.: � Receipt No.: 2a ___;�!z NOTE: Persons c retracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/OwnerSignature of contractor 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 ❑ 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 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 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.s100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 Location No. Date r I NORT1y TOWN OF NORTH ANDOVER • ; ; Certificate of Occupancy $ $._rev '••� Building/Frame Permit Fee $ l ACMUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ G Check # (' r �j NMding Inspector NORTH To" of : Andover 0 dower, Mass., T O LA COCMICMEWICK V ORATED S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System > / BUILDING INSPECTOR THIS CERTIFIES THAT........ 1... ........ ,. <^!r...... G? -t..-'.................................................... Foundation has permission to erect........................................ buildings on ...15 ....x??! .... ........................................ Rough 170 to be occupied as.... . �c� --..G✓ f .f.�e�.../L�e. ......�....... .. ?? Z�e Chimney provided that the person accepting this permit shall in every respect conform to the terms the a pliFinal 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 PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRU ON STARTS Rough ............................................... Service BUI 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. ,AORTH TOWN OF NORTH ANDOVER OFFICE OF �? 6E,t .••6 OL A BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 roo ay North Andover,Massachusetts 01845 �Ss/tCHUS�i Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please print DATEA - 1 - 09 JOB LOCATION: J 5 M 1 k Sree� Number Street Address Map/Lot HOMEOWNER�-�1'19 r1 , LjO W COIrGs- 9 7F- g (o Name Home Phone Work Phone PRESENT MAILING ADDRESS S-,5- tM Sfi k) A nd o v-e r MA S City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners 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 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 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 ,I1 Q l.Lt �Yll� APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 the tomrriM7Weaft of 1V=achuse#ts • r kf � Dep�e�of 1'nrfi�strial Accident - 0 f Investzgafioas 600 Tdfashirr ,on Street c7 Bort, MA 02111 Workers, ComperlslLtio,a �� rf zassgov/iia , A iicant Infflrma>Eion Affidavit Bra tiers/Contractors/Eiectriciants/Plumbers Please Print LeQihi Name (B+si�ssl0rgani�on4ndMdual); ' Address: r� CitylSt$tv/Z.ig; Are you all emPioyerl Cheek.the aPPr'oPriste.box: �— I: I u3nn a empiayer with 4. am a contractor end I Type of Projeet(required): ❑ 1 gflrteral . Ploy (full and/or part-time).* nave hired the sub- 6• ❑Naw caristruciion . 2. I am.a.sole proprietor or pier. Iistod Ship and have no mn 1 ees on the attached sheet 3 7. Q Remodeling working form in p 7"1 subi-contractors have any capacity, workers+ con ins 8' OD molition [No workers comp.insurance S. [] We P 9. []Buildi required.] are a corporation and its ng addition aftiaers have exercised their 1Q.(]Elect ical 3•A I am a homeowner doing ail work right of lv}oL I I. '� oradditiarrs myself~[No•workers'camp c IS 0 PiumbmgTepanoradditiom msr�ce, �. §I(¢),'and-we have no I 2.Rr loo f ted-]t Pja'Yews [No work=? ifs *Any aplicnntti�et �P• irisuranecrequired.] I3.0-Oth� checks boZ t#t nmst atso fill out the rection below t+lxuwiag theiraorlcat compenaetion oi' info #Iiofaeowneia who scbmit this affidavit indicssing fh t:aatracton thatch and Then hhe DME460 con P n? tmafion eek this box must artdofng an WOi� a an additional shwr showi>rg.ttee�of the rut;-cvft��and submtY a new affidavit su an enrpwyer&V&.p :K'ort.�^.'' tnefr worice� =�.r-„z''``ir- on irrformafinrL r;°�g �•,ry;,esamG�ri �nskrancefor niy.entvioves; lz�w.s tie paUCJ`4,d job site . Insurance Company?Janne: ' Policy#or Self-ins.Lie. #: Expiration Late: Job Site Address: Attach a copy of the worker' compensation Ctty/Stst~!L>p; Failure to seC Policy declaration page(showing the policy number and e ^ra a coverage as required under Section 25A of MCiL C. 152 can lead to the im ositian of zpisaition date). fine up to S`1,SD0.00 and/or one-year imprisonm Of up to$250.00 a �'�weR � civic penalties in the form of a criminal pmtalties of a- day against the vioiator. Be advised thax SMP WORK 0PDFR and a fine Investigations of the DIA for insmIance coverage verification,copy of this stat;ars�t forwarded to the Oftim of t do hereby certify under the pains and penaitier of perjray mat the infornrctioa ro ' 5i p bided above is tree and Qorreri Phonek- 3 . �a i&we only. Do riot write in this area,ris ie cnnrpteted L,�j,or town 01C1Q[ City or Town: Issuing Autho 'riP��'�� fy(circle one): I. Board of Health L Suildinb DePwtru nt 3.City/To. Clerk 4. Electrical inspector 5. PFnaihi�las 6.Other pedDr Contact Person: Phone#: Information a. jad In�Aructions Massachusetts General Laws chapter I S2 requires all emp;oyers to provide workers' =npetnsaiaon for tl:oir employe-.s. Pursuant to this statute,an employer is defined as"..:every person in the service of another under any contract ofhirc, express or implied,oral or writL-n." An emplayer is defined as"an individual partnership,zmc:%ciat:im, corporation or other legal entity,or arty two or more of the'foregoing engaged in a joint enterprise,and imludi"g the Iegal representatives of a deacasod employer,orthe receiver ortume=-of an individual,partnership,associatiaznt or other legal•entity,cmPioying employees. 'Howell the owner-of a dwelling house having not more than th=apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maimtermm,oonstruction or repair wdrlt an such dweilinfhors or on the gmunds or building appurtenant thereto shall no't because of such eruployment be,dammed to be an employer." MGL chapter I SZ,925C(6)also states that"every state ate local 6ceinsing Agency shall withhold the ismance.or renewal of a license or permit to apemte a business or tto construct buildings in the commonwealth for any appiicaat who has not produced ma ptable evidence-at c omprmnee with the insurance coverage required." Additionally, MOL chapter 152,§25C(7)states"Neither the commonwealth nor arty of its polifictll subdivisions shall enter iutto any contract for the perFonmuece of public work urnt'1 acccpfalile evidencx of complianc a with tree insunffiucx tzquuremmits.of this dmpter have been prod to-the,d=etracting authority." ApPlncauta Please fill out the workers'.campaws an-affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contracto(s)nzne(a�ad&ass(es):rad phone number(s)along with their=tificate(s)of insumm= Limited'LiaWity Companies(LLC)or Limited Liabiiity Parinmships(LLP)with no employees otherthan the members orpartners,arc not required1to cavy work='cC3-,Tnp=s:a ion insurance. Van LLC or LLP does have empioyees,a policy is required. Bo advised that this affidavit may be submitted to the Depwtmartt of Industrial Accidents fnr confirmation of insure=coverage. Also'Ebe sure to sign and date the atFidavit The affidavit should be returned to the city or town that tate appIicetion for the paint or truant is being requested,notthe Department of Industrial Accidents. Should you have airy questions re;Pw fig the law or if you are requimd to obtain a workers` oauapeansation poliq,please-ed the Department at the-number listed below, Self-insured oompanies should enter their ( ,; self-irnsu ance.accnac number on tha'appropriate heir. City or Town Officials Please lx snrc fhar�i�o at=nd$vit is complies and printed le 'bb,. Tho Dcpartrnerrt has provided a space at the bottom of the affidavit for you to fill out:in tht�event the Office of Investigations has to con=you rWding the applicant Pl=sc be surf to fill in the permit/license numb= w ll be used as a reference number. in addition, an appiicant that must submit multiple permit/licensc applications in any given yeast,need only submit one affidavit indic;a*-c=ant policy•informafaon(if necessary)and under"Job Site Address-ilei applicant should write:"all locations in (city or tovm).4'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 thB a'valid affidavit is on file for fuftm permits or lic mea. A new affidavit must be titled out each year. Wheal a home,owner or citizen is obtaining a licans= or pe:rrait not elated to any business or commercial venture (i.t a dog license or permit to bum leaves alt.)said persbn is NOT.mquircd to•complctt this afiidaviL The Ofiice of Investigations would like to thank you in advance for your cooperaticm andshould you have any questions, plaesc do not.hesitate to give us a call. 71c Department's address,telephone and fax number. The Commonwealth of M=ac hus= Dcpart rlt of 1 xidustrial Aczid=ts Officeof InVeR ii a ions 600 Washington Street Boston, IIIA 0,2111 TeL 9 617-727-4900 ei=406 or 1-977-"SAFE Fax 4 61 7-727-774Q R:vised{-Zb-DS www.taass_gov/dia "