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Home My WebLink AboutBuilding Permit #289-11 - 56 SURREY DRIVE 10/8/2010 NORTy BUILDING PERMIT o�ssLED /6 6 TOWN OF NORTH ANDOVER o - ° APPLICATION FOR PLAN EXAMINATION h ' Permit NO:4-41 Date Received °4 -0 ��SSACHUS�� Date Issued: / IMPORTANT:Applicant must complete all items on this page LOCATIO�X- 3G�. S'vrrc��. : ?R. Print ' PROPERTY OWNER�O . , s , _, Print '` :: :•-,* � �'�� MAP 210PARCEL: .ZONING'DISTRICT Histone District ye no f Machine Shop Village y 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 q;Septic . ❑Well ❑ Floodplain 0 Wetlands -.Vllateished District. ❑Water/Sewer J . ' DESCRIPTION OF WORK TO BE PERFORMED: ke pb4c e 6nttrd Luo ed - Add C Pz p/e Al 00 WS Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: Phone: Addeess t 1�• ,'.r Supervisor's Construction License: Exp: Date Home Improvement License: _ Exp. Date: ' ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ �� FEE: $ Check No.: Receipt No.: 3 3 ,�-3 O NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owne Signature of contractor 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 ❑ V THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Sii nature COMMENTS HEALTH Reviewed on Signature COMMENTS E r i 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- -- - - -- _ r Dimension Number of Stories:_Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL:L: 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 ® Notified for pickup - Date Doc.Building Permit Revised 2010/October 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 ❑ Flo or/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 MOTE: 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 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 2008 S� .Syn"'Si4vlo- Location No. Date de- M°^'h TOWN OF NORTH ANDOVER f � A • s Certificate of Occupancy $ �ssuMuSE<� Building/Frame Permit Fee $ - 39 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �� 235JO Building Inspector ' GE tO D7M 3? w �SSwCHUSE� CERTIFICATE OF USE & OCCUPANCY TOWN OF NOR'T'H ANDOVER Building Permit Number 289-2011 Date: December 9, 2010 THIS CERTIFIES THAT THE BUILDING LOCATED ON 56 Surry Drive, per ZBA petition #2010-13_ MARY KELEHER MAY BE OCCUPIED AS single-family in-law apartment IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Mary Keleher 56 Surry Drive North Andover,MA 01845 461 Building In Fee: n/c Receipt: n/a FORTH Town0 4 ° over _ ", 6 . A., No.— }( over, IVlass., " Y QQ L A K �, �j COCMICKEWICK V ORATED P"'�o C;P BOARD OF HEALTH Food/Kitchen P.ERMIT T �� D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.............. r .......Icl .....................................................................p.......................... Foundation ettlr has permission to erect...... ................................. buildings on ....'S.6....... .r ..... ...................................... Rough ��. s Chimney tobe occupied.as............. ............................. .......... ................................................................................................................ provided that,the person accepting this permit sha I in every respect conform to the terms of the application on file in anal 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 r PERMrr EXPIRES IN 67S �S S ELECTRICAL INSPECTOR 3 UNNLESS CONSTRURough ............................................................................................. 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. CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 289-2011 Date: December 9, 2010 THIS CERTIFIES THAT THE BUILDING LOCATED ON 56 Sura Drive, per ZBA petition #2010-13 MARY KELEHER MAY BE OCCUPIED AS single-family in-law apartment IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Mary Keleher 56 Surry Drive North Andover,MA 01845 ABuilldingeInspup$ctor Fee: n/c Receipt: n/a NORTH o 6 Andover Town _ - �v 1LLAK _o dover, Mass., y COCMICMEWICK ADRATED PP�t'i� S U ` BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR -_ THISCERTIFIES THAT.-.......... ....... ......................................................................................w.......................... Foundation has permission to erect...... ................................. buildings on ....S6...... .r�...... ...................................... Rough to be occupied.as.... ....... .......... ... . .f ...5......................................................................................... Chimney provided that the person accepting this permit sha I in every respect conform to the terms of the application 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 THS 3 ELECTRICAL INSPECTOR UNLESS CONSTRU N S ART 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. l NORTH T0VM of Andover O ..;F _ ;4.. ;J.�K;;... V = LAKE dover, Mass., COCHICHEWICK AO'? TED P'p�,�� `S U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.............. � I G �.�... .�........ ......................................................................................�.......................... Foundation ��...... .. . . Rough permission to erect. : .................. ... buildings on .... .... to be occu led aS Chimney provided that the person accepting this permit sha I in every respect conform to the terms of 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 3 PERMIT EXPIRES IN 6 THS ELECTRICAL INSPECTOR UNLESS CONSTRU N S ART' 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 o Alassach .f usetts `— Department o f Industrial Accidents Office of£nvestzgations 600 W ashinb ton Street BostoPz, MA 62111 WWWWorkers' Compensation 1;Qsuranceaassgov/dig AoQlieant Information �t' Builders/Contractors/Electricians/Plumbers Please Print Legibly Name (Business/Qrganization/Individual): In /?A Y.Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: I•❑ I am a employer with 4. [:] 1 am a general con acfT roject(required): . 2.❑ employees(full and/orpart-time).* have hired the sub-conw construction I am a sole proprietor or partner- listed on ship and have no employees These sul�e attached smodeling working for me in any capacity. contractors 8. ❑Demolition workers' comp.insura[No workers'comp. insurance ❑ We are a c$' orporation a9. ❑Builaing addition 3. required.] officers have exercised their 10 0 Electrical repairs I am a homeowner doing all work right of ex or additions myself. [No workers'comp. c. I52 �OIl Per MGL 11.❑Plumbing repairs or additions insurance required_] ' I(4'):and we have no ] t employees. [No workers 12•0 Roof repairs ❑ COmp.insurance requuired.] 13• Other aWI,�Fic�:+�chd.v-yov�i t HOmeo M'� also tint Orf 4^ese^e ee ,Wo.:., yti wIters who submir This affidavit indicating they a.�d�:......11.�.__ � CQ�"t'^• �'* r �J Y �t �OIItMCMrr that Cheri,th^ v....n "`E au uw6 ann hm h1I�UrtTSlde FOB.tIE:.'ty r'L'�r:.i� L—. 1r bO.. hed art addi{ioaai sheet showing the slruwrt a new name of the sub �da"n indicating such. conuaetors and their warkeis'COMP.Poesy information. I am an employer that d'Pro�ing workers'Com ensauos information. P insurance for my employees. Below is the policy and job site Insurance Company Name: Policy#or Self-ins.Lic.#; Expiration Date: Sob Site Address: Attach a copy of the workers'compensation policy declaration as City/State/Zip: Failure to secure coverage as required under Section 2 P be(showing the policy number-and expiration date). q SA of MGL c. 152 can lead to the imposition of criminal penal{1eS of a fine up to$1,500.00 and/or one-year imprisonment as well as civil Of up to $250.00 a day against the violator. Be advised that a c Penalties m the form of a STOP WORK ORDER and a fine Investigations of the DLA for' FY°f statement may be forwarded to tli`Office of insurance coverage verification 1 do hereby certify under the pains and penalties a er .fP lwY thezZ the information provided above is true and correct Simla . Phone# Official use only. Do not write in this area, to be completed by city or town official City or Town: Issuin Authority P ermit/License(circle one): . I.Board of Health 2.Building,Department 6. Other 3. City/Town Clerk 4.Electrical Inspector S.PlumbiaR spector Contac;Person: Picone'#: I Information an d Instructions Massachusetts General Laws chapter 152 requires all employs to provide workers'compensation,for their employs. 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 writtm" An employer is defined as"an individual partnership,associ motion, corporation or other legal entity, or any two or more of the foregoing engaged in a joint ente--rprise,and including the legal representatives of a deceased emplover, or the receiver or trustee of an individual,partnership,association ox-other legal entity,employing employees. However the owner of a dwelling house having not more than three apartmL eats and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintemarice,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 asency shall withhold the issuance or renewal of a license or permit to operate a business or to c--anstruct buildings in the commonwealth for any applicant who has not produced acceptable evidence of co=mpliance 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 uml:il 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 checkingthe boxes that apply to your situation and.if necessary,supply sub-contractors)name(s),address(es) and phone number(s)along with their certificate(s)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'comp=sation 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 in��*�nse coverage. .Also be cvjre to sign and date the affidavit. The affidavit should be mturned to the city or. `itS—n th the=mica iOn f01-the Pettor lecrose L4 be-ns reaeest�o,not the of Industrial Accidents, Should you have any questions*ngardis_.g the law or ii you are:.. ieired to obtain,a workers' compensation policy,please call the Department at the number=listed below. Self-insured companies should enter their self-imsurance license number on the appropriate line. j 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 on to fill in the permit/license number which will be used as a reference member. In addition,an applicant that must submit multiple pertnit(liceme 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 p=-neits or licenses. A new affidavit must be filled out each . . year.VJhere 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 bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to than you in Vance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address,telephone.an.d.,faxnumben_.-... . The Commonwealth of Massachusetts j Degartmem of Industrial Accidents j Office of I restigatfons 600 Washingtian Street Boston,M_A 02111 Ted. 4 617-72.7-4900 ext 406 or 1-8 7 7-MASS.AFE Revised 5-26-0� Fa-x T#617-72.7 777'49 WWW-Imam-a'ov/dla A0RTN TOWN OF NORTH ANDOVER • Q � OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 North Andover,Massachusetts 01845 SACt1U5E Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978) 688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please print DATE:_- 1z/i,1j a JOB LOCATION: ,�`u P�e C Number Street Address Map/Lot HOMEOWNER cP 78J ��s-7aos' dame Home Phone Work Phone PRESENT MAILING ADDRESS_ 3� �'y rrc No iu Da ver City Town Stwt- 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 fancily 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. q ements. HOMEOWNERS SIGNATURE v 1 APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PL.ANNTING 688-9535