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Home My WebLink AboutBuilding Permit #450 - 595 FOSTER STREET 2/23/2009 NORTH BUILDING PERMIT of TOWN OF NORTH ANDOVER 02 0 APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received 0p�SACHUS�� Date Issued: �� 0 �S IMPORTANT: Applicant must complete all items on this page LOCATION 415 P 'Prin � . PROPERTY OWNER �S Prin MAPNO: L�t_PARCEL- BONING DISTRICT: S- Historic Districtyes n Machine Shop Village yes o 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 WaterlSewer DESCRIPTION OF WORK TO BE PREFORMED: N7 4- Identification leaseYype or P int Clearly) OWNER: Name: �aS� c L'VZ Phone: Address: ��' �'�• �, d 1 �/ ovpr` CONTRACTOR Name: Phone: F Address: , x Supervisor's Construction`License: Exp. 'Date: ' Home Improvement License: Exp. Date: � � ARCHITECT/ENGINEER Phone. Address: Reg. No. l FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ Y40 FEE: $�� Check No.: 9-J3 Receipt No.: l4 �z NOTE: Persons contracting with unregiste d contractors do not have access to the guaranty fund Signature of Agent/Ovune f-o w nature of contractor Location ' !r No. 47�y — Date N0RT1y TOWN OF NORTH ANDOVER H 9 A ` Certificate of Occupancy $ ��s"'•°'E<�' Building/Frame Permit Fee $ AC Mus ' 3 Foundation Permit Fee $ v, Other Permit Fee $ TOTAL $ Check # (} n 1 2 ,1854 �' Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans 6 C 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 r Zon ng Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes t Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -7ernp Dumpster on site yes. no Located-at 124 Main Street Fire Department signature/date COMMENTS d 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) ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 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) Li 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 AL NOT C Date r Article , Section of the Zoning Ordinance WHEREAS, violations of Article�, Section-�-�=of the Building Code have been found on Article , Section of the Code these premises, IT IS HEREBY ORDERED in accordance with the above Code that all persons ease, desist From, and , /Vo STOP WORK at once pertaining to constle9tion, Iterations or repairs on these premises known as All persons acting contrary to this order or removing or mutilating t ' notice are liable to arrest unless such action is authorized by the Department. BUILDING OFFICIAL poRTlq TOWN OF NORTH ANDOVER OFFICE OF p BUILDING DEPARTMENT * 1600 Osgood Street Building 20, Suite 2-36 �.,'�•,,.o.�� North Andover,Massachusetts 01845 sswcNust Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please ffiat DATE: alc --310-7 JOB LOCATION: Number Street Address WOW HOMEOWNER 105f L„ vV o g7 k7 37Y7 '779 7b/9/ Name ome Phone Work Phone PRESENT MAILING ADDRESS S F6 v, M, M-A 1 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 APPROVAL OF BUILDING OFFIC xxvised 10.2005 Form Homwwws Ennvdon ROARDOF \PPEAI.S(M-9541 CONSER\'_MONF,88-9530 NE.U.,111688-95.30 PL.LNNING(889535 i i NORTH o of - Andover 0 No. &;,Sb 3" o 0 dover, Mass. 01 C HICHIEWICK �' +�ir '4'A-rED P"' BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT............ ............. ...... Foundation has permission to erect........................................ buildings on .......... ................... Rough to be occupied as........Ut -z-6......n.des.q. .................... terms of the application on file in Chimney P that the person acce in this permit shall in . �4-respect conform to 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 6 PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRNM�'LRT ELECTRICAL INSPECTOR Rough ........... ............................................... Service BUILDING SPE Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Fnagh u 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. EE The CO MmO?zweralth ofHirssachusetts Department 1/Wi P o f Industrial Accidents ;g ? ,H..., Dffice of.�nvestiQations 600 Washingto n Street Boston, M4 02111 c `- w►+'K'-mass.;ov/din Workers' Compensation Insurance.Affidavit: Builders/Con tractors/Eleetricians/Plumbers Ap Iicant Information Please Print Leaibl Name (Business/Organization/individual): OS --------------- 'City/State/Zip: t�,�� l,/✓ l� Phone F2. re you an employer?Check the appropriate box: am a employer with 4. ❑ f am a general contractor and I Type of project(required);mp}oyees(full and/or part-time). have hired the sub-contractors6• ❑ New construction 1 am a sole proprietor or partner- listed on the attached sheet$ 7• ❑ Rem.odeiing ship and have no employees These sub-contractors have orking for me in any capacity. work=s' comp. insurance. S' Demolition o workers' comp. insurance 5..❑ We are a corporation and its 9• ❑ Building addition 3.❑ required.] officers have exercised.their 10:❑Electrical repairs or additions I an a homeowner doing all work right of exemption per MGL I l.❑ P}umibing repairs or additions myself. [No workers' comp. c. 1S2; 1(4);and we have no insurance required.] t employees. [No.workers' 12.❑ Roof repairs comp. insurance required.] 13•7 Other 'Any applicant,that checks box#I.must also fill out the section below showing their workers'compensation policy information. Homeowners whe suU:nit•fibs atYitdevn in tile%!BSB L'Otn�cl E:1'clerr.W-1 Ll lhcn h'r-'outside Wmiraciore tnttjt submit a new at7liiHlr r ind: YConuactars that chccl:this box must attached an additional sheet showing the name Of the s:b cam„ does and their workers'nom , of i i. xtirg such.t am an.employer that is providing workers'coenation i P P c} information. infnrmatio>z assurance for my employees. Below is the poffcy and job site Insurance Company Name: Policy#or Self-.ins. Lic.#: Expiration Date: .lob Site Address: _ City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showin;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 ofa fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the f of up to 5250.00 a day against the violator. Be advised that a co form of a STOP WORK ORDER and a fine Investigations of the DIA for insurance coverage verification. p} of this statement may be forwarded to the Office of I do hereby certify under a nuts Ppnnlfi of perjurf�Zhal the information provided above is,true and correct Siortature: Dat>: Phone#: E, = e only. Da not write in this area, lobe completed by city or town ociaL n: PermitlLicense# thority(circle onej:Fiealth 2. Building Department 3. City/TownClerk q Electrical Inspector 5. Plumbing inspector son: Phone Information c .nd Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. 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 defined as"an individual,partnership;association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and includi zz,g 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 hree.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 b-, em deed to be an employer." MGL chapter 152, §25C(6)also states that"every state o r 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 accepta>bie 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 un 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 compi-etely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s), address(es) andphone 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'compensation insurance. If an LLC or LLP does have _ employees, a policy is required_ Be advised that this affi&a.vit maybe 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 reg2trding the law or if you are required to obtain a workers' comaensation policy,please call the Department at the nQT_nber: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 aftidavif is complete and printed leelbly. 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 appii=L 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/iicense applications in arty given year,need only submit one affidavit indicating current policy information(if necessary)and under".lob 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 perms or licenses. A new affidavit must be filled out each year. VJhe:re a home owner or citizen is obtaining a licenses or permit not related to any business or commercial venture (i.e. a.dog license or permit to burnleaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and far, number: The Commonwealth of Massa c:husetts Department of 1ridustrial Accidents Office of favesfigations 600 WashEington Street Boston; MA 02111 Tel. # 617-727-4900 ert 406 or 1-877-MASS AFE Revised 5-2645 Fax 4 617-727-7749 V'w•mass.gov/dia