Loading...
HomeMy WebLinkAboutBuilding Permit #461-11 - 597 FOSTER STREET 12/3/2010Y TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO• / // Date Received Date Issued: ORTANT: Applicant must complete all items on this page LOCATION t PROPERTY OWNER Print • 0 Sso MAP NO: /1 `i,6 PARCE . ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Resi ial Non- Residential ❑ New Building 670ne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alte .ation No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ElDDemolition ❑ Other em ---------.,,.. ,-.._ .--.. �.�..,_,f.,.n,-tr:x �—Z-I; OF WORK yITO BE I ntifi tion Ple pe or Print (Clearly) OWNER: Name: Address:�f� CONTRACTOR Name: g o � " &rowyi Phone: 8 5`% �'~-�� Address: '�G C"A rut6n gam ---m Supervisor's Construction License: � Zo'l 1 Exp. Date: _ 7%%�l�- Home Improvement License: Exp. Date: ARCHITECTIENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDINO PERMIT: $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASEDON $125-00 PER S.F. Total Project Cost: $ FEE: $"® Check No.: 9 Receipt No.: �3 NOTE: Persons contrac nwit unregrosed contyactors do not have access to the guaranty fund Location No. .�O/Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2 3 7 - 8 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Well❑,/ Private (septic tank, etc. L( Tanning/MassageBody Art ❑ swimming Pools ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature CQ",-3'MENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comm Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signa FIRE DEPARTMENT - Temp Dumpster on site yes Located at 124 Main Street Fire Departinent signature/date CONIVMNTS Located 384 Osgood Street no 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.$1'00-$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 Permi 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 !VOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit DOTE 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) El COPY of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit I all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals is t the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording u st be submitted with the building application Doc: Doc.Building permit Revised 2008mi Gerald A. Brown Inspector of Buildings TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 North Andover, Massachusetts 01845 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please print DATE• 1 JOB LOCATION:` Number Ij PRESENT MAILING ADDRESS Dtreet Address Home Phone Telephone (978) 688-9545 Fax (978) 688-9542 Ma /Lot Work Phone (:aty `rovm Sta*e 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. 11 The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures Ei3qeilem is and that he/she will comply with said procedures and requirements. _ HOMEOWNERS APPROVAL OF BUILDING Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 z E co CL ti Z co s CO) C O o CD c m `o C" Sc N 0 t w 0 Z 0 CD co �� w cn a 0 00 G w w U w a 0 ADD w w CL � a .Cpp w U co u". a w w" z w v cry ° z cn - Q G cn E co CL ti Z co s CO) C O o CD c m `o C" Sc N 0 t w 0 Z 0 CD co o a■ ;;C O v � Z o 0. O Q O � CD O H p 'C O A C 'E CO m v C3 0 CD L O� 3� C C CD ev � e_ov M a , CMQ o C ;t O -c o Cecc v J.O O � o CD C 0 ca v y Ea a o oY cc CO2 o c EE co 0 CL N W o :may :off . _m CO) W W3 0 CLw �C i V y m ; h d C t • m�Z � � c o H a m ym� _ H on :opo a0+ W O �wC .y AS O C �E dM Ca ti WLU C .3 ® o ® _c Vi CL A •O = A ` N .*- CL*m E co CL ti Z co s CO) C O o CD c m `o C" Sc N 0 t w 0 Z 0 CD co O a■ L v � Z o 0. O Q y C CD co p 'C O A O O 'E CO m 0 CD L O� 3� CD 0 o e_ov M a , CMQ ca -c o Cecc v J.O 'a. o CD C 0 CD CL v y R C ■� C cc CO2 The Commonwealth of Massachusetts Department of Industrial.Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip:. Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. t ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No. workers' comp. insurance 5. ElWe are a corporation and its officers have exercised their 3.Vpaired.] Iam a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling . 8. ❑ Demolition 9. 0 Building addition 10.❑ Electrical repairs or additions 11.(] Plumbing repairs or additions 12.❑ Roof repairs ' r�WG�''l 13.©0 er e 14toMe s *Any applicant that checks box 41 must also fill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Job Site Address Expiration Date: 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. Ido her9b-y—e_er`tb_ijncr r• thepa4Rss andpenaldeslyfperjury that the informationprovided above is true andcorr•ect. ��M � Official use only. Do not write in this area, to be compldted by city or town official. City or Town: Permit/License Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town CIerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other C ontact Person: Phone 4;