The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #493-13 - 60 COURT STREET 1/4/2013NORTH q BUILDING PERMIT TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINATIO7 - . 4 Permit NO: y✓? �-� Date Received �9SSACHUS�t�4 Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION -4 60sa-V I �z S Print PROPERTY'OWNER L°IL_G. Print MAP N0: � PARCEL: ZONING DISTRICT:—Historic District ye Machine Shop Village ye RR*— TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building A'One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition 0 Other [!;Septic p Well ❑ Floodplain ❑ Wetlands D Watershed District- ❑ Water/Sewer / Identification Please Type or Print Clearly) OWNER: Name: .r F j tO cA,0 5f I.(, Phone: baz, ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING P MIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Projecto t: $ tub FEE: 0 '60,00 i Check No.: t �4 Receipt o.: NOTE: Persons contracting with vgghtego�Wttifractors do not have access to the guaranty fund d Locatio No. Date ' 4 ' TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 0 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # d 26062 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools 0 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 ❑ ❑ COMMEN CONSERVATION COMMENTS HEALTH COMMENTS Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Com Water & Sewer Connection/Signature Date Driveway Permit DPW 'Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site yes Located at'124 Mair Street Fire DepartmeM.6igni ture/date y COMMENTS Located 384 no od Street Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, roast 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 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 submated with the building application Doc: Doc.Building Permit Revised 2012 l2 V n rA n uj z a _ I.f. _ .0 (ice :w n. U) CL 'Z O c Z µ- 0.2 O0 H! V d E Nom? m O d 0 F - Fx- E = Ii 0.- ' _ a F– Z U Z 7Z GSL(� J E L V :O (3- d �, 1- - `� a>i y N W a a`� a °W > -0 tVQ � �� c XZ O uQ, E c O W c Z. QW F - tH o O i/) x z = W _! J z � z a LL Q L O o i Q H O f/1 v m O 0) W- c7 a = •• n -0— O O N1 = O z w .� Z LU E Z W V Z r -O v O ._ L- O •a N .• N 0. = O0 Q 1=— s � CL 00 > mF2 H Q Q W p w m J LL c E m J C d W +7 t +a) ,au_+ T �+. Z Y N ar N L a1 u a c c t s u r ar +' Y -0+' c t E Z 3 E v O O a 7 :EC C O O O LL N LL 0 M U LL w iLL 2' N LL W LL co a`� N N uj z a 9 E d i �+ V Z O = t/1 0 •E M m CL •�• O+ v O O CL CL �Q O _ J .a •v CL O .a; Z O V tQ ca � CL U) 0 0 vI LLI W W 19 LWLI U) _ I.f. _ .0 (ice :w n. U) CL 'Z c Z µ- 0.2 p H! V d E Nom? m O d 0 F - E = Ii 0.- ' _ a F– Z Q 7Z GSL(� J E L V :O (3- d �, 1- - `� a>i y N W a`� o� > -0 tVQ � �� c XZ O m E c O W c Z. QW F - tH o O i/) W. > 3 = W _! J � CL CL Q' � Q L O o i H O f/1 v m O 0) W- W Li = •• n -0— O O N1 = O .� Z LU E �:E.2 o -0 W V L Q r -O v O ._ L- O •a N .• N 0. = O0 1=— s � CL 00 > 9 E d i �+ V Z O = t/1 0 •E M m CL •�• O+ v O O CL CL �Q O _ J .a •v CL O .a; Z O V tQ ca � CL U) 0 0 vI LLI W W 19 LWLI U) Gerald A. Brown Inspector of Buildings Please -print TOMW OF NORTH ANDOV]ER OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, -Suite 2-36 • North Andover, Massachusetts 01845 Telephone (978) 688-9545 Fax (978) 688-9542 HOMEOWNER"LICENSE EXEAPTION BUIDlNG PERNfIT APPLICATION DATE:/ JOB LOCATION: ,Z� avrL°f �7c Number Street Address HOMEOWNER /Wt Name. Home Phone PRESENT MAILING ADDRESS Map/Lot 6JP7-,K2�1"1�j Wor h - � � �� yr ��.� ��`L �� • ` CH Tnz*m G/ci" ` TS State Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings to two units or less and acts as supervisor). to allow such homeo ;:vers to engage an individual.for hire who do State Building (Code Section. 108.3.5.1) es not possess a license, provided that the owner DEFINITION OF HOMEOWNER Persons) who awns a parcel of land on which he/she resides or intends to reside, on which there is, oris intended to be, a one or two family structures. A person who constructs more that one home in a Which there o shall not e considered a homeowner. The undersigned "homeowner" assumes responsibility for Applicable codes, by-laws, rules andregulationscompliances with the State Building Code and other , The undersigned "homeowner" certifies that he/she understands the Town of Forth Andover Building Department minimum inspection procedures and require s and that he/she will co ly with,said procedures and requirements, HOMEOWNERS SIGNA ! APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530j' HEALTH 688-9540 PLANNING 688-9535 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Narne (Business/Organization4ndividual): Address: G 6 ( ft,,� .1. City/State/Zip: Mi _ 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. ❑ We are a corporation and its �lrequired.] officers have exercised their 3 . I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] i employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ Ne construction 7. Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11.❑ Pl bing repairs or additions 12. oof repairs 13. ❑ Other kny applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :ontractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site formation. tsurance Company Name: :)licy # or Self -ins. Lic. ►b Site Address: Expiration Date: City/State/Zip: ttach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). tilure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ae 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 up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of vestigations of the DIA for insurance coverage verification. lo hereb,Icertif rl�g enalties of perjury that the information provided above is trace and correct. Offacial use only. Do not write in this area, to be completed by city or town offacial. City or Town: 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 #: