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Home My WebLink AboutBuilding Permit #918-2016 - 60 RUSSELL STREET 2/26/2015Permit NO: �-- 2,0 � � Date Issued: z, -Q � 19 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received 0 of IMPORTANT: Applicant must complete all items on this page LOCATION I 6z V-Us5dl st, Print PROPERTY OWNER )C�O�Qs Print MAP NO: PARCEL��/ ZONING DISTRICT: Historic District yes Machine Shor) Villaae, ves TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building 0 One family 0 Addition Lvfwo or more family Q Industrial El Alteration No. of units: 0 Co'Mmercial [n"Repair, replacement 0 Assessory Bldg 0 Others: 0 Demolition 0 Other 11 Septic Ll Well 11 Floodplain 11 Wetlands El Watershed District 0 Water/Sewer 16dyks 00000( 504t at VJ re-c4oiAq W-1,roDm Identification Please Type or Print Clearly) X5 OWNER: Name: W,61-25 501o'ckku Phone: 176 -ZZ,3-5?8 -7 Address: JO 04DIt SI., 5(,)AA.Z�L6NIi o36 -7Z 11 CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Home Improvement License: Exp. Date: Exp. Date: ARCH ITECT/ENGINEER- NIA Phone: Address: 4 1 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: $ Z(" 0 Ob FEE: $ '31'L, 00 Check No.: Receipt No.:- 3oc)+J NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund tu nature of contractor Plans Submitted Plans Waived Certified Plot Plan IT 'Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer El Tanning/Massage/Body Art El Swimming Pooj�l El Well El Tobacco Sales El Food Packaging/Sales 0 Private (septic tank etc. El Permanent Dumpster on Site El THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature' CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes I Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/ Permit DPW Town Engineer: Signature: : . -4. - - --- -- - Located 384 Osgood Street EF ME I g3ELARKT-1— U qqt' t, 'Izli lernp um q-r-,qn.,5jeoj�yes iA. -- - qllro—caffd at 241 A IM t e -'i;iti: ffentrs i&Taft�ureja ate, ........... '021 0 M M E�Njr,,§ 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.$100-$l 000 fine NOTES and DATA — (For department use LI Notified for pickup Cal I Date Time Contact Name Doc.Building Permit Revised 2014 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 4� Building Permit Application �6 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 IOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ,;6 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/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (if Applicable) ,;6 Mass check Energy Compliance Report (if Applicable) Engineering Affidavits for Engineered produc s IOTE: 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 2012 IECC Energy code Engineering Affidavits for Engineered products IOTE: 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 2014 U�Q U" No. Date Check # 16�- 0 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ A Other Permit Fee $- TOTAL $ Building Inspector Enter construction cost for fee cal - North Andover Fee Cakulation Construction Cost $ 26�000.00 m $ - $ 312.00 Plumbing Fee $ 39.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 39.00 Total fees collected $ 490.00 62 Russell Street 918-2016 on 2/26/2016 Bathroom Remodel 0 cn U) 0 -0 0 CD 0 Z cnr-91 CD 0-0 F 0 a cn > cm 0 0 CD C <Q o D CL CD CD 0 ou w CD a CD a = a) U) CD 0 U) CD cn 0 -0 Z CD 0 0 r -l -L 0 CD 0 CD 0 0- Z� SM a z r - m Cl) cn 0 0 z cn 0 z cn Cl) c): cl): -0: m o --I: o -0 m m m Cf) 0 z q CO) :-:i z 0 h CD cm 0 S. co M CD co 0 U) 0. CL U) cn -0 CD 00 10 I -OL 0 = -1 0 = —h 0 cr Cn = :5. 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Brown Inspector of Buildings Please print DATE: 714151zbl� TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 North Andover, Massachusetts 0 1845 HOMEOWNER LICENSE EXEMPTION Telephone (978) 688-9545 Fax (978) 688-9542 JOB LOCATION: U ku-6efll Sv� Number Street Address Map/Lot HOMEOWNER Uc6aw 19orAetcnu) N 1A. q -79-U-3-5297 Name Home Phore Work Phone PRESENT MAILING ADDRESS -1 &tfj1r1f_*> ZMA Arowli MN 01% 0 City TAn 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 considereda 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 OFFICIAL Revised 10.2005 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 The Commonwealth of Massachusetts Department ofIndustrialAceidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov1d1a Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERNUTTING AUTHORITY. Amlicant Information Please Print Le0b1 Name (Business/Organization/Individual): N I &(O'kelanv Address: 15 VWle, 5f, t City/State/Zip: NJA 637,92 Are you an employer? Check the appropriate box: Phone #: 171-ZZ5-52V7 1. [] I am a employer with _________pmploym (full and/or part-time).* 2.F-1 I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.) 3. F1 I am a homeowner doing all work myself [No workers' comp. insurance required.] t 4.YI am a homeowner and will be hiring contractors to conduct all work on my property. Iwill ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5.F] I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insuranceJ 6,F-1 We are a corporation and its officers have exercised their right of 'exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 7. F1 New construction 8. [?temodeling 9. El Demolition 10E] Building addition 11. F1 Electrical repairs or additions 12. 0 Plumbing repairs or additions 13. E] Roof repairs 14. F1 Other *Any applicant that checks box # I 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 a now affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. Iainatiemployei-tliatisprovidiiigivot-kers'conipensationiiisurancefoi-niyeniployees. Below is thepolicy andjoh site information. Insurance Company N Policy # or Self -ins. Lic. M Expiration Date: Job Site Address: 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 MGL c. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under thepains andpenalties ofpeiyuiy that the inforinationprovided above is trite and correct Signature: '& *V4__ Date: z 7ZZ01 Phone #: q 70 -2 9 7 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License Issuing Authority (circle one): i 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: