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Home My WebLink AboutBuilding Permit #178-2017 - 61 ESSEX STREET 8/19/2016 •-' .. � �ORTFr BUILDING PERMIT : ;•,;,. .. ., o0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: �� Date ReceivedIr 9 Date Issued: �9SS�cHus�� IMP RTANT: Applicant must com Tete all items on this page I LOCATION 61 Essex Street Print PROPERTY OWNER: Steven N. and Anna L. Gesina Print ` MAP NO: 103 PARCEL: 4 A ZONING DISTRICT: R1 Historic District yes X no Machine Shop Village yes X no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building x One family Addition Two or m ore fam ily J Industrial x Alteration No. of units: J Commercial Repair, replacement a J Assessory Bldg Others: Demolition J Other x Septic x Well i F to o d pp la in _E]Wetlands x W a to rs h e d District W ater/Sewer Remodel within the footprint: Creating an open floor plan for living room; dining room; new kitchen and adding 1/2 bath. Structural engineer has submitted structural support plan for new beam support following a portion of wall removal. \ e will require Electrical and Plumbing Permits. Contractors will apply directly for these permits. ppiy; •n front f o ad-RDofll]T?or��'a6t8r +il�apply- ar Roofin-,Aermit�;}��cheddufe-allows fo�roofing-to-occur-(n-total-use - , -Fa ��4aII a}�plfor additional permit annrfo ec • o4"o --A-ptet-p subm' s at-i�— Identification Please Type or Print Clearly) WNER: Name: Steven N. Gesina 617-633-1968 (Mobile) Phone: 978-655-5660 (HM) ddress: 61 Essex Street North Andover MA 01845 CONTRACTOR Name: Home Owner Phone: See Above i Address: 61 Essex Street No. Andover MA 01845 Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER: Julie A. Johnson Phone: 978-470-2990 Address: 124 Main Street Andover MA Reg. No. 20070 FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTI ATED COST BASED ON$128.00 PER S.F. Total Project Cost: $ 114 500 FEE: �_3 Check No.: !%4 Receipt No.: 1 cpp NOTE: Persons contracting with unregistered contractors do not have access to the guaranj yt fund Y Signature of Aaent/Owne / ✓ t..,, Cinna i arc of Plans Submitted L► 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 ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM i i PLANNING & DEVELOPMENT Reviewed On Signature Nl� COMMENTS :� I CONSERVATION Reviewed on Si natur COMMENTS HEALTH Reviewed on Sinature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted ye: Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit Towl Engin Signature: Located 384 Osgood Street FIRE DEPARTMENT Temp Dumpster on site yes no ocated at 124 Main Street Department$i to I A St -7 COMMEN � Plans Submitted 0 Plans Waived 0 Certified Plot Plan 0 Stamped Plans 0 TYPE OF SEWERAGE DISPOSAL Public Sewer 0 Tanning/Mas\dy0 Swimming PoolsWell 0 Tobacco Sale0Food Packaging/Sales APrivate(septic tank ,etc. 0 Permanent Du0 THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑_ n 1 COMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ ^ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS 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 Located at 384 Osgood Street -- - - FIRE DEPARTMENT -Temp Dumpsteron site yes no___-- Located at 124 Main Street Fire Departmentsignature/date - ZVt COMMENTS 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 Call Email Date Time Contact Name Doc.Building Pennit 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 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks .4- Building Permit Application � Certified Surveyed Plot Plan Workers Comp Affidavit � Photo Copy of H.I.C. And C.S.L. Licenses � Copy Of Contract 4. Floor/Cross Section/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 OTE: 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 I ECC Energy code 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 2014 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 114,500.00 m $ - $ 1,374.00 Plumbing Fee $ 171.75 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 171.75 Total fees collected $ 1,817.50 61 Essex Street 178-2017 on 8/19/2016 Interior Remodel, kitchen, living room add 1/2 bath Plans Submitted i Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans TYPE OF SEWERAGE DTSPOS,A.L Public Sewer ❑ Tanaing/Massage/Body Art ❑ Swiinining Pools ❑ Well Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. YX Pennanent D-unpster on.Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM tPLANNING & DEVELOPMENT Reviewed On �� 1' Signature, fes+, & BEVEL•PM COMMENTS Ir lh — �1 C';*A I'll(- 1� t4A 1961) v, q- CONSERVATION Reviewed on �` ' Si natur COMMENTS ✓L Oj /HEALTH Reviewed on �� Signature c COMMENTS -h(� 6'jjj�knylfi'l Q 4�1 `� -- Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted ye: Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date DriyeWaV Permit Tow Engin : Signature: Located 384 Osgood Street FIRE DEPARTMENT Ternp Dumpster on site yes no ocated at 124 Main Street Department$i to 1rJiY Plans Submitted 0 Plans Waived 0 Certified Plot Plan 0 Stamped Plans A TYPE OF SEWERAGE DISPOSAL Public Sewer Swimming Pools A .� Tanning/Massagedy Art 0 g Well 0 Tobacco Sales 0 Food Packaging/Sales Private(septic tank,etc\ 0 Permanent Dumpster \Si0 THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT �__ ❑ COMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ ^ COMMENTS DATE REJECTED DATE APPROVED ,✓ � HEALTH ❑ ❑ COMMENTS 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 Located at 384 Osgood Street FIRE [ �i41T1V� -Temp Duster on slle des rye Looted at'*ItG;Wh Fke D sib f u`eL a COMMENTS �� NH ORT Town of sAndover O No. 7 * _ � z oh ver, Mass, &xks+ 2-a COCNIC Nl WKK y1� RATED P '�5 U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT %-w*4....`+ ...ApumA ..... , �...... ... BUILDING INSPECTOR has permission to ect .......................... buildin son .&.1 5 .� s'-C,C,....,,,,,,, , Foundation ........ . . ...... to be occupied as . ....� ...�. � . .. .� 1 ..1 .�..� .. Im. . .� Chimney Rough provided that the person accepting this permit shall in eve respect conform to the Arms ms of the a ion p p p g p every p pp Final on file in this office, and to the provisions of the Codes and By-Laws rela ' to the Ins ection, Alteration and Construction of Buildings in the Town of North Andover. Wr �� PLUMBING INSPECTOR ptcri' Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. bt&A S #• Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR._ . UNLESS CON I Rough Service ....... "' Final BUILDIN ECT GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERTWIT VG AUTHORITY. Applicant Information Please Print Legibly t ,rCs Name(Business/OrganizatiorAndividual): ewers ]fid.. Ge—s%,r.A t }•pr-wA L c�E'S►t"� Address:_L k C&s(zx SZ r City/State/Zip: A4 poo&Q Phone#: jyN Ofyj-��',56 K.C CSG J J- C-8'3-iQ 6 Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).' 7. ❑New construction 2.Q I am a sole proprietor or partnership and have no employees working for me in $, .A Remodeling arty capacity.[No workers'comp.insurance required.] 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 1 ❑BuildDemoing 10❑Building addition 4X I am a homeowner and will be hiring contractors to conduct all work on my property. l will ensure that all contractors either have workers'compensation insurance or are sole 11. EIectrical repairs or additions proprietors with no employees. 12.V Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.0 we are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] '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 a new 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. Yam an employer that is providing workers'conipetsadori insurance for my employees. Below Is the policy and job site Information. Insurance Company Name: Policy#or Self-ins.Lie.#: _ 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 e.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 cerlik tender the pains a d penal' of pei jury that the infornwtion provided71molz, a is rue and correct Sign Date: 2 Phone#: e3 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): ; 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector b.Other Contact Person: Phone#: � o TOWN OF NORTH ANDOVER OFFICE OF _ BUILDING DEPARTMENT - IL 1600 Osgood Street,Building 20, Suite 2035 +I. s North Andover,Massachusetts 01845 Gerald A. Brown Telephone(978)688-9545 Inspector of Buildings, Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please print DATE: JOB LOCATI.ON: L ��- C) j-- Ax Number Street Address Map/Lot HOMEOWNER ST, < � Name Home Phone Work Phone PRESENT MAILING ADDRESS luN A?p0l gL City Town State Zip ode The current exemption for"homeowners"was extended to include owner occupied dwellings of one or two family dwellings and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. 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 dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner.(780 CMR Section 110.R5.1.2) The undersigned"homeowner"assumes responsibility for compliance with 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. - HONIEOWNERS SIGNATURE ZZ V APPROVAL OF BUILDING OFFICIAL Revised 8.2015 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 683-9535 The Commonwealth of Massachusefts Department of Fire SeNicas office of the State i=ons Marshaljam P.o.Boli lots state Road,stow,MA 0I775 APPLICATION FOR PERMIT Date: 6Permit No qty or Town) (If Applicable _ ) Dig Safe Number In accordance with the provisions of M.G.L. Chapter 10 as provided in section 527 CMR 3 4 application is hereby made FStutate by 5 f'�')--"- G e s, v-L (Full name ofperson,Flim.or Corporation) tate clearly Addressurpo rhich a for v (Stroet or P.O.Box City or Town) ;hichpet For e�missionto Locate dumpster for construction/renovation/demolition .requested p Of s t r u c t u r e Comments: dumpster must be 25 ' from structure or cove re when not in use at (Give location by street and no.,or describe in such maner as to provied adequate identification of locaiaon) . Name of competent operator C(z v�k t Q Cert.No. (IfAppHcable) Date Issued-rejected By (SignatureofApplicant) Date of expiration �'u' lir- ,30 F S �/5..a Paid ✓Daae The Commonwealth of Massachusetts Department of fire Services t Office of the State Fire Marshal P.0.Box 1025 State Road,Stow,MA 01775 PERMIT Permit No Date; City of Town) (If PPlicable) ESfartDato Number In accordance with the provisions of MG.L. Chapter 10as provided in section 5 2 7 CMR 34 This Permit is granted to: Fn1I name of person,Finn or Corporation Permission to locate dum seer for construction/renovation/demolition of structure Comments: dum ster be 25 ' from structure or covered with tarp or plywood Restrictions: at end o f w o r k d ay at (Give location by street and no.,or describe in such manner as to proved adequate identification of location) Fee Paid$ IIDZF This Permit will expire (Signature of offica1 grantin permit) Offical granting peamtt True �� THIR PERMIT MI LRT•RF CE�NCI�lf'_1 i{11I.CI V 13f1CTRn I IPnM T1.19 PR9U1CFq -*Mm