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Home My WebLink AboutBuilding Permit #232-2017 - 62 WINTERGREEN DRIVE 9/1/2016 x.J Y I I AAL LY-) �►ORT►� BUILDING PERMIT -. b°�:f TOWN OF NORTH ANDOVER 77 APPLICATION FOR PLAN EXAMINATI N - � x a � Permit NO: Date Received C Q� �,/ �9SsAHUS Date Issued:Cq"/ 0/ 24/ MORTANT:Applicant must complete all items on this page LOCATION L Wccs ��ry✓tta �r. A/ 0/ 7 7 PROPERTY OWNER De, Print MAP NO: PARCEL:ZONING DISTRICT: Historic District ye no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 2 One family ❑Addition ❑Two or more family ❑ Industrial A'Alteration _No.of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other ❑Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer ncishf, //Identification Please Type or Print Clearly) OWNER: /-F Name: �Gti,c yt",aL Phone: CIU- V9'y Address: �� — CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: u' Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDINGGP�PEkMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Coit: $ 000,90 FEE: $ �^ Check No.: !U 2.7 Receipt No.: v NOTE: Persons�contracting with unregistered contractors do not have access to the g aranty fund Signature of Agent/Owner Signature of contractor Plans Submitted.[ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL' Public Sewer ❑ Tanuing/Massage/Body Art ❑ Swimming Pools Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Pennanent Dwnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature 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 DPW Town Engineer: Signature: S ,c Located 384 Osgood Street FIREDEPART�MEIVT „Tem_p Dumpsteragon+siteyes .i t;Lo t d at 124_Ma nS eet~�' ` ' ° ; f •�» }fir ,i.;!'. ` '�"' ..`' $}R� � Fire Dep Cr nt signature/date •, .a ' Y»' y d '..eS�t # t� jiri'r; C'�r,l }+r$�4,4'�$:*y� '•�Yr��:.�.� ,.Y'�"`.Sf"' m u R s,..—..��...a.�. „�`t ,�- - 2_ Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: l ELECTRICAL: Movement of Meter location, mast or service drop requires a Electrical Inspector yes p q pprovai of No DANGER ZONE LITERATURE: yes No MGL Chapter 166 Section 21A—F and G min.$1o0-$1000 fine NOTES and DATA— (For department use) { LI 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 1 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/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 Doc:Building Permit Revised 2014 Location 6b,7, ' No. `C9- d Date. /7 ,y • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ' Check# i 30333 3 .. Building Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 81000.00 m $ - $ 96.00 Plumbing Fee $ 12.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 12.00 Total fees collected $ 220.00 62 Wintergreen 232-2017 on 9/1/2016 master bath remodel NORTH '9 own o _ sAndover 1 y C% h ver, Mass, 0 COC KIC @41 MACK 01 y1. A�RATEO /'Q�`�.�5 S u BOARD OF HEALTH Food/Kitchen PER D Septic System ' BUILDING INSPECTOR THIS CERTIFIES THAT ....Y[�. .L.:.......... ...... ...1�.1 ........ ... K .................... has permission to erect .......... .� ,,, ....�. 4Foundation p ................ buildings on . . ....3!r4 .,....,............ Rough to be occupied as ............ ...... . ... . .. ........ . 0.a............................. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS TION Rough Service Final BUILDING"�i 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. f I ORT#t TOWN OF NORTH ANDOVER :$•`�``°�'• °� OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 North Andover,Massachusetts 01845 �4SSAcNu Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings `Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE;8/31/2016 JOB LOCATION:62 Wintergreen Dr 210/104 B-0194-0000 Number Street Address Map/Lot HOMEOWNERDaniel & Caroline Armet 585-530-9844 Name Home Phone Work Phone PRESENT MAILING ADDRESS 62 Wintergreen Dr N. Andover MA 01845 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 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 of IndustrialAccidents VAtMEEI I Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Annlicant Information Please Print Let_ibly Name(Business/Organization/Individuai): Daniel Armet Address: 62 Wintergreen Dr. City/State/Zip: North Andover, MA 01845 Phone#: 585-530-9844 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.E]I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required] 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 10 0 Building addition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietorswith no employees. 12.®Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. fi Homeowners who submit this affidavit indicating catmg the are do' all work and then hire outside contractors must submit a new affidavit indicating suck Y >n8 ch. catmg =Contractors 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. I am an employer that isproviding workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: i i Policy#or Self-ins.Lie.M Expiration Date: Job Site Address: City/State/Zip: j 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 DTA for insurance coverage verification. I do hereby cern der the pains"and penalties of perjury that the information provided above is true and correct Si ature: Date: /S� �b Phone#: -7 S)y y 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.CitytTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: