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Home My WebLink AboutBuilding Permit #326-2017 - 64 FOREST STREET 9/27/2016 �� v5 Scflw�ED ✓ � AW .� I �10RT1i BUILDING PERMIT ,.� b�:: ^ '• °� TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION Permit NO: Z�—261 Date Received Date Issued: 2-1 (op � CHUS i IM ORTANT:Applicant must complete all items on thisis1 a ee A LOCATION r Print r\� ' PROPERTY OWNER � �a its� C� 1 Print MAP NO: /U G, PARCEL:ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE e 'dential Non- Residential ❑ New Building )Wne family ❑,Addition ❑Two or more family ❑ Industrial /NAlteration No. of units: ❑Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic Well Floodplain Wetlands Watershed District Water/Sewer %�Id�epntification Please Type or Print Clearly) p / OWNER: Name: 46ot 1 � 1� Phone: Address: CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED M$125.00 PER S.F Total Project Cost: $ ' Od FEE: $ Check No.: Receipt No.. NOTE: Persons contracting w' nregistered contractors do not have access to the guarantyfund Signature of Agent/Owner / Signature of contractor �, r` NORTH BUILDING PERMIT °�tt'E° b;�tio TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION e Permit No#: Date Received �'qs RATE° SACHUS Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT:_Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial [I Alteration No. of units: [I Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of contractor Signature of Agent/Owner g._ Location i No. t. Date ' 1. . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ T Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# Building Inspector / Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art F] Swilnming 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 �li� \--,/- PLANNING & DEVELOPMENT Reviewed On Z� Signature_ COMMENTSP PlGJ1 f) 14 — Sofrv�s�Qv- CONSERVATION Reviewed on Si nature - COMMENTS HEA TH Reviewed on �� Signature COMMENTS_ °et5 , I t 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: Located 384 Osgood Street FIRE DTl:�4 ARTMENT - Temp Dumpster on site yes no Located Main Street Fire Department signature/date 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 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 ❑ 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/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 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 submitted with the building application Doe:Building Permit Revised 2014 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost 5,000.00 m $ - $ 180.00 Plumbing Fee $ 22.50 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 22.50 Total fees collected $ 325.00 I 64 Forest Street 326-2017 on 9/27/2016 Farmers Porch NORT1i Town of 1 ndover o No. i ��1- * t - - o K§ ver, Mass, ;)8dfV06',r C;11.;q COC NIC N!WKR '9s V t BOARD OF HEALTH Food/Kitchen PER TSeptic System THIS CERTIFIES THAT Q.YL BUILDING INSPECTOR ................... ....................... .. .. ............ . ...... ................ .... has permission to erect .... ................. buildings on .. Foundation .` ....fir ..... .... .. -................ Q Rough to be occupied as .................. ... 5.........Q Q.. . .......................'..... .�.................................. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Final 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 0 Rough Service .. ... . . . .......... ...... . .. BUILDING I ECT R Final GAS INSPECTOR Occupancy Permit Rmuired 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. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ ❑ Private(septic tank,etc. Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On 7 Signature_ COMMENTS el , J _ Ns7T i JU Gt- �t�►�eo► czr 5,j CONSERVATION Reviewed on. % Si nature COMMENTS o 0, S Ota HEA TH Reviewed on Signature COMMENTS Q et5 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Con nection/Sgnature& nate Driveway Permit DPW Town Engineer: Signature: - Located 384 Osgood Street FIRE`DEPARTMENT - Temp Dumpster on site yes Located at 124 Main'Street Fire Department ria4ture/date _ COMMENTS The Commonwealth of MassaChusetts Department ofXndustrialAceldents X Congress Street,Suite 100 _ Boston,MA 02114-2017 • �� www mass.gov/dza OM S��V Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plum ers. TO BE FILED WITH THE PERNIIT ING AUTHORAY. please Print Le 'bl A licant Information Name(Business/Organization/In 'vidual): Address. City/State/Zip: �� U`� Phone Are you an employer?Check the appropriate box: Type project()requi-red), em to ees(full andlor part time).* 7. dw constr&tion i.[]I am a employer with P y IF]I am a sole proprietor or partnership and have no employees vVorking for me in $. �Remodeling ny capacity.[No workers'comp.insurance required] 9, emolition 3 I am a homeowner doing all work myself[No workers'comp.insurance required.]t 1OQn Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.❑Electrical repays or additions ensure that all contractors either have workers'compensation insurance or are sole bin repairs or additions proprietors with no"employees. JZ.F Plum. g 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 11 goof repairs These sub-contractors have employees and have workers'comp.insurance.$ 14.0 Other 6.FJ 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.] n policy information. *Any applicant that checks box#1 must indicriatmg th y are doing out the section all work,and then hire outside oontracto�s must submit new affidavit w showing their workers' indicating such I Homeowners who submrt , tContractors that check this box must attached'an additional sheet showing the name of the sub contractors and state whether or not those.•entitiesave employees. If the sub-contractors have employees,they must provide their workerscomp.policy number. lam an employer that is providing rkers'compensation insurance for my employees. Belo is the olky and job site information. Insurance Company Name: / Expiration Date: pr Policy#or Self-ins.Lic.#: _ d ( J ( City/State/Zip: Job Site Address: "1 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date . nal violation punishable by a ffilb up to$1,500.00 Failure to secure coverage as required a der MGL c.152,§2 form of as 5A is a STOP WORK ORDER and a fine of up to $250.00 a and/or one-year imprisonment,as well penalties copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance day against the violator.A coverage venficatio . X do hereby cert der the pains andpenalties ofperjury that the information provided a �ve�is rU �dForrect. Date: Si ature: Phone#: official use on o not write in this area,to he completed by city or town official. Permit/License# City or Town: Issuing Authority(circle one): i 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#: Contact Person: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for theiremployees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual;partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver'or trustee of an individual,partnership,association or other legal entity,employing employees..However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants \ Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub=contractors)name(s),address(es)and phone numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. -. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(ifnecessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASS.AFE Fax#617-727-7749 Revised 02-23-15 wwwmass.gov/dia TOWN OF NORTH ANDOVER M_ g OFFICE OF WELDING DEPARTMENT - 1600 Osgood Street,Building 20, Suite 2035 +L North Andover,Massachusetts 01845 Gerald A. Brown Telephone(978)688-9545 Inspector of Buildings, Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTKON DIJHDING PERMIT APPLICATION Please print DATE: � � JOB LOCATION: Number � Street Address Map/Lot HOMEOWNER - UC -67 j7Z C C-73 II— 7 7c "UL Name Home Phone Work Phone PRESENT MAILING ADDRESS Sr, - NK N.4^ City Town State Zip Code 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 6id s the Town of North Andover Building Department minimum inspection procedures and req irem ill comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFIC Revised 8.2015 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 365,3t' CHI IELD wiAM �� w INFlLTR TOR CHAMBERS INSPECTION (46.291 S.F.) PORT N .. ;—i ldp• �tf VENT D—BOXM'f / 1500 G a SEPTIC TAN _ f `1 f all owe. J VV C. 7 f l v. r .A S B�TILT PLAN OF Nov i OTTT30TT10V A f4V MCIlDnQ AT i Lo rAe sa ��a �,�• 1a q Nis �o M �d S►�� c % -------------------- ------------------- 04;�- o (r ---- - -r i i I T