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Home My WebLink AboutBuilding Permit #356-2017 - 64 RUSSELL STREET 10/3/2016 �7�Ah1 J CfI A/h'� /)74Y. BUILDING PERMIT o� NORT/1 Iqti/ V 1 •tiED�� V 2 h�-�'- ' 'h '6 O TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION '-O Permit No#: 3 y ' AP/13 Date Received 16 - Y, 201 (0 q�AATto Qa' Cl �SSACHUS�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION -�z Qusse-II St. Print PROPERTY OWNER P,Lko1oS (S-rje,1440 Print 100 Year Structure yes Q MAP PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residentia Non- Residential ❑ New Building ❑ 9peffamily 0 Addition wo or more family ❑ Industrial ❑ eration No. of units: ❑ Commercial pair, replacement ❑Assessory Bldg ❑ Others: emolition ❑ Other ❑ Septic ❑Well ❑ Floodplain 0 Wetlands ❑ Watershed District 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: c ►Z'nn v1na ArVialwl1_ 4t)1a�r►u wifA IZIS Cz),Li 10Ns}(Vchon,l� IGsitr CP-111A 0A WoU5, inc lakl Act 6i-Vc.� elt6ft►cai, AluMbJ"5 chNn4.L.( Identification- Please Type or Print Clearly OWNER: Name: N*,-1nola5 Phone: q?B ZL5 5?,g7 Address: (pz zis ) s fcd' / O&A XnLuc,- M k &OLi Contractor Name: Phone: Email: Address: I 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 ON$125.00 PER S.F. Total Project Cost: $ Z 51 �U�•O� FEE: $ �� Check No.: Sys Receipt No.: 30'79 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Plans Submitted ❑ 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on Signature 't�::aMMENTS .4 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 FIREvDEPAR�TMENiL - TemwDumpster onsite: ,yes ;nok i Locatediaf 12,4iMain,;St�.eet .Fire4Depar";tmentsignature/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 DANGLER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department ruse) i ® Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 -i 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 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 pp 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 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 No. �S(n- 4 Dt� Date r • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 3�U Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# �'lM J / t� �Cy 9 � / Building Inspector Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost $ 25'5,000.00 m $ - $ 300.00 Plumbing Fee $ 37.50 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 37.50 Total fees collected $ 475.00 62 Russell Street 356-2017 on 10/3/2016 kitchen remodel NORTH '9 own of t_ 6 n over O No. h ver, Mass, / 0 q 0 'pA c0cwic"NW1CK �1 ' 41,9 °R�rEo �Pa� 5 S � U BOARD OF HEALTH Food/Kitchen PERMIT T LD I- Septic System THIS CERTIFIES THAT �.!G.:�f..O.I.!9.. ........ d� e I qnr�! BUILDING INSPECTOR ................................................................... //,�,, Foundation has permission to erect .......................... buildings on .....� ............. ..........!t:. .�.f.vS S<< . rr . //// L t �- Rough to be occupied as ....5 h e.. ....4P:"!<..... .:!9..`J' ./ l............ .. ............................................. 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 CONSTRUCTI N STA TS Rough /V GService ......... .... ............[..1/1................................................. Final BUILDING INSPECTOR 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. TOWN OF NORTH ANDOVER OFFICE OF _. r BUILDING DEPARTMENT 1`d3.ENT a - 1600 Osgood Street,Building 20, Suite 2035 North Andover, Massachusetts 01845 Gerald A. Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION DUIDING PERMIT APPLICA'I'10N Please print DATE: JOB LOCATION: Number Street Address Map/Lot HOMEOWNER N►LLao�4S 9 ocJ4iu,y 44 a78,1 x,52 7 Name Home Phone IW6r1c Phone PRESENT MAILING ADDRESS 62— F—osSri)) - TE; r- m{' Af-- �n�6� M4 6181-1S 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 I IO.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. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 8.2015 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 ]HEALTH 688-9540 PLANNING 688-9535 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: Ni'holns gotItlant) Location: pZ TzusS -e(( SF�c,f City N ort' Ay� Ja vke e Phone E2-am a homeowner performing all work myself. 1 am a sole proprietor and have no one working in any capacity F-11 am an employer providing workers'compensation for my employees working on this job. Company name: Address City: Phone#: Insurance Co. Policv# Company name: Address City: Phone#: Insurance Co. POlicv# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and enalties of perjury that the information provided above is true and correct. Signature Date /d IG Print name Ni tanotaS QOf"anJ Phone# Q $ 2,7,1 7 Official use only do not write in this area to be completed by city or town official' ❑ Building Dept ❑Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone#: ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION ........... ---- ---------- cl, ............ ............ ........... F—I .......... Tz ........... j.. .......... 4_11i ........... 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