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Home My WebLink AboutBuilding Permit #457 - 64 SAUNDERS STREET 2/25/2009BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: K_o– Date Issued: IMPORTANT: LOCATION le Iola �i ev /w Date Received .cant must complete all items on this page Print PROPERTY OW NER�-�Ct4 r, / - ---* -Xa �e4 e:./ I.a e E. Print MAP NO PARCEL: ZONING`DISTRICT Historic3District yes- Machine Shop Village,- yes v-tt�ev ,6*,ryO\ 9_ no no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition . Two or more family Industrial Alteration No. of units: .;7 Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands -Watershed-,District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Iz q dv't' ,RZd xg1.4sfer• a PV1 Z,ra1, /Al il-i Ari . 100n/dn.i Identification Please Type or Print Clearly) OWNER: Name: fir/ .��h�a �i,s Phone: 978 X88'`8 3D� ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: 4koo FEE: $, Check No.. —Z Receipt No.: 021 �xd NOTE: Per ons 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH_ • Reviewed on Signature s COMMENTS Zoning Board of Appeals: Variance, Petition No: Planning Board Decision: Conservation Decision: Comments Comments Zoning Decision/receipt submitted yes Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: 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 - Date Doc.Building Permit Revised 2008 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 o Copy Of Contract ❑ Floor/Crossection/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 Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Location No. -3 Date r ' f NORTH TOWN OF NORTH ANDOVER F 9 • : ; ; Certificate of Occupancy $ ,ssACNUst�� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 21842 Building Inspector 0 pORTrI TOWN OF NORTH ANDOVER °•'"�• OFFICE OF A BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 North Andover, Massachusetts 01845 Gerald A. Brown Inspector of Buildings HOMEOWNER LICENSE EXEMPTION Please vrint DATE: o? S O JOB LOCATION: 666 5gyA)D Pis' S7- Street Address Home Phone PRESENT MAILING ADDRESS lei S -T— Telephone (978) 688-9545 Fax (978) 688-9542 Work Phone /vee v e 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 helshe 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 Reed 10.2005 Form Homeowners Exemption TIOARDOF \PPE:\LS (88 9511 CONSERVATION 688-9530 ITE.U.Alf 688-9540 PLANNING 688-9535 �s The Commonwealth of Massachusetts t Deparment of Industrial Accidents Office of 1"1zvestigations ' 600 Washington Street '.., �ft Boston , M14 02111 w►vrv. rizass.go v1dia Workers' Compensation insurance .Affidavit: Builders/Co Acant information ntractors/Eiectricians/Plumbers "I__ . .- Name (Business/Organization/Individual): Address: 4 / ��v N V e -r2 s City/Sfate-/Zip IJ ,. -✓�` f Phone #: - Are you an employer? Cbeck the appropriate box: 1.❑ I am a employer with . 4. ❑ I am a oeneral employees (fill and/or part-time).* 2. ❑ I am a sole proprietor or partner- ship and have no employees wori:ing for me in any capacity. No workers' comp. insurance ,--.,/equired.] 3.11d t am a homeowner doing all work myself. [No. workers' comp. insurance required.] t r= contractor and I have hired the sub -contractors listed on the attached sheet These subcontractors have workers' comp. insurance. 5.. ❑ 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 re Type of project (required): .6• ❑ New construction 7• ❑ Remodeling . S. ❑ Demolition 9. ❑ Building addition 0:❑ Electrical repairs or additions i l.❑ Plumbing repairs or additions 12 ❑ Roof repairs quire ] 13•7 Other *Any applic ant.that checks box # l .must also fill out the section below showin their work M' eom ensation 1 oft t g rtomeownets whe submit •t3tis aiid8vft lfidicati tg tliey are doir- as w,,-rk p P c mrotmatim xConmetors that check this box must "'u mcn ht:r outsttie cantraciurs mast su'tmtti a new amaav attached an additional sheet showing the name of the sub -c it ircicadng such. f;,iu`dCtorS and thsir wnri,—, . UM un employer that u providing workers' co ensation - y - information assurance for'M' a to ees. Below is the poficy and job site Insurance Company Name: Policy # or Self -.ins. Lic. #: Expiration Date: ------------ .lob Site Address: City/state./Zip- Attach a copy of the workerscompensation policy declaration page (showing the policy number and expiration Failure to secure coverage as required under Section 25A of p ration date). fine up to $I,500.00 and/or one-year imprisonment as well as civil penalties in the to of a STOP WORKimposition of IOI p�alties of a of up to 5250.00 a day against the violator. Be advised that a co RDER and a fine Investigations of.the DIA for insurance coverage verification. copy of this statement may be forwarded to the Office of .) .I.. f_ ___L_. •-••��• � .,- way anger rase pacnc and pe 'es ofPj er u rJ that the information provided above is, true and correct Sicznature: Date: Phone FOfficialuse only. Do not write in thisarea,tobecompleted b3, city or town official Town: Permit/L,icense 4 gAuthority (circle one): I. Board of Health 2. Building Department 3. City/Town Inspector Ins. Clerk 4. Electrical Inspector S. Plumbi 6. 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