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Home My WebLink AboutBuilding Permit #96-11 - 643 SOUTH BRADFORD STREET 7/30/2010Permit NO:- eno' —//- BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Buildin 9 �ne f a <:�� Addition ' —te Two or more family Industrial CA I r—a f—io n— No. of units: Assessory Bldg C I ornmercial Others: Repair, replacement Demolition Other m 'fe' ED - 5 lgg NOW, 'A' nq P NAOMI ':rip DrCRIPTION OF WORK TO BE PREFORMED.,,, OWNER: Name: Identification Please Type or Print Clearly) :9 7�6 '40 S s --q s5 o. ARCHITECT/ENGI NEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING'_gERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST'SASED ON $125.00 pER S.F. Total Project Cos�t: FEE:$ I '; I Check No.: Receipt No.: e9 NOTE: Persons contracting witliunifRVire�co-nti,act-o--r—s do not have access to the guaranty.fu-n—d A I V 5 11'/ 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 Si-ghature COMMENTS HEALTH Reviewed on Signature COMMENTS, Zoning Board of Appeals: Variance, Petition No: Z oning Decisionlreceipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town En,&eer: Signature: Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter 16 cation, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section'21 A —F and G min.$100-$l 000 fine Doe.Building Permit Revised 2010 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 Li Building Permit Application a Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses ci Copy of Contract ii Floor Plan Or Proposed Interior Work. u Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or..Decks u Building Permit Application Ei Certified Surveyed Plot Plan o Workers Comp Affidavit u Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (if Applicable) u Mass check Energy Compliance Report (if Applicable) u Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit 1 -1 -New Construction (Single and Two Family) u Building Permit Application u Certified Proposed Plot Plan Ei Photo of H.I.C. And C.S.L. Licenses u Workers Comp Affidavit u Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (if Applicable) o Copy of Contract u Mass check Energy Compliance Report u 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 el Doc: Building Permit Revised 2008 " Y7ie Commonweizith Of Alassachusers Department qf rJ2,dust-ial A cciden ts office Of Ln vesz�,-atins .600 Wavhingto?z street BOstOPz, M4 62111 WKW. rnass-6010-PI&a Workers' COMPensation Insurance Affidavit: Mlicant 1nfnrmaij.. Buflders/Contractors/Electrictaii-s/Plumbers Name (Business/organizati,,Adi�,idual): Address: City/State/Zip: Phone #: A -re You an employer? Check the appropriate boxi am a empioyer with 4. am a general "acto Type of project (required)�: j lu 'MPIOYees (full andJor par -t -time). 2.7 I am a sOlt -ra ont Ontractor and I have hired the sub -contractors 6. 7 New construction 6 New co struction [7 PrOPrietor or partne7- ship and have no employees ] t1l listed on the attached sheet. I Z 7. 2Remodchy emodclMy worIcing for me in any capacity. These sul>-cOntwtors have workers Demolition [No work='comp. Insurance we cOmP. insurance. It a corporation - 9. B ding uil addition requ=d.] 3X. I am a homeowner doing and rts Offic= have exercised their 10-0 Electrical repair, or additions all work myself. [No workers'comp. right Of exe:mption p MG er L c. 152, (4), and J 1 - F7 Plumbing repairs or additions in . surance required.] f we have no employees. [No woricers, 12.[] Roof ncpairns Comp. Insurance required.] 13- D Other 3 [] 0 er that ch—k- box�A! 'St al 011-11. the Be —ay. , L- 1-10meMm-s Who mbmi, &is affidavit indicating the:3, —6 1 wofj- , -- P-1; 't doi— all anci thm him otrtside contmeta_ r� - , �Contractor- that nb=k this bOXMM", a--ched au addlu a a! sheet showing the indinating .. , _ _Ubm,t E, new afiidavit r-- -- " I . ziam- of the sub`cOntractars such. and�th�eir wcrk�� I - — — ","Yar UUZ1 IsPrOMWing workers I compens n - - -- , �—.y auurmmon. informadom ado ur-Tzerancefor MY emPloyees. Below is thepo&:�j, andjob site Insurance Compiny Name: Policy or Self -ins. Lic. # Job Site Address: Expiration.Date: ----------- ---------------- city/state/zip: A,ttach a COPY Of the workers, compensation Policy declaration page (showing the policy -------- nuunherand expiration date). Failure tO secure coverage as required under Section 25A Of MCTL c. 152 can lead to the imposition of fine UP to $1,500-00 and/or one-year imprisonment, as well as civil pe criminal penalties of a Of lip to S-150.00 a day against the viol 'nalties in the form of a S ator. Re advised that a cc)py of this statement TOP WORK ORDER and a fine Investigations of the DIA for insurance coverage verification. may be forwarded to the Office of I do hereby c unde e andpanaldes ofp,,,j.,3, th4rt the infornaaoft proVide Si e: above iF true and correct. 3.0.20 one #: -7 C Official use only. Do no, nrite ij7 this area, to be com p1d, b J, c4oil or town ofjl-ciaL City or Town: h r1uiR.' , Authority (circle one): 1. Board of liealtb Z. Building Department 6. Other # C"Y'TOW11 Clerk 4. Electical Inspector contact, PersDn: Phone Inspector Information an- d Instructions Massachusetts Gencral Laws chapter 152 requires all -employ 4=rs to provide. workers' compensation for their =Dloye-�g. Pursuant to this statute-, an employee is defined as "..xvcry pc---rson in the service of another under any contract of hire, express or imphed, oral or written." An employer is defined as "an individual, partnership, associ,=xtion, corporation or other legal entity, or a . ny two or niore of the foregoing eagaged in a joint enterprise, and including t1he I -Zai representatives of a deceased emplover, or the receiver or trusine. oil an individual, partnership, association ox7 other legal entity, employing employees. However the owner of a dwelling house having not more. than three apartnL ents and who resides therein, or the, occupant of the dwelling house, of another who =ploys persons to do mainte--:Iciance, construction Or repair work on such dwelling ., house or on the grounds or building appurtenant thereto shall not be- c--ause of such, employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or loq=Rl lice a- n s using e cy hall withhold the issuance or renewal of a license or permit to operate a business or to c-- -onstruct buildings in the commonwealth for any applicant who has not produced acceptable evidence Of co3mpFmce with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the c--ommonwealth nor any of its political subdivisions shall enter into any cont= for the performance of public work um -til acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contraLcting authority.,, .kpplicants Please RE out the workers' compensation affidavit completel-y, by checkirig the boxes that apply to your situation and, if necessary, supply mb-coritractor(s) name(s), addrekes) andphone number(s) along with their certificate(s) of insurance. Lirndted Liability Companies (LLC) or Limited Lizibility Partnerships (LLP) with no employees other tim the members or partners, are not required to carry workers' cOMP emation instrrance. 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 -kccidcnts for confirmation of insurance coverage. Also be 9xwe to sign and date the affidaviL The affidavit should be. returned to the city or town thatt the arroplica-l' for the -errnit =10n. or he=sse in being requested, not the D-c-partmen't of Industrial Accidents. Should von have any que-c6ons rcgardimcr the law Or i-fy I � .1 -VI on art to &Dtain a Work-erS' compensation policy, please call the Dep I ent at the aumb=x listed below. Self-insined companies should -enter theu self-insurarice license number an the appropriate line. City or Towio Officials Please be sure that the affidavit is complete and printed lepibl3r. The Department has provided a space at the bottom of.thc affidavit for you to fill out in the event the Office of Irn-'estigatious has to contact you regarding the applicant Please be sure to fill in the permit/licanse number which will be used as a reference number. In addition- an applicant that must submit multiple pernut/lizense applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Addrrss— the applicant should write "all locations in (city or town)." A copy of the affidavit that has been offici�EY stamPe-d or marked by the city or town may be providzd to the applicant as proof that a valid affidavit is on file for future per:rnits or license&, A new affidavit must be fille�d out each year. Where a home owner or citizen is obtaining a license or p=Mit not related to any business or commercial ventire (Le. a dog licerise or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Offi-ce of Investigations would ble to than you in advance for your I cooperation and should you have any quesfioris, please do not hesitate to give us a calL The Department's address, telephoneand,fim-mumber: Tle Commonweala Of Massachusetts DePa�Cnt Of Industrial Accidents Office of lnrestigatiGns 600 Washmgtan Str=t Boston; M -A 02111 Tel. # 617-72.7-4900 = 4,().6 o,,r I -g —/7-1VLkSSAFF Revised 51-26-ff FaxT4617-72-7-7/7'49 vrv,v,, -mass.- zov/dia w z fX4 0 �2 0 �2 Cf) u w or. u CIS �r. C, u u ct Cl) 0 cz r. 14 ZW 6 cn 41 0 C/) Ica tca CL "'D CF 'co E.S 0 CD C2 C.3 a ts cm A� CD all Ir C� C,* Mo ;-C—D CO) cm CL CD CD CO CC .C. cm C=M C=, S C.3 0 CM2 2! C3 M— cm CL. 0 ci 0 CD cc L, coo C=c CL:s -.S L E 0 . 0 CC.D2 CD LLJ C3 WE co C.3 COO CL .0:9 0 -S 210 10 CD C) 0 -:a — rl-^ :*.. CL.P CO ::No V A I z 0 z 0 u Zra N 2 t3 4� CD 0 E CD z CD CL CO2 CD cm CO) -0 CD LA cD E ca cc CD CD L- CL CD cm CD Q L- CL m CD = cm< IS cc c-, C42 Z G3 CL CO) co) cm LLI UA C4 LLI W LLI LLI U) ,AORTH TOWN OF NORTH ANDOVER 0 OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 North Andover, Massachusetts 01845 Gerald A. Brown Telephone (979) 688-9545 Inspector of Buildings Fax (978) 688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please prin DATE: �j 30 Z2-01,0 JOB LOCATIbN:_L_q_S 5, 13 (,,,4 6,p Number Street Address HOMEOWNER K—) rA �,e v, 1,) + )�, L Tt),) Name Home PRESENT MAILING ADDRESS /in doj e 9 7'�20 - (a SS —q550 Work Phone City Tovm_ 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 responsibil - ity for compliances with the State Building Code and other Applicable codes, by-laws, rules and regulations. 11 The undersigned "homeowner" certifies that he/she understands the Tow n of North Andover Building Department minimum inspection procedures and require and thaLlie/she will comply with said procedures and requirements. 27 r-\ HOMEOWNERS SIGNA APPROVAL OF BUILDING OFFICIAL— Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLAWNG 688-9535 Location No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 2 CMUS*, Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # /,3--4 3 2 3 2 Building Inspector