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HomeMy WebLinkAboutBuilding Permit #153-11 - 644 SALEM STREET 8/23/2010 BUILDING PERMIT p1ORTy OFtt,�o t6�ti TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION '- 7 ^o e« Permit N0: 1,53 —i Date Received �i9 S•1TE0�'�� Date Issued: IMPORTANT Applicant must complete all items on this page Na r t .5; u s.i .�.� �y •t..ry i'i'i; a 'e`E � nt �s 'y�F rFak r�PJllir $•'. tisk. } y� u� v e L a. t tsa ti 7i .r^ '"-�•";'� t �t `rbr� r ,r, t•S 4a+c.-f' 'sly �t�'�i ,(s R. w,LrfTlf � txz,{y� r J ; � �r ilF�nr"S r a.�` �v s;.c �"4.�.' ",� � s,.'7"F•�r� �'1'S�'. ��{�'rsl�i .�'� ����"+i'r4�..�itl rc-'s.:. rsy r �rr+� '7 G � ��`�'����';�sLs '� F� �r�.eJ£-'.���'F a �^r,(�.�L�h-`�'Y ��i'r t •-s €`4� 3�..-� ,.t ��,• rr. �ru�».r .ter k .,,:.,n.� '� a-.+� a r}a�, � TM�t�;.�ti:i{�2�,Ft:..�'�'r�� viM`'"` 1t pkv" u-s A16��7�'g1��T�*-�7�N�1� ,e'J�x,� •e � 5 ^+ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building &--117n-e family Addition Two or more family Industrial eration No. of units: Commercial Repair, replacement As sessory Bldg Others. Demolition Other a Im i ,�z�: ,�' +"-1 „ ,y''b 'ee a1J,.� a, ^*iy '; {} /•� x y�i- , Sv i, �trYPi. +y w rt �4�atf a ,.r..,,r,-.. .- _". s�.��._,m�'`�a'�.=- {"'�I".a�.t'Sr� �:r���'� Z -�`.:-r-�s'�+��'.,4'j^� DESCRIPTION OF WORK TO BE PREFORMED: Identification PIease Type or Print Clearly) OWNER: Name: S J�/ s� �� d f vM,Ad Phone: 0-6 V j7 Address - m-'�d�.mn.---�t.s'x�-T`e�1.,'1sy,r-"-+',=�u',x�','•7¢'fi�-tiKu r3'F ���'` �'."�a�b'{7r'",i�k.��L:'t ., �u , asa -rta�7 w� t r=m1; r -� ,�...�.�"�`y�-�,w; .Z' a .y,�^-- ✓�"'ti� �r• ''' S+irk -�'..g �"�'�i_,,,,,zr:5- �7`��5�'a�• i '�i w� S� ��n ,,�. �:^a'f[£- c�,"p.'�1F ' & MEN �" n• -F +1+�;rr� +t b�-y ,t^ T'-titi 'r�4}y' ��a k„ yz,4J 'T ilrs sad,''fit: J... - tz an a- eq, ➢'rtt �N`P'1 WINE' 'hLY F m- r � l - ,t... # 'yrtes,.`° uaS�l ,�-�r'}x+c.�.•rGes.�da'"�P.�s,Y.i„*t'yra.r�;r�,A4�-�r�•`-r- '�,^sT•M L��7r�"�;,ixlLt�,�'vkh�/`ri. �r•.'-�ux`���aitar+$U-e°'t�',,*,'�>L��,rk,fi.cr�ti"��'''f"aze�.�'F�T f�s�iF'sr.r�^��-'x'`,ir,::�.ia{5�kKF..�.!t`.c�t�3�,�v.,r'.''vr;�.r.r g1ar1,rl0ce.KiaxF � 4 IFAM,•'I,R PN 4 N „ 5 . Mrk 5 - yy M "uF�ll'or} - F- . '+� � '�"�:-'v_-�FF'�.,�^.0'�.i[r'£`, f N d}} �. ��'uFs' 2'hJ.kl r=y,r "�;'G� �„�..�t:.�'/Ai`$M+-. .Y :(+�R1tk � t��'r�✓$. G.��•�` ..ZJ ua Y.:T b J Y •" At' ia�`l't� Jc'�. I�c-r J 99I.�`� �rY�k�x `�, 'V"4'd^Y{Tr":i1' 4. �.- �5: a' �,�:•;,,y,,;�, rbSi h4.a,,�yt� 15u�`fir•� 1�rr.. r � �' '.r-'� -�' r 1''`�ij'`- r'�' '�rC rfyS",. �r�.eC..+�9'1�_ -,•,.�`rr-ar y E� 7ti;Ct x'�r=� �> E s '45�N.. 1:--4,R. ,�y ,5 a•��-. s s ap"��._ ARCHITECT/ENGINEER Phone: .YE Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000,00 OF THE TOTAL ESTIMATED COSTBASED ON$125.00 PER S.F. Total Project Cost: $ (� v� FEE: $ Check No.: Y-a ?- Receipt No.: stered contractors do not have access to the guaranty fund NOTE: Persons contracting with unregi gnaturefcoctor' 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 o 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/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. License_ _s ❑ 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:Building Permit Revised 2008 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 i THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED ' DATE APPROVED PLANNING DEVELOPMENT COMMENTS I i CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zaning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water$ Sewer Connection/Sicgnature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Os ood Street F�IRE�PT=Ili11NTferDthrpserr� rt .7- Located�tj1 Plain Sfreef r Er~�re� Sae �r rnena-sigh,a��relda�e z a ' CP �ivTS M�n Dimension i Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: i ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No j MGL Chapter 166 Section 21A—F and G min.$10041000 fine NOTES and DATA— (For department use) h i i i I i ❑ Notified for pickup - Date Doc.Building Permit Revised 2010 , Location No. S3 Date R T N O M F TOWN O NORTH ANDOVER ° .o O ~ 9 h « Certificate of Occupancy $ MUs<� Building/Frame Permit Fee $ 3 "' Foundation Permit Fee $ Other Permit Fee $ . TOTAL $ Check # 233i�a Building Inspector of µoeTH TOWN OF NORTH ANDOVER a° �= b`9 ° OFFICE OF BUILDING DEPARTMENT ° 1600 Osgood Street Building 20, Suite 2-36 North Andover'Massachusetts 01845 �SSac►+uSE� Gerald A.Brown Telephone(97.8)688-9545 Inspector of Buildings Fax (978) 688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please print DATE: JOB LOCATION: (NumberStreet Address Map/Lot HOMEOWNER v a_L( 'e(� C)C4 \ /i� T/ -6 Name HorAe Phone Work Phone PRESENT MAILING ADDRESS City Town stwte. 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 Ch,41G APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 The Commonwealth of Massachusetts Department of Industrial_9ccidents Office of investigations 600 Washington street Boston, ALQ 0211-7 WWW.M ¢ssbov1daWorkers' Compensation InsuranceAn Iicant Information -Affidavit: Buiders /Contractors/Electricians/Plumbers Please Print Legibly Name (Business/OrganizationAndividual): c f e G� Address: City/State/ftp: ,f/ Ai a Phone I l - Are you an employer? Check the appropriate boa: 1•❑ I am a employer with 4• ❑ I aim a general contractor and I Type of project(required): 2.❑ employees(full and/orpart-time).* have hired the sub-contractors 6• New construction I am a sole proprietor or partner- listed on the attached sheet x 7• ❑Remodeling slip and have no employees working forme in any capacity.. These mob-contractors haveworkers' com insurance. g' Demolition (No workers'comp. inctaranc8 5 Pdi 9. ❑Building addition � P ❑ We are a corporation and its required.] officers hake exercised their 10.0 Electrical repairs or additions 3. I am a homeowner doing all work rim t of ex / myself motion per MGL 11.0 Plumbing repairs or additions Y [No workers'comp. c. 152,§I(4) and we have no msurancerequired_] t emP to ees. [No w , 12.0 Roof repairs Y orkers comp.insurance required.] 13•0 Other 'A-)'w?icaa:that checkc box,it t must also M,ou."the Be^L7Q^ 'Homeowners who submit this affidavit indicating they a.�doing al! andhire r +Contractors that thenk this box must attached as additional sheet showing the nurea outside contiactc:s: U9'submit a new affidavit indicating such. ame of the sub-contractors and their workers'co I am an employer that is providing workers'compensation incur �.pow���• information ante for my employees Below is the policy and job site Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: Attach a copy of the workers' compensation policy declaration,pane(showing th/e oli�n Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to thpolicy ositi nbber o f"ted expiration date fine up to$1,500.00 and/or one-year imprisonment,as well as civil �P summa)Penalties of a Of up to$250.00 a day against the violator. Be advised that a co penalties in the form of a STOP WORK ORDER and a fine Investigations of the DIA for insurance coverage verification. PY of statement maybe forwarded to the Office of Ido he. e c under a ns and peiza es o er fP .IurJ th4rt the inform ton provided above is true and correct Signature ` Phone#: 31-7 Officia7- H o not write in this area, to be completed by city or toren of iciaL City or P ermit/License# suing circle one): I. Boar2.Buildinb Department 3. City/Town Clerk 4.Eiectrica!Inspector 5.plum6. Othebrut Inspector Contact Phone #- Information alt d Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. 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 t=ae Iegal representatives of a deceased employer, or the receiver or trustee of an individual partnership,association ox-other legal entity,employing employees. However the owner of a dwelling house having not more than three apartnz cuts and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintt--mince,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 bindings in the commonwealth for any applicant who has not produced acceptable evidence of coampU=ce 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 uu-til 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 afdavit coin lete mP p ly,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es) and phone number(s)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' comp cation insurance. If as 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 remmed to the City or tcm,-n tha—i,the a1'i'ulica ion for the per i for licen-st:s being requested,not the Depa�:erlt Of Industrial Accidents, Should you have any euestions regarditz gthe law or if you are rNqi:ired to ocain a workers' compensation policy,please call the Department at the numbe=r 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 ED in the permit/liccuse 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 cuzent policy.information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stampe=d 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 rebated to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a calL The Department's address,tel phone and.,fag.number:._..._. The Commonwealth- of Massachusetts. Department of Industrial Accidents Office of 1mv-estiastjoas 600 Washington Street Boston,ILA 02111 Tel. 4 617-72.7-4900 cot 406 or 1-8-7-MASSAFF Revised 5-26-05 Fw, #617-72.7-7749 vrvrv,.mass._aov/dia �.1O R TH TONNM of over 'tLAKE _ o dover, Mass., O COCMICHEWICK .e DRAT E D P? C, 7`S BOARD OF HEALTH Food/Kitchen �PERMIT T D Septic System SA BUILDING INSPECTOR THISCERTIFIES THAT .!'!tiv� �_...... .... .................................4 4r...�..�,. �...................................................................... Foundation has permission to erect........................................ buildings on....� ........5Q.L.9.e ..... ................................. Rough �/ �N� GG �d/tea rtl Chimney to be occupied as ...........:�f.:l.. v .... � ............................. provided that the son accepting this permit shall in every respect conform to the terms of the application on file in Final 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 CONSTRUC T T.S BUILD Rough ..... ........................................ ..... .......... . ..... Service SPECOR Final Occupancy Permit Required to Ocmpy Building GAS INSPECTOR 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. SEE REVERSE S 1 D E Smoke Det.