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Home My WebLink AboutBuilding Permit #160-13 - 65 MAPLE AVENUE 8/27/2012 i BUILDING PERMIT No oT TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit N0: /0® )-3 Date Received 7�p�RTeo►PRS,�5 9SSACHUS�� Date Issued: �! IMPORTANT:Applicant must complete all items on this page Pint' PROPERTY OWNER' ( MAPs2 � PARCEL: Prnt ING:D_IS, RICT'. H_ i- stone:District yes,,' no Machine;Shop.Village, yes: 10,OjYear OldiStructur ; yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition U Tw* o or more famil ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic D Well EJ Floodplain; ❑'VVetlands� ❑ Watershed�District Uwti`fee-r/Sewer DESCRIPTION OF WORK TO BE PERFORMED: y. h? / e e-c 9b Nell, 4,1 J yam. Identification Please Type or Print Clearly) OWNER: Name: FAmris yimvd Phone: 5'0 - r Address: /6, ®l yl�- 940-6f�--19-1 ZC� CON� =RAQTOR Name: �-J _2�t t �� _ _ Phone:_ �i � ��.�► ��`` •Add_ress: In a? GJ 4,fJ7d29 S%: I117�00e�Jj all Dl jT Y Supervisor's Construction Lieense: ' 7 Exp Dater f t? i H. ImprovementL-icense '1 _. . 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: $ SL')Ob 4)/1,nC'4&,frA1J FEE: $ j�!Q Check No.: &/ Receipt No.: ,:�qo S —40 NOTE: Persons cont acting with unregistered contractors do not have access to the guarantyfund 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 d Workers Comp Affidavit ❑ Photo Copy of H.I.C. And/O CDLcenses —e 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 VOTE: 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 2012 I gnafurerof:Agen t/Ownerl � f%�'M - Signature of contractor_ _____---_�� 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 HE�,LTH. Reviewed on Signature COMMENTS 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 at 384 Osgood Street—978-685-0950 _ _ FIRE DEPARTMENT - Tem Dum .ster,,onsite, p p yes no: Located°at 124WM in,St-- et-978 688-9590 Fire Department signature/date I COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: a+ ELECTRICAL: Movement of Meter location, mast or service drop requii 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 AQ olgtcA r l'a b i S r 1�S � c 12- Q Notified for pickup - Date {F I Doc.Building Permit Revised 2012 Locationi� No. Date TOWN OF NORTH ANDOVER lsU . Certificate of Occupancy $ Building/Frame Permit Fee = Foundation Permit Fee rF,u1ha Other Permit Fee $ TOTAL $ Check Vo 25654 Building Inspector Location No. 140 — 13 Date //h//z— TOWN / /3 /z-TOWN OF NORTH ANDOVER 00 y . Certificate of Occupancy $ wz' Building/Frame Permit Fee $ g w ,af"d Foundation Permit Fee $ ' Other Permit Fee $ TOTAL $ Check# 25950 Building Inspector OMO°T of♦``e.•.Y,`.oOL i;, •r �SSACHUSE{ CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 160-13 on 8/27/2012 Date: November 13, 2012 THIS CERTIFIES THAT THE BUILDING LOCATED ON 65-67 Maple Avenue MAY BE OCCUPIED AS a two family home IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Francis Murphy 65-67 Maple Avenue North Andover,MA 01845 Building Inspector Fee: $100.00 Receipt: 25950 Check :1054 I� ONO oTM9 _ . N O r p M i �SS�CHU'+E4 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 160-13 on 8/27/2012 Date:November 13, 2012 THIS CERTIFIES THAT THE BUILDING LOCATED ON 65-67 Maple Avenue MAY BE OCCUPIED AS a two family home IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Francis Murphy 65-67 Maple Avenue North Andover,MA 01845 Building Inspector Fee: $100.00 Receipt: 25950 Check :1054 tkORTH To-wn o J.- I Ina� No. _ 10 h ver, Mass, 'd Coc.uc Ml WICK y�• �i9 ADR�ITED LPp�� S V BOARD OF HEALTH PERM �IT. T LD Food/Kitchen Septic System THIS CERTIFIES THAT BUILDI G INSPECTOR 40; 6 has permission to erect 4� . ....... buildings on . FSU .... ... ►x.......... ...........1!114 2 .to be occupied as ...... ��. ... ..� . ... ��1. �s . Da provided that the person accepting this permit sha a respect conform o the terms of the application F 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 IN P TOR Rough,::4PL . 1k, "/71 Z_ VIOLATIONof the Zoning or Building Regulations Voids this Permit. Final .�� PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR s UNLESS CONSTRUC ST .. Rough ......... ............................................ Service ............. BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in Conspicuous Place on the Premises - Do Not Remove Finai p Y a p No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE a IR , LIMITED TO ITEMS BELOW PRMIT(COPY OK)..or no inspections Foundation, Frame, Insulation, Final. 1 for columns i R (fabric filter/cover and outlet connection. - 1 or joist ,at,elec,etc. Ir bearing partitions. f ing at rafter cuts. h bearing at walls. connections. :e proper connections and use"Hurricane Clips"tie to plate. And heal support. i/hanger nails. I seal. �e bearing at foundations les in foundation pockets. ends. red for Beams/LVL's Trusses. eaders/Beams etc. M-stairways, under beams Attic Access. kit in P. Jhr/3' headroom above). Crawl space access. (min. 18x24). Bath exhaust fans to have metal duct to exterior(not in soffit). Firecode S/R wood frame of"0"clearance fireplaces&stoves Window Schedule or Every Habitable Room Must Have: Natural light equal to 8%of floor area. of required glazing shall be openable. Bedrooms required min.20x24 egress window or door. Vent attic spaces-"proper vent", soffit and required ridge vents. , Firecode under stairs if used for storage FIREPLACES: Separate permit required. Inspections at Footing-Smoke Chamber- Finish Smooth parging, clean joints,8"solid @ combust. DECKS: Lag to house, provide flashing. Rails min. 36" high, Baluster max space 4"on center. Over 8' above grade, use 6x6 posts w/lateral bracing. ` Lag all posts and rails. Pier footings down 48", Conc. pad at stair base. FINISH: Handrails returned to wall/newall post. Guardrails required alongside open cellar stairs. Exterior grading complete. Certificate or occupancy required prior to occupying structure. Temporary Stairs required for inspection. Re-inspection fee- $30.00(Be Ready). Certificate of occupancy required prior to occupying structure. �J NORTH F own o sAndover 0 - No. t - h y ver, Mass, coc MIc Ml W1cK ��• U BOARD OF HEALTH Food/Kitchen PE . Septic System M JV R T LD THIS CERTIFIES THAT �. Vr ............... BUILDING INSPECTOR ...fAr.. ................ .. ........ .............. . ... . .... . .. . ... Foundation has permission to erect . ..................... buildings on .....�... ........ ........... .... Rough p� .. A. U0 ... ..C� 1mney to be occupied as ................u��.an.*..... ..�..... . ........ provided that the person accepting this permit sha a respect conform o 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 4101b PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTUA ST Rough Y Service ............. .... 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. SEE REVERSE SIDE . -•-.---��--., fir_ - Office of Consumer Affairs ,"Ind Business Regulation 10 Park Plaza =Suite 5170 . Boston, Massachusetts 02116 ' Home Improvement Contractor Registration _ Registration: 159651 rI Type: Individual EDWARD RAUSEO 'f i i Expiration: 5/1972014. Tr# 225437 �,,,� EDWARD RAUSEO ' 62 WASHINGTON ST METHUEN, MA 01844 �{ Update Address and ret— urn ct,rd. 1VL rk reason for change. Address ❑ Em . . pi r"a 20M-05/11 ❑ ❑ Renewal "' ployment ❑ Lost Card Office of Consumer Affair.{ Isior registration valid for individul use only ME IMPROVEMENT f&re'Ihe expiration date. If found return to-*, '; gistration: 59658` y N s: Gffiee f Consumer Affairs and Business Regulation xplraion: c.=5619/2014 1 Individual 10 Parr Plaza=Suite 5170 ✓ARD RAUSEO = " Boston!MA 02116 /ARD RAUSEO 1`1 ==- a fASHINGTON ST IWEN,MA 01844 �. Undersecretary Not valid without signature C UOV, t, O 6FQ�y SSP• e;a /0 ,%� 011 •:FT95, �✓ "Ilk? a4Q ��rf��,�f, r Tti •� fico O cy c S S' '� r go78gg�� Qi/,��''Ser�oV� V t i Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 5,010'010.010 m $ - $ 600.00 Plumbing Fee $ 75.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 75.00 Total fees collected $ 850.00 65-67 maple ave permit 160-13 renovation The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: S ,1— City/State/Zip: TCity/State/Zip:1`7 Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2. am a sole proprietor or partner- listed on the attached sheet.$ F]Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. tam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins..Lic.#: Expiration Date: fob Site Address: �/� 'r City/State/Zip: "e s. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a Me up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine )f up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of hvestigations of the DIA for insurance coverage verification. .r do hereby certify under t Mdns an enalt' of perjccry that the information provided above is true and correct. ii nature: G' \ Date: t�! Z /�2- ?hone ?hone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and 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 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 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' 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(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 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 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,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 revised 5-26-05 www.mass.gov/dia