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Home My WebLink AboutBuilding Permit #896-16 - 66 CHADWICK STREET 2/17/2016BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#:,-)' *7 JW_1_ 40" Date Received Date Issued: I- I1%PORTANT: Applicant must complete all items on this page 0 LOCATION —� Cwma/, S('. Print PROPERTY OWNER 62 u?/Km- &I VG�Ci �� Print 100 Year Structure yes no MAP &&�2 ...-PARCEL: ZONING DISTRICT: Historic District yes n Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ❑ Well ❑ Floodplain ❑ Wetlands. ❑ Watershed District Water/Sewer . DESCRIPTION OF WORK TO BE PERFORMED: e�(� rev rC�i-'o�„�fifiror�.� Identification - Please Type or Print Clearly OWNER: Name: �4 M ILA -L2 aul 105� Phone: Address: Contractor Name: Email: Address: Supervisor's Construction License: Home Improvement License: ARCH ITECT/ENGINEE Phone: Exp. Date: Exp. Date: 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: $ �`�� FEE: $ Check No.: �/� (� �1 Receipt No.: c,_�'o NOTE: Persons contracting with unregistered contractors do not have access to the gharanty fund NORTH BUILDING PERMIT TOWN OF NORTH ANDOVER 32 5t. •_ h.:6 APPLICATION FOR PLAN EXAMINATION '- ~ * " Date Received Permit No#:A �14A°areD �Paty (5 gSSACHUS�� Date Issued: PORTANT: Applicant must complete all items on this page LOCATIONCRARNiC& ST- ,� Print PROPERTY OWNER ,l'C,/IlJfl' t;Sl�l V&t" Print 100 Year'Structure yes no MAP �PARCEL: ZONING DISTRICT: Historic District yes n Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units`. ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other i Septic Well- ❑Floodplain 'Wetlan'd's ❑ 1NatersfietltlsD�sr�ct,- - NS Sewer - -_ - - -- - - -- - - i DESCRIPTION OF WORK TO BE PERFORMED: Identification - Please Type or Print Clearly OWNER: Name: ��,t ILLA jr�AOU.IKZ Phone: Address: Contractor Name: Phon Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Date: ARCHITECT/ENGINEER Phone: Address: Reg. No FEE SCHEDULE. BULDING PERMIT. $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ �&2 Check No.: Receipt No.: ,�0 NOTE: Persons contracting ufth unregistered contractors do not have access to the g aranty fund Location 1,I) L No. Check # Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee s—CL Other Permit Fee TOTAL Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL, r Public Sewer ❑ Tanming(MassageBody Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Duiupster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On COMMENTS Signature, CONSERVATION Reviewed on Signature COMMENTS 14EALTH COMMENTS Reviewed on nature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Commen Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 364 Usgood Street FIRE,DEPA(RiTMENTTe"rnp)Qumpst- r onsite ,,yes, -1 u'. 'no, F ,.,. Locatedlat .1241 MamrSt�eet - --- LL _ Fire�Departmentsignature/date _ . _. .._... � • COMMENTS. Plans Submitted F1 Plans Waived F1 Certified Plot Plan 11 Stamped Plans F1 TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Taming/Massage,/Body Art ❑ Swimming P001s El Well ❑ Tobacco Sales ❑ Food Packaging/Sales El Private (septic tank etc. El Permanent Dumpster on Site El THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature CONSERVATION Reviewed on Signature COMMENTS HEALTH COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes -1 Plarining Board Decision: Comm Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: -., -�-b& - - LOcatea 364 USgood btreet IlRig ;-PAR MENQ��-iTb' mpj-umpsterpmsite 'k r6aited �V ffa A•ktMi t --e-nt F M VN COMM}{ ENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Rueter 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 Call Email Date Time Contact Name Doc.Building Permit Revised 2014 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 ®ANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine Doc.Bi lding Permit Revised 2014 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 4. Workers Comp Affidavit 4, 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 TOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4. Building Permit Application Certified Surveyed Plot Plan ;6 Workers Comp Affidavit .4 Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract ;rw 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 TOTE: 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 2012 IECC Energy code 4. Engineering Affidavits for Engineered products TOTE: 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 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 4. Workers Comp Affidavit 4. 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 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 66 2012 IECC Energy code 4 Engineering Affidavits for Engineered products TOTE: 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 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 209000.00 m $ 240.00 Plumbing Fee $ 30.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 30.00 Total fees collected $ 400.00 66 Chadwick Street 896-16 on 2/17/2016 Kitchen and General Renovations < o 0 1V O W 2MU W' CCD o - m p 0 CLC a ;u U) • Z o 3 -o v,' 0, u rt T. -n C „-F o� o CL m =0) :3 Cl) cc C C' "O CD to o -� N CD <D 2 c m O c� co N a CO) r. 110p 0 5' CD ooCD CD 0 CD 010 ;zZ c O c� Qr—n' n I—'M 0y �O `b �� CCD OM cc OH — Cl) •— `o Z ft N cC >CQ•� n� «� -0or" s SCDCRL OZ y � o - _ _ 0 cn < 0a N CL CD cn CDO ti. ;um �C CD CL C — CD -� Z U) O C7 -o as CD CD O Cn W O CO) _CD Zo :Cro CL CD �0(a cQ CD ZdlLCD C v ti CD A r► y �D Z C �� F y CID v 05.2" o o G):C. CD " Z cn: O < CD � : °« p oCL Ln V) w T � T V) Z7 T Z7 T n � T VI T C O_ 3' N O �' O S O O (D O rD ,� 7 Q" 77 (D(D O m '"' rD S n S S 7 S fl_ 0 \ lD 0 rD o 0 0 Y o - = m m -n rm- m W 3 C C W �o G1 9 O m W 0 > W f1 Z 'V r G) C D H O n H N V m m O m m D z = 0 4w Imw 0 c Gerald A. Brown Inspector of Buildings Please print DATE: TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street, Building 20, Suite 2035 North Andover, Massachusetts 01845 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Telephone (978) 688-9545 Fax (978) 688-9542 JOB LOCATION:6k Cftki 4 ft Number Street Address Map/Lot. HOMEOWNER Home Phone - Work Phone PRESENT MAILING ADDRESS kp Cffdpwal ICT 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,rop vided that the owner acts as su erp visor. 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'fndustriaiAceidents 1 Congress Street, Suite 100 — r Boston, MA 02114.2017 www mass.gov/dia �Torkexs' Compensation GEA'�[T>8[TJ�EIPERMi'a'x7I`1CAr�O�,z,.�•triciansA'lumbexs. Appizcani7nfoxmation please print I,e�ibly Name(Businessloxganizadon&dividual): a :'6�� Address: C� City/State/Zip: 1"u. /7N Uy w A.reyon au employer? cl;'Atlie appropriate box: Phone #: C9� 01 10 I am a employer with employees (full and/or part-time).* 2. I am a sole proprietor or padnership and have no employees Working for mein any capacity. [No workers' comp. insurance required.] I am a homeowner doing all work myself [No workers' comp. insurance required.] t I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will ensure that all contractors either have workers' compensation insurance or are sole 5.� I am a general contractor and I haye hired the sub-coiitractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.t 6.Q We area corporation and ifs ofCgers have exercised theirright o£'exemption perMGL c. 152, § 1(4), and we have no, ein�ployees. jNo workers' comp. insurance required.] Type of project (fAquired): 7. [] New construction, 8. [] Remodeling 9. ❑ Demolition 10 [[ Building addition 11.C7 Electrical repairs or additions 13.E] Roof repairs 14. [] Other *Any applicant that checks box#1 must also till outthe sectionbelowshowingtheirworkers'compensation policy information. i Homeowners who sutiriiii this affidavit indicating they are doing all work andthen hire outside confractors must. submit a new affidavit indicating such. fffomectors that checktbis box must, atEached an additional sheet showing the name of the sub contractors and state whether or not those entities have . employees. Ifthe sub -G6'.. Have employees, they must provide their workeis' comp. policy number. am an employer that is py 6vidir�g workers' compensaiion insurance foN my employees ' .Below is the policy and joh site information. Insurance Company Policy # or S elf -ins, Lic. i#:. Expiration. Date: fob Site Address- City/State/Zip: eomapensation p olicy declaration. page (showing the policy number and expiration date). Attach a copy of the workers' Failure to secure coverage as required under MGL o. 152, §25A is a criminal violation punishable by a iine 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 of up to $250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA. for insurance coverage verification. coverage aereby certify under tlae pains and penalties ofpe+juty tlaat the information provided above i%s true �a"nd correct. Official use only. Do not write in dais area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of (ealth 2. BuildingDepartment 3. City/'Town Clerk. 4. Electrical. Inspector 5. Plumbing Inspector 6. tither 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 bf Hire, express or implied, oral or written.." An employes is defined as "an individual, p�.t inersl ip, association, corporation or oilier legal entity, ox 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. Ho Oever 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'coniractoi(s) name(s), address(es) and -phone number(s) along with their certificates) of insuse bimi#ecLaabliiyomparries (bLG) orLimitertLrabilityrtii�rlu(T DP witno 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 bidustrial Accidents for confumation 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 yoWare required to obtain a workers' compensation. policy, please call the Department at the number Iisted below. Self iir'sur6d companies should'enter•their self insurance license number on the appropriate line. City or Town. Officials d 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 areference number. In addition, an applicant that must submit multiple peimittlicense applications in any given year, need only submit one affidavit indicating current policy information. (ifnecessaty) 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 ormarked 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 homeowner 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 Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of .Tndusbrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 TeX. ## 617-727-4900 ext. 7406 or 1-877•-MASSAFE Fax # 617-727-7749 Revised 02-23-15 wwwmass.gov/dia