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Home My WebLink AboutBuilding Permit #147 - 67 RALEIGH TAVERN LANE 8/19/2009 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: / Date Received Date Issued: IMPORTANT: Applicant must complete all items on this 1page LOCATIONl.�l, - C-�r 1�I Ne,�Q -►' Tint PROPERTY OWNER 41/l ll /��'.�s 4" Gf 17 1-% Print MAP N . Q?&-PARCEL: ONING DISTRICT: Historic District yes no Machine Shop Village yes no 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 E CRIPTION OF WORA TO BE PERFORMED: vGo t Identific on Ple s Type or Print Clearly) / OWNER: Name: L7�✓iC� G Phone Address: CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: 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: $ O�� FEE: $ 96 ---- Check No.: . Receipt No.: J 3`4— NOTE: Persons contractin ct unre istered contractors do not have access to the guaranty fund Signature of Agent/Own ignature 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 APPR6VED: . PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH 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 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 ❑ 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: Doc.Building Permit Revised 2008 Location No. Date 4 NORTH TOWN OF NORTH ANDOVER , 3jo..•�.o :.,goo F � a * Certificate of Occupancy $ f Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �a aY0 4) 226 Building Inspector MQRTH Town of � z over No. IAI = = dower, Mass.,-- LAKE COCMICKEWICK V ADRATED ,. M,. BOARD Off' HEALTH Food/Kitchen Septic tem F F. �,,. . ept' Sys BUILDING INSPECTOR THIS CERTIFIES THAT....D..ftff .... ...........:.................. ........................................... Foundation has permission to erect........................................ build' s on ..6 .......�......:. . ....�-� .....-.� Rough to be occupied as............... • 40 . Chimney .............GA................... ............. . . .... ................. ............................. .... . provided that the person 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 CONS ON STARTS Rough �.--___ _ Service BUILDING IN�OR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Diane EIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVEESE S1 03E Smoke Det. i Inc LomPnonrueala of Massachusetts �`i J Departrnerzt of industrial Accidents' Eirl�;, j mice of Invesfig ti'. xs� 600 Nfashingrion Street f Boson MA 62111 -. Workers° Compensation Ins' W W"�S.9I iQ A i!icant Information ixr -4fF.><daviL_ Ruiilders/Contracctors/Eiectrici$tts/PiQmbers Name Busing l Please Print LeQibl izafion/individua►); ✓ `� h� Address'. �•- City/stafelzip;� y,, a ��r �yl df�� Me a Are you an employers Cbeck.the appropriate.hoz: 140 - l: employer with � . Type of prjed r e'nPloy (full and/or— 4' I am a general contractor and I (required): P - ). have hired the stdreatttractora 6• ❑New construction 2. I am.a cola proprietor or pie., listed Si4 and have no employees on the attached sheet 3 7. 0 Remodeling working for me an 'I'h.s_stti3-eont�actars have o w workers' comp.insurance. 8' []Demoiitiort rrrquiredo COMP.iasuranae 5. Q We ire $ cotpora#ion and its 9. 0 But'Iding addition 3• I sin s homeowner doing all work o�ic� have exercised their I0Z Ele.^trical gilt of axcin an repairs or additions �I£[No•workers'COMP c IS Fh Per MOL I I C Plwnbing rcpaira or additions Insurance•required.];t I(¢l,and we have no .-employees:[No workers' 12.0 Roof repairs `any appiicatn that drecks bei# must �P• insur Mcx required.] I3.0.0t= t fiomeownM who also fs11 outfhaseabon beeiow showing theirwarkartI co adbmit this atndavit indicating they ars s�sation poiicy information. _ tCarttractors that dreck this box mustat�an ad(Etioaal Barg" end the E►iis omaid,contractors nuist wiirg.the num of the cuh_=nvscyv�and submit a new Affidavit indim* �' I nr;�.at a `"` rrfpioyet fisdf hpr»viautg:wnrk.,:�' � a leap worldrs ec:p .ric;ilii ion. br Orrnafior_ 11lSaaranCeJpT gprAlOVVP� j, Insurance Corn Be!rew jr ,e t.�t .am job site Fany Name: Policy#or Ser-ins. Lic. #: Sob Site Expiration Date. Address: . Attaeb a copy of the workers' ca Crty�tatr2� Failure to se otpeesation policy drat on pt fine {showia;the cra•e coverage as required under Section 25A of pogc3'number and expimf nn date, . fine up to 5;1,5D0.00 and/or one-year im IvIGL c. 152 mm lead to the imposition of Crim of up to$250.00 a 0 as well �s civil P=dfies in the form of a STOP WO uzai pena}4°S of a Envesti against the violater. Be advised that a copy of this stai�rrr. � RK ORDER Mui a fine gations of the DIA for insurance coverage veTin" cm, mai forwarded to the Office of I do hereby cerfi nder a pains • °lPe at fhe infnl`mafioa providedb aove ' arae Si .. Qorred Phone#: , Date: 996 4,f�'Icia!asp only, do not wriae in tfris os ea,an be r»rrtptet�! L*or town ofticzo[ Cdy or Town: Issuing Authority(circle one): PermwLiconse# 1. Bf Heaftb L I3nifrling De 6 Otboard oer parfinent 3.City/7own Clerk 4. Electrical Inspector S. Man:bing Inspeciar Contact Person. Phone#: Information a lad In4ructions- Masmhusetts General Laws chapter l S2 enquires all emp Ioyers to provide workers' compensation for their employees. Pursuant to this statute,an moya is defined as"..:every person in the service of another under any contract Aim, express or impiied,oral or writtm" An eft Player is defined as"an individual partnership,association, corporation or other legal entity,or arty two armon of the'forr ping engaged in a joint enterprise,and includi"g the legai mpresantaEives of a deceased employer,or8re rmceiver ortwstm-of an individual,partnership,associatiorm or other legal tray,employing employe—es.'However the owner of a dwelling house having not more than fhr w spa rtrrrerrtc and who resides therein,or the occupant of the dwelling house of another who employs persons m do nmimtenance,construction or-repair wcidk on such dwellinghouse 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 as-local 6eensing agency shall withhold the issuance or renewal of a iimose or permit to operate a baseness or *o construct buIid'ncgs is the commonwealth for any applicant who has oiot produced acxeptsble evidem-aV compliance with the.iesaraum coverage mquimd." . Additionally, MOIL chapter 1S2,§25C(7)statos"Neither the,commonwealth nor any of its political subdivisions shall enter into any contract for the perfiorn eee of public wane urutil accepfabte evidence of compliain=with the insurmnee hs4uirements.of this chapter have been presented to the cartiz=fing authority." Apprlcani"a _Please fill out tie workers'.compensation.affidavit compi.---tely,by checking the braces that apply to your situation and,if necessary, supply sub=cotrtiactnr(s)name(sl addresses)Lind phone numbers)along with their cerrificate(s)of insurance. Limited'Liability Companies (LLC)or Limiim Liability.Partnerships(LLP)with no employees otherthan the members orpartims,are not rcquiredlo ca rTy workers'=i-rnpensation insmai= Ifan LLC or LLP doeshave employees,a policy is enquired. Be advised that this afndavit may be submitted to the Department of Industrial A=idmit for wnfama6cm of insurance coverage. Also Eye sure to sign and date the affidavit The affidavit should be returned to the city or town that the application fw the peirnit or license is being Mquested,not1hr Department of Industrial Accidents. Should you have any questions nes-ding the law or if you aro requimd to obtain a workers` oompensation policy,pleasrcall the Department at the-nm m- ber.listed below, Self-insured corrcpanies should enter their self-'rxaaursncx license raum=on tito'sppropfiate irszr. City or Town DMaini s Please be sure tient 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 lnvest l;ztions has to contact you regarding the applicmr t. Please be sure to fill in the permit/license number which w-ill be used as a reference number. In addition, an appiiomnt that must submit multiple pamit/iicense applications in any given year,need only submit one affidavit indiratingcurrent policy Infonnation(if necessary)and under"lob Site Addr-ess"the applicant should writo"all locations in (city or tm►m)."A Dopy of-the affidavit that has bexs►.officiaiiy stamped or marked by 6e city or town may be provided to the applicant as proof that a'valid affidavit rs on file for future permits or liccoses. A new affidavit mast be Med out each eys year. Wha home owner or cif=n is obtaining a license ar permit not related to any business or commercial vennae (I& a dog license or permit to bum leaves eta:.)said person is NOT.requimd to-cornplet:this afndaviL The Of=nco of InvesiWi6ons would like to thank you in advance for your cooperation and should you have any questions, please do not•hesitate to give as a call. The Depm mont's address,telephone and fax number. The Commoirwemlth of Massachwetts Department of lmdustrW Accidents Office of Envestip ions 600 Washington St cwt Bosfon, MA 02111 TeL f 617-7274900 6•-.t 406 or 1-977-MASSAFE Fax f 61 7-727-7744 fL.vired S'26-�1?5 www.man.gov/dia �' F NORTH TOWN OF NORTH ANDOVER _ `�� OFFICE OF ° = -.0 A BUILDING DEPARTMENT * 1600 Osgood Street Building 20, Suite 2-36 gyp'°q�rto ^' S North Andover,Massachusetts 01845 �gSACHUSEt Gerald A.Brown Telephone(978) 688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please print DATE: JOB LOCATION: � s/� tJ Number Street ddress Ma /Lot � HOMEOWNER �✓rL �� ~4 h �� Name Home Phone Work Phone PRESENT MAILING ADDRESS �S` yYf �� 17j 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 h e understands the Town of North Andover Building Department minimum inspection procedures and requir ents nd that he/she wi com ly with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535