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Home My WebLink AboutBuilding Permit #049-14 - 68 LINDEN AVENUE 7/14/2013 L I { TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: v%7 Date Received Date Issued. 7 /7" 1`3 IMPORTANT:Applicant must complete all items on this page LOCATION ,� (� �IAMe q/ �. Pnnt; 'PRO PEIRTY OWNER �/U /Lz_ - 100 YearQld'Structure yes' no:- ,.f� rint MAP NO: /-�- PARCEL: ZI ZONING DISTRICT: :Historic District` yes no Machine,Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 2'6ne family 11 Addition 11 Two or more family 11 Industrial kAlteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other - [i Septic. ❑:Well' ❑ Floodplain ❑Wetlands [I Watershed District 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: like a Identification Please Type or Print Clearly) , � ' OWNER: Name: — Phone: 7 Address: f 6f ' CONTRACTOR Name: Rhone: ' Address: - Ex Date Sup.ervisor'&Construction License: p Horne,Improvement License:: Exp. Gate: 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: $ FEE: $ Check No.: Receipt No.: 9.GA d?i s to the ua ra n and cces f NOTE: Persons contracting with nregistered contractors do not have a g tY Si ;nature of contractor Si nature'of A ent (5 h"-: �aivedCertified _9 -- Sig F. ,__. Plans Submitted ❑ P anPlot Plan ❑ Stamped Plans ❑ . Building Department The folwing 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 o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses Li Copy of Contract o Floor Plan Or Proposed Interior Work o 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 Li Certified Surveyed Plot Plan o Workers Comp Affidavit o 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) ❑ Mass check Energy Compliance Report (If Applicable) o 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) o 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 1 o 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 api)aal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submated with the building application I i Doc: Doc.Building Permit Revised 2012 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 DumP ster on Site F1 THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - IJ FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS I HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes .a. . 'Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Tow;! Engineer: Signature: Located 384 Osgood Street FIRE DEPARTIYIL-Nt Temp Dumpster on site yes no Located at 124 Mair,Street Fire Departmerit-signature/date 9 COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: I ELECTRICAL: Movement of Deter 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 I NOTES and DATA— (For department use �I 1 D Notified for pickup - Date E F Doe.Building Permit Revised 2010 Location No. �� Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ , Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL Check# 20" 6 21 B ddtng Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost 280O01-,0m $ - $ 33.60 Plumbing Fee $ 4.20 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 4.20 Total fees collected $ 142.00 68 Linden Avenue 049-14 on 7/11/13 3 Season Porch to 4 Season Porch � N ORT H Town of ndover 0 �. - 1 No. .. Iq - h ,� ver, Mass, COCHICHt WICK �,�A�RATEU ►`P�,��y S V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System r THIS CERTIFIES THAT ... ' "-y... �....i' `'.. '..^`y `'...... `--......................................................................... BUILDING INSPECTOR . ....... . . . . ....... has permission to erect .......................... buildings on ...EE �.'YP k�t:.............................. Foundation _j ��S Off. a'`"� � �rR _` �Cy Cr C% .�t`�S d+`'� d� �•� Rough tobe occupied as ................... ............................................. .................................................... .... Chimney provided that the person accepting this permit shall in every respect conform to 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TARTS Rough Service ,.......................... BUILDING INSPECTOR Final 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 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost 0 m $ $ 33.60 Plumbing Fee $ 4.20 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 4.20 Total fees collected $ 142.00 68 Linden Avenue 049-14 on 7/12/13 3 Season Porch to 4 Season Porch The Commonwealth of Massachusetts Department of lndustriglAccidents Office of Investigations qu 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/OrganizatiorAndividual):_ r1 V\ t6w_ ✓wcry Address: K City/State/Zip: At-d- Phone#: 5—d 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 o employees(full and/or part-time)." have hired the sub-contractors ❑New o bn•stractin listed o the t 7. ❑Remodeling 2.❑ T am a sole proprietor or partner- n h attached sheet. p p ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers comp.insurance. p 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.❑Roofrepairs 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 ace doing all work and then hire outside contractors must submit anew affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am 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: Job Site Address- City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL o. 152 can lead to the imposition of criminal penalties of a fine 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido Hereby certify under the padpenalties ofperjury that the information provided above is tr a anti correct. signature Date: 7/1 Phone#: Z.fo —OV.319 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.PIumbing Inspector 6.Other - - - Contact Person: Phone#: i 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 j oint 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 ofpublic 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 maybe 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: TheDepartmeiit has provided a space of 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 ofMassaohusetts - Department ofladustdal.Accidents Office of Investigations. 6.00 Washington Street Boston,MA 02111 Tei;,#61.7-72.7-4900 ext 406 ox 1-877:, ASSAFB Revised 5-26-05 Faz,#617-727-7749 WWW.Mass,gov/dxa 3� �asr do MW OF NOR T� T$ANDOVER OFFICE OF - BUILDING DEP 1600 os AR�NT sod �a g Street Building 20,-Suite 236 North Andover,Massachusetts 01845 Gerald A.Brown Inspector of Buildings Telephone(978)688-9545 HOMEOWNER•LICENSE EXE1VlPTION Fax (978)688-9542 BRIDING PERMQT.APPLICATION Pleaseyrint ' DATE . . . ,• .•• . i 2 • � z® 3 JOB LOCATION: Number SlreetAddress Map/Lot 1JOMEOWNER (0 Name Home Phone Work Phone PRESENT MAILING.ADDRESS W4 eV 114 Qe- �vd � Gn— C'zi-si T [C► �� zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings to t4vo units or less and a suss suer horrrneo:vers to engage an ndividual•for hire who sloes notpossess a tat7 cense,provided that the owner � acts as supervisor). Se 3uilding (Code Section 108.3.5.7) DEFINITION OFHOMEOWNER Persons)who awns a parcel of land on which he/she reside tends to reside be,a one or two family structures. A person who constructs more that Ane home, ia two-year o then eis,Or is rio*d shall intended be to considered a homeowner. The undersigned"homedwner"assumes responsibility for compliances with the Applicable codes,by-laws,rules and regulationsState Building Code and other The undersigned +� homeowner certifies that he/she understands the Town of Borth Andover Building Department minimum inspection procedures and requirements and that he/she will comply with,said procedures and requirements, HOMEOW.N'ERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption 13DARD OF APPEALS 689-9541 CONSERVATION 689-9530 HEALTH 688-9540 PLANNING 688-953i