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Home My WebLink AboutBuilding Permit #377 - 69 BRIGHTWOOD AVENUE 12/4/2008 BUILDING PERMIT oFyORT11ttOR TOWN OF NORTH ANDOVER 0�44 ''' APPLICATION FOR PLAN EXAMINATION +� oq cm Permit NO: 3�'��— Date Received �� R�TEo ` �O �SSAC11 HUS�� Date Issued: IMPORTANT: Applicant must complete all items on this page 4 LOCATION 69- ' Print PROPERTY OWNER q-_7 I m o -f )O Print MAP NO: PARCEL: Ar— ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family- Addition wo or more famil Industrial Alteration No. of units: Commercial epair,_r_ acem Assessory Bldg Others: emolition Other Se;ptic Well , Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION C OFCO T BE PREFORMED' 2�n a Identification Please Type or Print Clearly) ,, OWNER: Name: 6Lti Phone:(f-,(/ Address: li CONTRACTOR Name: Phone: I 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: $ �S _ FEE: $ ��td Check No.: �b et� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund - - ku....-.Signatureof Agent/OwnerSignature of contractor Location 4z 7 :2l No. Date ae— MORTh TOWN OF NORTH ANDOVER F AL • Certificate of Occupancy $ �'�;';� s.�'• Building/Frame Permit Fee $ a 6 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2 763 ( - Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public SeTanning/Massage/Body Art Swimming Pools —Sewer 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 HEALTH Reviewed on Signature t COMMENTS 4 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 i 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 PP 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:Building Permit Application Revised 2.2008 NORTH c Town of over , 0 No. � 77 _ C. o dower, Mass.,LAKE /,�• �• �� COCMIC EWICK ^ A°RgreD '9S E BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.............. AAJ)X.AV-W.... Foundation has permission to erect........................................ buildings on .��-..7/.... pp A .................... Rough to be occupied aso..A444..:......6J-Xm4 ' .... !��! "...... '....... ...... �I^.�,.. �............ Chimney conform to the terms of e a l!cation on file in provided that the person accepting this permit shall in every respectpp 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 Now PERMIT EXPIRES IN 6 M®LATHS ELECTRICAL INSPECTOR UNLESS CONSTRU S TS Rough ............. ................`........................................... ................ Service BUILDING INSPECTOR 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 Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. t pORTM TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT • > = r 1600 �$ Osgood Street Buil 20 Suite 2-36 North Andover Massachusetts 01845 �sswcNus'�t Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please i� DATE:. JOB LOCATION: 6Y-?� Q� liJ�f9v� Number 'Street Address maplLot HOMEOWNER_ 7 33. Name Home Phone Work Phone PRESENT MAILING ADDRESS -3 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 helshe 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,riles and regulations- The undersigned"homeowner"certifies that helshe 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 10.2005 Form Homeowaus Exemption TIOARD OF \PPFA1 S 6RR x)54I CCNcEN'. ON 688-9530 0 IIE.11;I'H!,xs-95-10 PL.LN\ING(8R-9$3$ L f - I The Commonwealth of Massachusetts Department of Industrial l Ai � %! Office of Investigations 600 Washington Street Boston , MA 02111 I° wwK>-mass-gov/dia Workers' Compensation Insurance.Afficiaviit: guilders/Contractors/Electricians/PIumbers APPlicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone#: �(9 �ag .� a Are you an employer?Check the appropriate box: 1.❑ 1 an a with 4. ❑ 1 am a general contractor and I employer Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.F71 am a sole proprietor or partner- Iisted on the attached sheet ?. em-odeiing. ship and have no employees These sub-contractors have 8. E] Demolition working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its 9• ❑ Building addition required.] officers have exercised.their 10:0 Electrical repairs or additions 3. 1 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions yself. [No workers' comp. C. 152, §1(4),and we have no insurance required.] t errs to ees 12❑ Roof repairs P Y . [No workers comp. insurance re vire 1.3.❑ Other *Ari a iii q �) t{ y pp amt,that checks box#I.must also fill out the section below shown the' Homeowners who submii.i9tis affidavit indicatitt�L`ie"r ace uvi[i�r's_3 _ _g their workers'compensation policy information. Fri fhcn hire outside corrirnciurs muni submit a new at`ndavit indicating such. xContractors that check this box must attached an additional sheet showing the nacre of the sub-oaaactors and their workers'comp,policy information. I am an employer that is providing work information. ers'compensation insurance for ng�employees. Below is the policy and job site Insurance Company Name: Policy#or Self-.ins. Lic.#: Expiration Date: Sob Site Address: (ro�—7/ ""C�7��rAn�4/ 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 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. I do hereby cerciunder the ains d anpenalties of perjury that the information provided above is true and correct Si--nature: l� Date: Phone#- 13 Official use only. Do not write inthis 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#