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HomeMy WebLinkAboutBuilding Permit #281-15 - 70 SALEM STREET 9/19/2014 t NORTH q BUILDING PERMIT 0 2o�t,Eo 16 TOWN TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 'E 70 Permit No#: Date Received �ssgcHus���5 Date Issued: / IMV'ORTANT: Applicant must complete all items on this page LOCATION �� �C� Ce%'1 +- Print PR OPE TY OWNER I ��-�— 14)-a fid- ---- -- nntr� � 100 Year Structure yes no ,MAI _PARCEL: ZONING DISTRICT. Historic District yes no M'acfine Shop Village yes no ; TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building line 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 Aater/Sewer DESCRIPTION OF WORK TO BE PERFORMED: .36AAr' 7AL entifi io 's pe or Print Clearly OWNER: Name: �` /�4Phone: -C-,7o -(��7 S Address: 0 Contractor'Name: Address: - - Supervisor's Construction Lic` nse: _ _..._ __ _- Exp. tDate: _ _ Homo 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: $ Z�Gd0, C) FEE: $ 72-'00 Check No.: �( Receipt No.:---:Z 01�9- NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund .A �� _ Signature, of Agent/Owner _ l i Signature of contractor _- 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 o 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/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) o Building Permit Application a Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) a 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 Doe:Building Permit Revised 2014 J _ 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature b f COMMENTS 4- L • i l +i 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- Located esLocated at 124 Main Street Fire'Depar.tment signature/date COMMENTS - a. 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 I NOTES and DATA— (For department use) I I I I i i i ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Location -20 No. / /lj Date J' TOWN OF NORTH ANDOVER • Certificate of Occupancy $ • `�,r,,..++ 7 s Building/Frame Permit Fee $ e � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 28035 /`B—q ding Inspector NORTH Town of 2 s E ndover 'I to No. dog, AIL oh ver, Mass, C OGNICNl WICa ��• l �,AS RATED P'PP�,�S U BOARD OF HEALTH Food/Kitchen PERMIT T LD J, Septic System THIS CERTIFIES THAT ...........1, : ' ..GC .. ............................................................................ BUILDING INSPECTOR / �. � /� �. S� Foundation ....................... buildings ... .: J has permission to erect ... g ,,� ............................................. l f Rough to be occupied as..�� .��hf'.U.4. :T..........................................................o©'ter �� � •�� �?�?.......... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR • UNLESS CONSTRUCTIO TARTS Rough Service ......... ...... . ... . .: „- ............................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildine 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. �oxr � H a gop OFFICE OF _ DEPARTMENT • ' o by :' 600Osga0dgrcet$tzild.` ` s ann s� ,Massachusetts 01845 S Rcuu � TarthA�dovex Gerald A.Brown Telephone(978}68$-� � Tnspeetor of Buildings - . zozv�OwNE 'tzCFax ENE ;EMP I`IOI� (978)688-9542 Bm)waPPI> TAPPLICAUoN • please'arint • DATE: q-��— M LOCATION: Number SfreetAddress 1VIap/C of (J`• Name. Home Phone wJworkphone PRESENT MAMM.ADDRESS 0 S� 7;p Codi The current exemption.for"homeown_erS"was extended to?nclude owner o ccupied dwellings to t4vo units ox;ess 2nd to allow subh homoo mCITS to engage an i cdividual•forhire,who does aotposwss a license,provided that the owlner acts as supezt, or), 8iate3uilding (code ect?on.708.3.5.1) DEEINITION OF HOMEOWNER Persons. r t awns a parcel of uses. p which he/she resides or intends to reside,an which there is,or is intended to be,a one or two feDWn structures. A person who constr cts more that.one home in�a twoyearperxo d shall not be considered a honaeownez: The undersigned"homedwner"assumes responsibility forcQmpliances with the i8tate Building Code and other Applicable codes,by laws,rules andzegulations, The undersigned"homeownez"certifies that he/she Inderstauds the Town of North.AndovarBuilding De�ax(ment M'nimllm inspection procedures and requirements and that he/she wall mpIy vxth{said procedures and xequirements, -U0Affi0WXBRS SIGNAx ORE , APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Bxdmgon _ sDARD OFAPPBA75 688-9541CO7\r r SIIZVAITON 688-9530 REAL r 688-9540 PL.&NNING 689-9555 The Commonvearih ofHas:sachuseits • . Offiee offnesfigafeons ' 6#0 WashineonSfreet Roston.,MA 02111 mpip.massgovIdliz . WQ)r.ex,g'fCoxnpemationftmanceAffidavit:SuzZc�er�elCo��acfo�'�I�X���re�czan�l�'��be�� .APPMant Wo ma-don 'Xease. ` zn bXy Nme(Business/OxgauizationlFndiuidual): Bay i— �1( f Q Phone: �C11 .57 5— Axe yoix an —A xepoutan em)g1Dyer?6ePAthO appropriateleox: Type of project(regp_ired) 9. E]X am.a general contractand nd I 1.[� T ata a er3aploper with•__. 6. L]New construction employees(-all aad1oxPmt fame)T have Wredtho sub-conixactors 2.E] S am a sole proprietor or pRlftex listed onthe attached sheet.T 7. �]�-emodeling SMP gaX1aveno.empl0yees These sub-contractors have S. Demolition working forme in any capacity. workers'comp,insurance. S. Building addition PTO workers'comp.znsuxaur-o 5. El we axe a coxpoxation and its 10 f]Electricalxepdrs or addi�fions xecluixed.� officers have exercised their 3. am a la omeovra�er doing all work right of exemption per MGL 11.[]Plumbingxepairs or additions myseff Ego wg&xsl comp. c.152,§1(4),andwehavano 12.PRoofxepalm irisurancere ed. j employees.[No Workers, Otlier comp.insurancereguired.] 13,0 Atyapplicanttlaatchoobbox#lmusialso fill ouitheSection bel6wshowingt airWbibrecompmsafion.polieyinformation. Homeownerswho submif filgaffidavRiadlcaftiieygodpingaaworKandthenbiteoutsidecontracforsmustsulmatanewaftidayitindica ngsuch. xConiracforsthatcbeoktbisbe mtistaifachedanaddiiionalshoat showingtbenameofthesut�-eonfracfarsandtheirv�orkers'comp.poticyinfomlaiion, am ccxt ern Toy t't/igt is p aviclir2g 1 o�7�exs}eornpevsatlon.hisuraneefox my eWfoyees. .Eelotg is thepolley amllo i site in,fa�maiior�. . Pnsmance Company Name:. Policy#Orsalf%im.Y1c.#: Expiration Date: fob Site tddres�: City/State/zip: .t&ftaeb aCopp o t lewoxlCers'coxapertsation-poReydeclaration page(showing•thepolicynuxaherand expixatiou date. Failure to securer coverage as xeq&ecT under Section 25A,ofN.t'GD c.152 can lead to the imposition of eximinalpenalties of a e- p to$1,500.00 and/ox ones-peak Nprisopment,as well as obilpenalties in the form of STOP-WORKORDER and a fine free ofupto$250.00a.day against the-W*t0r. Beadvised that acopy ofthisstatem,entmay beforwarded tothe Office-of investigations ofthe,DfA.for ibsurance coverage verification. - too 7iaeby ee tzfy uric% the Tains an penaffles of perkuay tXiattrie information provided above is ttGze, �te and cora Si at-�zre• Date• ( ` /`/ . :'hone#: OfeiaZ use oxtry, vo not vrue in Miff area,to be conWfeted y eity oi-town offtelfff City or Town: PermPULicenge# Isming.Anthoriiy(ekele 61e): 1.$card of�fealtb ?.SrxildincgXDepartanend �.UfYffom Clerk 4.Electrical Inspector 5.Mmbbighspector f.Other - - - Lformatxon and Instruction _ Massachtlsefts General Laws chapter 152 requires all employers to providewoxke.ts'compensation for their employees. Puxsuaxit to this statute,an e>'�,pTayee is defined as`:..every'person ki the service of another under any contract of hka • express Orimplied,oxal oi:written" Au.erTloyea js defned as"ay.ladivzdual,partnership,association,eoxpoxafzoxt or otbexlegal entity,ox anyfvra ox ore' . ofthe foregoing engaged in a joint enterprise,anal includingthe legalxepxesentafives ofa•deceased em�plo�e,.or the redeivex ortrasfee of an individual,partnership,association or Otberlegal entity,employing employees. Rowevex the owner Of adwellinghousehavingnotmorothutkaoapartments audwhoxesidestherein,ortheoccuparrEofflze ox o dwelii e house of another who employs persons to do maintenance,consfruction.or•repair WCA on such dwelling house nthe grounds oxbuilding appurtenmtthereto shatlnot because of such employment be doomed to be an employe•." MGL chapter 152,§25C(6)also states that"every state Or local liMnsiug agency shall withhold the issuance ox renewal of a license or permit to op erate a business or to construct huildtags in the Commonwealth for arty app14caxtt who has xtat produced•acceptable evidence of coxaplianca with tho insurance Voverage r ecpa xecl:' Additionally;MGL chapter 152,§25C(7)states"b7either the commonwealth nor any ofits political subdivisions shall enter into any contract for the perform ace ofpublic work until acceptable evidence of compliance with the insurance xogaixements ofthis chapterhave beerxpresentedta the cgxtracting,authoxify2" Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your sifuaiian and,if iiecessaryy,supply sub-confxactor(s)uame(sp,addxess(es)andphonenumber(s)alongwiththeir certifzcate(s)of insitxance, LimitedLiability Companies(LLC)oxLimifedLiabilityPaxtnerships(LLl')withno members oxpartners,axenotrequiredto caemployees otliexthatrthe rry worizers'compensationiusurance, Ran C orLLP doesha a exnployees,apolicyisxequixed. $eadvisedthat' is a:MdavitmaybesubmittedtotbeDepafraontof lizdustriaZ Accidents for confnnation of insurance coverage. Also be sure to sign and date the affzdavi: the affidavit should bexetwnddtothe city ortown thattheapplicationfor theper lit or license is beingrecpaested,xtotthe Dq�axtmentof kdusfrial Accidents. Shouldyou have any questions xegarding flie law or if you are required to obtain,a workers' comp ensationpolzcy,please can the Department atflienumber listed below: Se1i`insuxed companies should enter their self insurance 1[cense numb er on the appxopxiate line. City or Town Of 9dals PXeasebesuxethattlte az`,xdavitis complete andpxinfedlegibly TheDepartm-enthasprovidedaspace at the,bottom offhe affidavit fox you to fill out in.the event the,0fflce of lrtvestigatioushas to contacxyou reg arclingthe applicant Pleasebe-suxeto"llinthepeimif/12censenumberwhiohwillbeusedasarezexencenumber, fhaddition,anappEcant that)Lust submitraultiple perm t1Rcama applications in any given year,net)d only submit one,affidavitindicating current po7lcy infOymation WecMEW)and under"Tob Site Address';the applicantshould wxife"all to cations in. (city or town)"A copyof flie affidavitthathasbe'en of�ciallysfatn�pedoxmarkQdby the city ortowamaybepxovided to to applicant as pzoofthat avalid affzdavit•is on fWox-LUMepexmits orlicenses. .Anew af(1davitmustbefClled out each year.Where a home owner or citizen is obtaining a license o6exmitnot related to any business or commercial venture (i.e.a dog license orpermit to bursa leaves eta.)said person is N'OT xegT&ad to complete this affidavit. The Office of Investigations would like to ffiank you in advance for your cooperation and should you have any questions, Please,dQ not heaifate to give us a call. The Depattment's address,telephone and fax number. ThoC4? 9r3 v�. OfM—asa g wAtIq Moe om1VOSRAP00,1m 600 WaWngton ro AS Sup, Revised 52605 ��� ���"���"���� WM-M a,l ov za