HomeMy WebLinkAboutBuilding Permit #299-15 - 71 LIBERTY STREET 9/24/2014 ORT
BUILDING PERMIT O� NLED $6 qti
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TOWN OF NORTH ANDOVER o
APPLICATION FOR PLAN EXAMINATION
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Permit No#: Date Received A�q,TEo ""�c5
gsSACN�1`-+��
Date Issued: 2ILI
IMP TANT! Applicant must complete all items on this page
LOCATION
Prin
PROPERTY OWNER dl �' Ia C'k
Print 100 Year Structure yes (no MAP �PARCEL:- ZONING DISTRICT: Historic District yes o
Machine Shop Village yes
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 ZLR� TO BE PERFORMED,
L lil
s
Identification- Please Type or Print Clearly
OWNER: Name: 5kiv1-e -- Phone:
r
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: $ e—Dppo FEE: $
Check No.: Receipt No.:
NOTE: Personsontracting itZue,'Ielred ontractors do not have access to the guarantyfund
gnature of Agent/Owner _ gnature of contractor
Plans Submitted ❑ Plans Waived Ell 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 Siqnature
y I
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Si nature& Date Driveway Permit
Connection/Signature v
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
I
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 Call Email
t
Date Time Contact Name
Doc.Building Pen-nit 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
❑ 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)
❑ 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:Building Permit Revised 2014
Location :6
� �LL
No. Date
. - TOWN OF NORTH ANDOVER
Certificate of Occupancy $�=,�0
Building/Frame Permit Fee U
-- Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#
1 I
Building Inspector
r -I NORTI, .
ic . . ve'
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No. * t _
oh ver, Mass,S
COC NIC.!W IC. A.EU /.P %I-
U BOARD OF HEALTH
PERM. IT T LD
Food/Kitchen
Septic System
M** �
THIS CERTIFIES THAT ....... 5140c1`0. BUILDING INSPECTOR
. .............................................................
has_permission to erect �, WID Afte+ Foundation
.......................... buildings on .... . .......
Rough
p rte. ......�iV.a r. e.
t0 be occupied as ..... ... ... .... �.��. .... .. .....�.�.�.......................................... Chimney
provided that the person accepting this permit shall in every rec ect conform to the terms of the application pp 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'v MONTELECTRICAL INSPECTOR
�• UNLESS CONSTRUC T S Rough
vow"z Service
... .... .............................................. Final
BUILDING INSPECTOR
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.
X
L '01
2
D
ao 0
DIMENSIONS ARE IN INCHES NAME DATE
TOLERANCES: DRAWN <C O M P A N Y N A M E>
FRACTIONAL±
ANGULAR:MACH± BEND± CHECKED
TWO PLACE DECIMAL ± ENG APPR
PROPRIETARY AND CONFIDENTIAL -
THREE PLACE DECIMAL ± MFG APPR.
THE INFORMATION CONTAINED IN THIS MATERIAL _ O.A"
DRAWING IS THE SOLE PROPERTY OF COMMENTS:
<INSERT COMPANY NAME HERE>. ANY
REPRODUCTION IN PART OR AS A WHOLE FINISH
WITHOUT THE WRITTEN PERMISSION OF NEXT ASSY USED ON -- SIZE D"wG. NO. REV.
<INSERT COMPANY NAME HERE>IS A
I I
PROHIBITED. APPLICATION DO NOT SCALE DRAWING SCALE:I:?oo WF.GHT: SHEET 1 OF,.
North Andover MIMAP September 24, 2014
3 LIBER ST
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Interstates
—I
SR Horizontal Datum:MA Slateplane Coordinate System,Datum NAD83,
--Roads Meters Data Sources:The data for this map was produced by Merrimack
NORTN Valley Planning Commission(MVPC)using data provided by the Town of
r Easements pf�t�ac North Andover.Additional data provided by the Executive Office of
Q MVPC Boundary ,r�� r��o Environmental Affairs/MassGIS.The information depicted on this map is
Parcels 3 _ G for planning purposes only.It may not be adequate for legal boundary
F o definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER
MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING
# t{ THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY
#s ^ # OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT
ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
THIS INFORMATION
SSACHUS�
V 141 ft 4-
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ddo WaSUBgto-D Street
.804071,.cam 02111
'O)c ex0'Compematjoi.bmanceAffidavit:S c e l o ac o f Xcc re c axe J1' b60
Hama(l3usinesdOzganiza&nlind�+vzdud):_ 1 .
AddxeSS:
City/Statof ` : l V1 t'�y'�lvt 6Ci'� -ti' 'ha : 7 6 S, JL
&()you an employer?Cke&the appropxzatebox: ofpxoject(eecluir ecd}
I.a I am a ernployet with_ _ _ 4• d h am a general contractor and h 6, ]dew c6nstt7 e-RDA
employees( llanc ox ax t e�T ha'venedthe sub-conf'actom
2.Q S am a solwoprietor orpartn.ex
listed onthe attached sheet° `f• El Remodeling
shYp annaveno.employees Thesesulx-contxactorshave 8. ernolitzon
working foxzne in any capacity. woxkers'comp.insurance. 9, E]B- ff&g addition.
JN'o worj<.exs'comp.plsurauce 5. Q we are a corporagon and fig 10,11 Fllectricalrepairs ox add-Wons
recluired.� oftershavee exercisedtheix
light of exem tion exSY OL 11,. (1'lumbingrepairs oxadditions
am.a homeowner doing all work p p
myseL.o oworlerrs°comp. c.152,§1(4),andwehaveno I2,QB.flofxgai�
insuraazc�recpzixed.�i employees..PToworltexs° 13.E]Other
comp.insurancereciairerl.]
AigaPPlicanttha�ccheoksbox#ITVA a n�llouitheseetionbelb�rshowing$teirl�bzkers'compo agonpolicp'inEoimation.
i omeawn.rswho submitthi affidayiiitrdicatiugifiejr d ingau�orT andthenbireouisideconizaotorsrnUs�su7im anewafudagi indica igsizch.
xConfcacfors ibaL aheokttus box anusf attached m addiiional sheet showingtho mmo atho suf�-ou tradom andthe4Fwork W comp.policy informafio".
I Im im emyloyer tfiat zsproviditlgW,91'ren"compensation bsuranegformy ergf0yeey, .Below isMepo.11ey izmI jori Sit�`e
h. Samce CompanyN'ame:.
I'oliay or del;ins. ic.#: ExpirationDate:
S'ob Bito Addzess: CityfStatef ip:
Affach,acopy 'compensation-Volzeytleelaratzoxtpage(shpwlng.t)4epolicynmaaherand expixatzortdate)
.
failure to secures coverage as reclu�x'ecl.uudex�eetion.�S.E�.ofN.�G.I�c.I52 cart Iead io the impositzan.of criminalisenalties of a
$ue up to$I,SQ O.OQ andfox�ne�year.7mpriso�nent�.as well-as oivilpenaliies i�z the torn?ol:'a,�'pOF�!ORIS OBDEI�.a�xd a fine
,ofup to$250.0 0 a day against the violator: B0 advised that a copy ofthig statomentmay be forwarded to the Oftx"ce-of
hvestigationg 001e fox" Ge,coverage veTwe'aRon.
afro Xiazeby ce ffi .a" cc ripe ties OfFarp�y Mier Am information provided aLoovvje is frue and cond,,
e
12-4 A4
atcrre: Date:
8 G92- 2
offleid u sa mly, DO nol vilte in tfizs area,to be eomwfetd fay city or town ofczar.
City or Town: Bex�nzt/�zcense#
�sufng.��€ihoxity'(e�•cle one).
1.Board of�ealth�.BuilclingDepartm.ent I Ci€yf7Cown Cleric 4.Fllectxzcalpnspeetor 5.RIurabingh8pector
6.Other r
bfOrmation and Instructions .,
Nlassachasef#s Generalf aws chapter 152requires altemployexs to pxovidewoxkexs'compensation orthei employees.
Parsua 1'01119 statUe,an err�ployee is dAmed as"..,evexy pexson rti tf to sezvzce o an oflzex landex any contract o�bi�e;
express orimpTned,oxal orwriffen."
.An eraTloyq is WhI od as"an.individual exs .
,,.l ,paxtn 11p,association,coxpoxatioxt or othexlegal entiiy,or anytro oxmaxe
ofthe zdxegg7ng engagedina joint enterprise,andincludingthe legal representatives of Wdeceased emplayex,.ox ED
zed Orr , fse e:.as kdivtduat part exsh%p,agh elation or Aar legal entity,employing 61410yees. Aovlevex the
ownexoi a dwe7lingb,ousehaving�.otmoxetl�antbxee apat-�ments andwba resides lJxexein,,oxt*ccupazd:ofthe
dwollinghouse ofanother who employs paxsans to do maintenance,consinxctnan oxxepairwork on sucl dwellinghouse
ox OnEc grounds oxbuilding shallnot because ofsuch employmentbe deemedta be an employe:"
MGL chapter 152,§25C(D-)also states that"every state or local Zzc-ening agency shall witlIhold the issuance or
renewal of a Incense ox p ermit to operate a business or to comtruct huifdings ixz the comaxtanwealth fox any
app)Rvant who ltas not produced•acceptable evidence of compliance With the Insurance coverage required:'
Addrttionally;IS-GL chapter 152,§25C(7)siafes"Meithert o commonwealth nex any of its political subdlvi`snons shall
entexinto anycontractforMe-performanceofpublicwoxkMMacceptableevidenoeofcompliancewith theksurance
xequirements ofthis chapterhavebeenpxesentedtathecQutxae&gaufhority.,,
.A.ppucan�s
Please M out the woxkexs'comp easaifon of tdaet completely,by chac�ing the boxes That apply to your situation and,is
A6cessaty,supplysub-contraclox{s)nanaddresses)andPhortenumhex(s)along witltheir caa-Mcate(s)of
inSnrauce, LimnfedLnaMHVCompanies(LLC)orLimitedLiabill Partaership9(LU)withno Otaployees Other tha ma
members orpartners,axenotreq*edto carryworkem'compensatzoninsuxance, anL!C oxLLp doeshave
employees,a pollcyigxequired. Be advisedtltatthi�af.davitmaybesubmitcedtothe Departrnenia udustdal
Accident fox canfvenatzon of insurance cavexage. .Also he sure to sign.and date the aMvl: 2ae affidavit should
bexef�tedto the c'ty or io��.thatth�applicatiQnfoxtlepeza}it orincenseis beingxeque�fed,no�thel7e�a�iment of
W—ustf al.Accidents. Shouldyou have any quesiious xegarding the law ox if you are xeclait ed to abiain a oxkers'
compensaf7onpollcy,Pleasecall thaDepa--mientatftnunbexlisted below. SelfirmedcompatuessltouldenferMelt
self u�suraztce Incense number an the appxopxlate line.
Caty or Town MIA
�'Ieasebesuxaibat'dteai"zdavitiscompleieanclpxinfecllegibly. T$el�epax�n.entbaspxovzdedaspaeeatthebofcom
oftha ai-i�davztl'oxyottto�]1 oui�.tbe eventtbe O.�ee oxSnvestigatzonsbasto con.iaciyouxegardingiheap�lZcanf:
please be sure fo z�lt ixt'cbe pexnait/Inceosenumbex�vhzcb v�i7l be used as a xezexence number, In.addiiion,art appllcani
thatxnustsubmitmultiplepexmt/licenseapplicationskany givenyear,xteedonlysubmit one,azfzdavittindicatingcwR,,
palncy infonnaiion(ifnecessary)and mdex'J'ab,Site.Address"the applicant shouldwxite"all locationsin. •(cite or
tow&.)."A:copy oftlie affidaQthathas been ofciallysfainped Oxmarkedbythe city oxtovun.maybepxovided to the
appllcantasprao thatavalidafrtdavitisoni"xle�oxlUtUxepezmitsCrIfoo ses. ,A.newa�davit�n�istbe�lledouzeach
Yem. bexe ahome ownex ox oitien is obtaining alicexse oxemnoixelafed to anybusiness or commercial venture
(x.e.a dogllcense orliermitto burin leaves eta)sazdpexson.is NOTxequiradto complete this affldavzc.
The,Office ofIUvestigatsan wouldl&etoffi nkyouInadvanceforyomcooperationandsh.Quldyg-ahaveanygizestions, "
please do zzothes%tda to give us a call.
Tba Depaxtmee s address,tefepbone aid fanumbex:
'hQ CQ vxb- -Gal O S1� S a�hU P
Dgpaximmt Q'McIuMa GC C t
6001 aq ftQm xe
DodQ-4,. i.02111
Rovised 5 26-05 "
WWW-Ma,govId`a
TOWN OF ; flRTff AND O Y E.0
OBFICE OF
• ' x Rp t`y�y •
.:1600 Osgood 5tr`oatBtttichng.20 .S1&U,-2-36
'C7�S�Rcu •�5 •North Andovex,Massachnsette 01845
Gerald A.Brown Telephone(978)6889545
InspectorofBuildings - Fay (978)688-9542
nQ—YMQWM-- R- QBN9E tXEMPTI'ON '
BM)TG)?RRw t`•P'BUCATf0'N
Please��g , •' •
DATE: 2 ,
JOB LOC
ATON: �
Numbez StreetAddress MapJLot
' 1�OMOER
Name. Horne phom 3 ��
—( WorkPhone
MSEN-1 M&Ri4G,A.DARES
otoev- a
1 0A
Msi TL
. lip G`rJd�
The-current exemption far"•homeowners"Was extended to
to allow su�T,hompo,,- - uGIude ownez-eccdpied d�yeT�',gs to i�vo urdts or loss and
ue�s to engage an E'Mdual•forbiro,who toes uotpossess ahcense,provided that the owuez
acts as suparvisor)- S,ate3uiiding (Code Section I08.3.5.1) -
DEFINITION OF HOIVMC)WNBR.
Persons)who Awns a parcel of land on which holshe resides or zutends to O reside,ort which Mere is,or as intended to '
b"e,a one or two Iaa y structures. A p erson wlto constzucts more that one h omt,in a two yearpeisshall slot be
cansidered ahDMetlwner.
The undersigned"homedwner"assumes respousi-bbility forcompliances wz-Elt the State Building Code and otlte
Applicable codes,by IaWs,rales andzegulations. r
The lmdersigned"`homeowner"ceztifes that helshe- slands
m�mum.inspectionproceduresandrequire
inents atliels uofNo AndoverBuiidiiigDeliarfinent
.requirements, mply ,sa' acedures and
.I-IOAMOWNtRS SIGNATUItt-3
&P-RO•VAL OF BII.i UNG OFFICIA"L,
Revised 7.2009
xbrmnomeowners}sxemptio.0 .
'13DARb OFAPPEA.LS 688-954I CONSERVATION 688-9530
HEALTH 688-9540 PLANNING 688`9535