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Home My WebLink AboutBuilding Permit #545 - 71 PLEASANT STREET 4/16/20091— Permit NO:. TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received Date Issued: lQ I U I ORTANT• Applicant must complete all items on this page C LOCATION �_T___T ✓ �� " � Print PROPERTY OWNER 1. V[/ Print MAP NO: PARCEL: ZONING DISTRICT: Historic District no Machine Shop Vi age ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 11 Addition ❑ Alteration ❑ One family El Two or more family No. of units: El Industrial ❑ Commercial .#Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ` Sepffc ®yV lltyy' _4.OWat_er/Sewer_ a--� ' �� ❑ Other Wa'ter' shed71 1 trriictp �--� Floodpl ��Wetla `nds 014 -..-t x.- _`•; —a- TT TTT T/ITT .TTT. VrLI)t I"1WIN Vl' Vvvtus 91IN—A nil. Print (lpariv) OWNER: Name: M CONTRACTOR Name: Address: Supervisor's Construction License: S Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phon Address: Reg. No. /- Phone: V � FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASED ON $125.00 PER S.F. Total Project Cost: $ .� moa FEE: $ 30 4� Check No.: Receipt No.: `I NOTE: Persons contacting with unregi�red co t �gors do not have access to the guaranty fund 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) 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 o -Engineering Affidavits for Engineered products 40TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals hat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording lust be submitted with the building application Doc: Doc.Building Permit Revised 2008mi Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ElSwimming 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 COMMENTS CONSERVATION COMMENTS H�ALTH COMMENTS DATE REJECTED Q DATE APPROVED 70 Reviewed on Signature Reviewed on Signature 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 Location)( No, "' � Date 4p*TM TOWN OF NORTH ANDOVER F S Certificate of Occupancy NUS Building/Frame Permit Fee $ "�- y., Foundation Permit Fee $ p= Other Permit Fee $ TOTAL $" Check # 2364 Building Inspector The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston, MA. 02111 �. www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information M Please Print Legibly Name (Business/Organization/Individual): �� YL��/Cali 10 Address: S City/State/Zip: y / y V v 40 a—Vg0ne Are you an employer? Check the appropriate box: 'I ❑ I am a employer with 4. ❑ I am a general contractor and I mployees (full and/or part-time).* have hired the sub -contractors listed on the attached sheet. 2. a sole proprietor or partner- 0 is;and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3.1] I am a homeowner doing all work right of exemption per MGL \myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling . 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. El Plumbing repairs or additions 12.0 Roof repairs 1311 Other �J/l�Qf�/,t/ k Ct�O�/i�, *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new 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 employes 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 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 certify under -X76-6Vyz that the information provided above is true and correct. 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. CitylTown CIerk 4. EIectrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone Town of North Andover Machine Shop Village Neighborhood Conservation District Commission 1600 Osgood Street North. Andover, MA 01845 A I pplicadon For EXCLUSION From Certificate to Alter Certain alterations are excluded from review by Me Afacliine Shop Village ATeighborhood Conservation District Conunission in. accordance with the Bylaw. Applicantsfor exempt projects must -fill out the form below and submit to the Commission Chairperson (contact info below). Date: WP, P'-_!W4A Contact Name & Addiesg: Project Project Description (attach additional pages, if needed): Exclusion From Review Requested For: �:"' ' ............. -1 141 Q 1. Interior Alterations existing conditions including materials, design and dimensions. - El 2, Storm windows and doors, screen windows and doors. 9. Replacement of existing substitute doors, substitute siding or substitute EI 3. Removal, replacement or installation of windows with new materials that are gutters and downspouts. substantially similar to the existing condition. LJ 4. Removal, replacement or installation of window and door shutters. 10. Replacement of original fabric windows or doors with substitute 0 5. Accessory buildings of less than 100 windows or doors that maintain the square feet of floor area, architectural integrity with respect to form, fit and function of the original 0 6. Removal of substitute siding. windows or doors. 0 7. Alterations not visible from a public ❑ 11. Reconstruction, substantially similar in way. exterior design, of a building, damaged or destroyed by fire, storm or other disaster, L3 8. Ordinary maintenance and repair of provided such reconsti-action is begun architectural features that match the within one year thereafter. MSV NCDC Page 1 Current Chair: Liz Fennessy, 77 Elm Street, lizettafennessv@yahoo.com 978-688-2915 2)14' CO) m X x CO) CO) F) . v H .O C � CO2 cl) CD CD c� Z y CCD O 'C ar 5 Ca SUC O. = CO) O CD CDCL O Q CD Er CD O CD CLO CO) O Ca CD S OCO) 10 . Z O .Ort C,** O CD O CD wi A I C 0 0 d yoCD ®8 m H�a� 2. = • Y U' D y M. rr m N Co. O O CD ;; -%CD n O O C y� .)) : .� O CD r a = Lr CD CD y 1 0 CD cl, CD d y ad: W � G o • C to CD: : y H 1 Co m CO)en .Z7 = O O C. ...� O CD O 1 CAo CD 0 1 • a3: CD y d O'0 C3 s . = CDA m m _' CL �. cin, C2 CA CD 1 _ C, z 0 0 y 0 0 c rZ ClCl)I aq n O r O G O O d z 0 0 y 0 0 c ,4ORT" 2w{� en �a Ary�p F � 'M ' I own of North Andover . ' = Machine Shop village Neighborhood Conservation District Commission 1600 Osgood Street North Andover, MA 01846 SACHUS Application For EXCLUSION From Certificate to Alter For ItS 9,10 or 11, provide the folloxving documentation: mtos/drawings of existing doors, windows or siding, as applicable 1 DescriptionJCatalog Cuts of proposed materials to be used for doors, windows or siding Plann and elevation of reconstruction for Item 11 L Determination: This project is determined to be exempt not exempt from review by the Machine Shop Village Neighborhood Conservation District Commission. Projects that are not exempt must complete the Application far Certificate to Alter, available from the Building Department and be reviewed by the Commission. Neighborhood Conservation District Commission 97 CJ Date MSV NCDC Page 2 Current Chair: Liz Fennessy, 77 Elm Street, lizettafennessy@yahoo.com, 978-688-2915