HomeMy WebLinkAboutBuilding Permit #964-16 - 710 SALEM STREET 3/11/2016V 1 y4w 4-� Lr
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PermitNo#:
Date Issued:
BUILDING PERMIT.
TOWN OF NORTH ANDOVER',,
APPLICATION FOR PLAN EXAM] NAT104`1
Date Rece ived.
'ANT: Applicant must complete all items on this'
LOCATION -71-0 -5,A L, t5ZLA -5 L, -
Print
AV%4 4
PROPERTY OWNER. Zy
Print 100 Year Structure yes
MAPD05 PARCEL:.Pn ZONING DISTRICT:' -Historic District yes
Machine Shop Village yes.
r �D,
W1771
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
D New Building
[] One family
0 Addition
El Two or more family
D Industrial
0 Alteration
No. of units:
El Commercial
0 Repair, replacement
El Assessory Bldg
El Others:
0 Demolition
0 Other
17-710�,Septi%P; �\Qel
Q Flog f) 71IM-1 —IdA, MA
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DESCRIPTION OF WORK TO BE PEKI-UKMhL):
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Identification - Please Type or Print Clearly
OWNER: Name: :2rA&-Les (�7144--vk Phc
Address: 710 -5AuO'-\ 5;L7 t), a:rj-t
1.--nnfrnr-fnr Nlnmp- . Phone -
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4
Supervisor's Construction License: Exp. Date:
Home Improvement License:
ARCH ITECT/ENGI NEE
. Date:
Phone:
Address: Reg. No._
FEE SCHEDULE. BULDING PERMIT: MOO PER $1000.00 OF THE TOTAL ESTIMATED CQ&TaASED ON $125.00 PER S.F.
Total Project Cost: $ 0400 FEE: -
Check No.: —Rep -10
NOTE: Persons contractinj with unregistered contractarsdq,-�nofhave acre.ss to the guarantyfund
A
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
4. 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
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
4. Building Permit Application
,4. Certified Surveyed Plot Plan
4. 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
OTIE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
+- Building Permit Application
,;6 Certified Proposed Plot Plan
4; Photo of H.I.C. And C.S'L. Licenses
.4, Workers Comp Affidavit
Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Copy of Contract
2012 IECC Energy code
Engineering Affidavits for Engineered products
10TE: 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
9
Plans Submitted 11 Plans Waived [I Certified Plot Plan 11 Stamped Plans 11
OF SEWERAGE DISPOSAL
FTYPE
Publhic Sewer
Sewe
'r
Taming/Massage/Body Art El
Swhm�g Pools El
well El
Tobacco Sales El
Food Packaging/Sales 0
Private (septic tank etc. El
Pennanent Dumpster on Site El
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
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comm
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
I nrnfnr4 qPA
od Street
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.$100-$l 000 fine
NOTES and IUAIFA — (Forr department use
El Notified for pickup Call Email
Date Time Contact Name
Doc.Building Permit Revised 2014
Location
No. ?6 C/ - Date
Check # /C) -!,,l
30-113
- "- - - t
TOWN OF NORTH ANDOVER
Certificate of Occupancy $-
Building/Frame Permit Fee $
Foundation Permit Fee
Other Permit Fee
TOTAL
E�uilding Inspector
N
El
Enter construction cost for fee cal -
North Andover Fee Calculation
Construction Cost
$ 30),O)DOLOG
m
$
$
360.00
Plumbing Fee
$
45.00
Gas Fee 100 comm.
$�
11000,D)
Electrical Fee
$
45.00
Total fees collected
$
550.00
710 Salem Street
964-2016 on 3/11/2016
Remodel Bathroom, Dining Room and Kitchen
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Gerald A. Brown
Inspector of Buildings
Please prin
TOWNOF NORTH ANDOVER
:OFFICE OF
BUILDING DEPARTMENT
1600 Osgood Street, Building 20, Suite 2035
North Andover, Massachusetts 0 1845
HOMEOWNER LICENSE EXEMPTION
BUH)tNG PERMU APPLICATtON
DATE: A? – / I - z1d5 ( (0
Telephone (978) 688-9545
Fax (978) 688-9542
JOB LOCATION: -� 10 _,< �– (_ en- A S —L–
Number Street Address Map/Lot
HOMEOMNER 7q_Avvt e;-5 GOze� 7 7 19 Z 53 -
Name Home Phone Work Phone
PRESENT MAILING ADDRESS_�'? 10 157A L r-_ I— f L�_
OA -r- L__(
0/14 -
Town State
"Kd&F_W 6 114WL.)&f?_
Zip Code
The current exemption for "homeowners" was extended to include owner occupied dwellings of one or two family
dwellings and to allow such homeowners to engage an individual for hire who does not possess a license, provide
that the owner acts as sqpervisor.
DEFINITION OF HOMEOWNER
Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to
be, a one -or two- family dwelling, attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two-year period shall not be considered a homeowner. (780 CMR
Section I I O.R5.1.2)
The undersigned "homeowner" assumes responsibility for compliance with State Building Code and other applicable
codes, by-laws, rules and regulations.
The undersigned "homeowner" certifies thal he/she understands the Town of North Andover Building Department
minimum inspection procedures and jrequi ments and that he/she will comply with said procedures and
requirements.
HOMEOWNERS SIGNATURE
_ V /J1__
V
APPROVAL OF BUILDING OFFI AL
Revised 8.2015
Form Homeowners Exemption
I
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
.The Commonwealth ofHassachusetts
Department ofindustrialAceldents
1 congress Street, SWte 100
Boston, mA 02114-2017
www.mass.gov1dia
Ider,s/Contr,letors/F,le4�WeianslPlWbers-
Worke)�S� Compen . sation Insurance Affidavit: 13W
TO BF, FILFJ) WITE[ TEE PERMTTING AUTRORITY
AL-opucan-EMV1 (S jZ
Name (J3,sinss/Or'ge�nizaiion)lndiviliial)
Address: -710 54 k-1
I If A /I
City/,State/Zip: L4
t�,eapproprlatebox:
Are you an emp!OYO c
LI. -I
V OeL Phone 4:
-time)
I.F] I am a employer vvith--L�—Olplcyccs (full and/or part
-2.E] I am a sole proprietor or partnership and have no employees Working for me in
any capar -1
,ity. (Noworkprs'comp. insurance required
3.[:] 1 am ahomeowUer doing Aworkmyselt (No-vvolkers, comp. insurance required.] T
4&am. ahorneow4er an�will be hiring contractors to conduct 811 Work Onmy property. 1will
ensure that all contract4is either have workers' compensation insurance or are sole
proprietors with U.,
I am a general contractor and I)kave hired the sub-confractors; listed On the attached shoot.
5-E comp. insmanceJ
These sub-coltr4� *444,q� ;6i-yees'and have workers'
6.nWearoac(
152, §1(4),
I f�c&s have exerci§eMoir right of bxemption per MGL 0.
empjo,yd�e LNO work- o required.]
_rs, corop- insuranc,
- VZ-7-�Fo/
;1'6 fill out the section. below showing their workers 001APBns n V in ting
*Any appliarit that ffi,�� s �atjng they are doing all work. and then hire outside contractors must submit anew affidavit dca such'
I-lomeoviners -who submit,this affidavit indi of the sub -contractors and statq whether qrpot th=.Pnti*� have
TContractors; that checkjbi'�'bok,jv6t! attached hn additional sheet showing the name
ovide their workers' corop. policy n—ber-
employees. IfthD sub-c84a�tPis have employees, they MustprovicLe...
-Viding Ivorkers' comvensatioR insurancefOP my eMP 16yees. 1�ejow is thepolicy andy0b Sit�
an em
lam ployer t1lat ispro
information.
Type ofproje�i iXeq"�'U-iki
7. El Nd*-'66nstrdc�OR
8. E] R*cmodellhg-
9. 0 Demolition
10 0 Building addition
11.E] Ejec#ica I'rppxs or OditiQA3
2 %flpj Wn. ing repqrs or dddilions
. bi
11E Xb6kre�ahj
14. Other
insurance Company
Policy # or Self -ins. Lic-
ExpiratiortDOa,
fob Site Address- City/State/Zip- ation. date).
Attach a copy of the WQTkers' comPellsat'on Policy declaration page (Showing the policy number and expir
Failure to secure coverage as requixed under MGL 0. 152, §25A is a criminal violation punishable by a fdb up to $1.,500-00
and/or one-year hnprlsOnment, as well as civil penalties in the form of a STOP WORK ORDER and a flne of up to $�,50.00 a
day against the violator. A copy of this statement may be forwarded to the Office of fnvestigdtions of the DIA for hasurance
coverage verification. IFI71�je plin s an d p �en alfles o1fP e1ju rY t1i a t ti, e info Ym a do n pro -P ide d ab o v e is true an d correct
ldo��Unl T)ntw
Official use only. Do notwrite in tHs area, to he completed by city or to-wn officiaL
City, or Town:
permit/License
Issuing Authority (circle one). i
I.Board of Ifealth 2. Building I)epartment 3. cityfrown cierk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: — Phone
Information and Instructions
Massachusetts General Laws chapter 152 requires' �11 Umplbyqs to provide workers' compensation for their
.
Pursuant to this statute, an employeeis defined as'�--evw person in the service of anotherunderany contractofm
express or implied, oral or written."
An MPIOYer & deffid.d as "an itidividuat, partnership, association, corporation or other legal entity, or agy two or more
ofthe foregoing engaged in ajoint enf6rprise, and including the legal representatives of a deceased employer, or the
receiv6f'dftr * ustdd 6fan individual partnership, association or other legal en*, employing emplbypp§.. lil?w9ver the
owner of a dwelling house having not more than three apartments and who resides therein, or the occuip'"i df lhd'
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwq4jtg 4ouse
or on the grounds or building appurtenant thereto shal.1 not because of such employment b6 deemed to be an employer.�7
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 op6rate a business or to construct buildings in the commonwealth for any
applicant-wh6i has'not. produced -acceptable evidence of compliance with the insurance coverag required.
6
11 0 yof t
Additiona. y, MGL ter i52, §25C(l) states "Neither the commonwealth n r an 1 s political subdivisko'ns shall
enter intp any contract for the performance ofpublic work until acce p*table evidence of compliance -with the insurance
. I
requirements ofthis chapter have been,presented to the contracting authority."
Applicants
bleasb fill out thoWorkersl compensation affidavit completely, by checking the boxes that apply to your situation and, if
ncce*ry, supply sub-'contractor(s) name(s), address(es) and phone number(s) along with their certificat '
P(g) bf
insurance. tirnii6d, Liability Companies (LLC) or Limited Liability Partnerships (LLP) -with no employe 's . ( oilier than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP d6c'schave
employees, a policy is required. 13c advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The Affid4vit should
be returned to the city or town that the application for the permit or license is b eing requ�steq, not the Dep. artment of
Eadustrial,Accidenis. �hould you have any' questions regarding the law or if you are req*ed to obtain, a -Wftrs'
comPensatioii'poliby, please call the Department at the number listed below. Self-insured companies sl��Ikenter their
self-insurancie license number on the appropriate lin(j.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Jnvestigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number whichwill be used as a reference number. In addition, an hpplicant
thai must submit multiple penuMicense applications in any given year, need only submit one affidavit indicating current
policy information (ifnecessary) and under "Job Site Address" the applicant should write "all location� in _(city or
town)." A copy of1ho affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proofthat a valid affidavit is on Me for fbture permits or licenses. Anew affidavit must be filled out each
year. Where a homeowner 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.
4
The Department's address, telephone and fhx number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4900 oxt. 7406 or 1-877-AIASSAPE
Fax # 617-727-7749
Revised 02-23-15 www.mass.gov/clia
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17'.73/8'
28`5 3/8'
>
GROUND FLOOR
North Andover Residence
Greer + Dame
0
DEMO PLAN
Renovation
benjaminjgreer@gmail.com
1/8" = 1'
710 Salem Street
617.827.8081
FEB. 20, 2016
North Andover, MA 01845
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1/8" = 1 -
FEB. 20, 2016
North Andover Residence
Renovation
710 Salem Street
North Andover, MA 01845
Greer + Dame
benjaminjgreer@gmail.com
617.827.8081