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Home My WebLink AboutBuilding Permit #169 - 75 BRIDLE PATH 9/1/2009 eNOR H f BUILDING PERMIT o�<t�■°�°gtio TOWN OF NORTH ANDOVER o? APPLICATION FOR PLAN EXAMINATION 1 Permit NO: L? Date Received ��SSACHUS Date Issued: - IMPORTANT:Applicant must complete all items on this page LOCATION �'/c✓ -�( �' �' 1 P' PROPERTY OWNER l/714e 2 S,�i ' cc ,1 Print MAP NO: D '! C PARCEL:,5;2.ZONING DISTRICT:— Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE I Residential Non- Residential New Building One family Addition Two or more family Industrial Alteratio No. of units: Commercial Repair replaceme Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION�F WORK TO BE PREFORMED: /w / Ile pptification ease Type or P 'nt Clearly) (' v OWNER: Name: NcA f-r� �G salcler c Phone: 3�� Address: -2 �� 1 CONTRACTOR Name: Phone: Address: Supervisor's Construction License Exp. Date: Home Improvement License: Exp. Date: - ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:MOO PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $_ ,Da� �'IL"�o'�'S FEE: $ Check No.: 0 Receipt No.: NOTE: Persons contractin2 wit re istered contractors do not have a es anty fund Signature of Agent/Owner Signatureeoof contractor Location No. Date " M,6 o TM TOWN OF NORTH ANDOVER .� . .�O Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ 2 s�cwuse 9 Foundation Permit Fee $ Other Permit Fee $ ' TOTAL $ Check # d 226io Building Inspector 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS t' 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 2009 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) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o 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 2008 t4ORTH TOWN OF NORTH ANDOVER Qf "E D ,6• ° , °� OFFICE OF ° • BUILDING DEPARTMENT rD + 1600 Osgood Street Building 20, Suite 2-36 p cec.rc.+�.. Abp �9S gArgo�rPifi� North Andover,Massachusetts 01845 SpC14 Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please print DATE: JOB LOCATION: 7 �-' �� .� Ag Number Street Address Map/Lot HOMEOWNER A �� r-stfL)e_ cj,_ 31 ,2 j/Y 1'22k Name Home Phone Work Phone PRESENT MAILING ADDRESS 7 ) ��^ c��-C /,�q Py /i�c�✓ti / O 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 he/she 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,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and re u* sand that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 FORTH Town of Andover . No. /to 9 _ _ 9 . , (dover, Mass., • 0 COC Lk HICHEWICK �ADRATE D �C '4S BOARD OF HEALTH' Food/Kitchen PERMIT T D Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT 0004 �. C.4ik.A.... .. ..................... ..�^'�.�..�.��. .►........II....__.................... ..j.�.................. Foundation has permission to erect........................................ buildings on........(.. ............. �!�...A!` •.... d ............ Rough to be occupied as....P.I.qdo�o } v Chimney provided that the person accepting this permit shall in eve respect con rm to the terms of the application on file in 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 C){� PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC ARTS Rough - -� Service BUILDING INSPECTOR Final Occupa my 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. 1 ne uOmrnorrweakk of Massachusetts DePxtmenr Of-Indust-id Acd&,, cce a E;1�,, _ � f Irtvesttg afiorrs 600 Arashin,�tnn Street Boston, AIA #2111 Workers' Compensation fnsitranee - �grry/din . A 'cant worngattion Affidavit~ Builders/Contractors/nectrictans/Flnmbers Please Print Leeibl NSB fBnsic�ss/OrgaAi�ation/tna;vidusl); c� Lw Address: 7)— �`�ri��-c 11144 Art / you an empioYeri Cheokibe s ro I'am a employer with PP Pete boz: . I am $general contractor end I .. Type°{project("nir* PIoY=s(fulland/or part-time).* have:bird the su& 6. C New con.strucfion . 2.[] Iam.asole.. cors Ptaptietor or pwtner. Iistod ship and have no em I can the attached sheet 3 Remodeiing p uYees. 7b=-Re su�..eontractors have working for at arty capacity, work 8. ❑Dsmoiitiorr jNo workers'oom em' comp.insurance. p sastaer:ce S. We are a corporafaan end its 9• ❑BW'lding addition 'p9d) of�rs have exercised their 10•(].�ie^trical 3• i Mn a homeowner doing all work right r'eP�s oradditions myself[No-work=' Sht of exemption Per MOL 11.[]Plume ' L52, §1(4),and-we have no �rtP�.or additions insurance;r-Quired.J.t . •0MPlaYee-L[No wormers' IZ•L]Roof repairs 'AmyVplimmtic gyp• ir�stlran=Mquked..J 13.1].0}}= terecics bob#I mast also fits out the section haaw ahowiag theerwoticId,e Homeowners who Miihmit this RWIh vit hrdirnting th r� o sefioo oi' Caaoactars that check this bone rnm filmy mg wori �semi hue omsi8e oonaectors mfom<s(ion at>BoFed an aticF.atiooal sheat she athmit 1 rMW aftidnvit rndiaet eh' K'ieeg•tier mm�e of the sub-conttectms .f6• en o � wyer isPa�o+¢iaarg:reorl'.er'arrr,errsy�eirsurance or R s -p irfoz�ton. J m1' vlayees Brow k tfePj?ff r' yob scrp Instranec Company Name: Poiiay#or Sell'-ins.Lir.#: avirabon Date. Job Site Address: AtimA a copy of the workers'.camjpeusation Po decia 0ty/s ,p. y =at>iiao p e've(showing the policy number and e Failure to secw�e coverage as required under Section 25A of . xpirptioa date}. . fine up to$1.500.00 andlor one-year imPrisonm MGL c. 152 can lead to the imposition of criminal poet of a Of up to S250-DO a ;as weR a 5 civil peTtalties in the form of a S717P WORT{ORDER and a fine Investi the violator. Be advised that a copy of this statecment may be frorwarde-d to thr Ofrtm of gallons of the DIA for insur estce coverage verity"motion. I do hereby certify tt aeidPeRalf:.,.o,rpegv-y Beat the taformoiionrn ' 5i p vcded above is twee and Qorred Date: Phone i#- Ofj"ici&ase only. Do not write in this'rev,&,6e,coerrp[�e or to by city WN.dflu:a[ Crit'or Town: ninb/+erfltority(circle one)• Permit/Liaense I. Board of"mltb Z-136"R9 R9 Department 3.C' aoiw L Other n Clerk 4 lrleatrieal Inspector $. Plnmbi�I� Pectnr Contact Person: Phone#: Information a. fid In-Aructions- MasslichussmCrancral Laws chapter IS2 requires all amp 3afl-m to provide workers'compensation for their employees. Pursuant to this staiute,an a i*yee is defined as"..:every person in the service of another under any cantract ofhire, MWI-ss or implied,ora)or written," `. An employer is defined as"zn individual,partnership,association,corporation or other Imo entity,or arty two Orin Orr, of thelkineping engaged in a joint enterprise,and includis- gthe legal repres-rrtafives of deceased employer,or flit raxiber ortauster•of an individual,pasfnership,associatiozr or od=Iegal amity,employing arutpioyees.•1.lowemthe owner•of a dwelling house having not more that th=apartment and who resides thercK or tare oceupait of the dwelling house of another who employs persons to do mairrtmumcc,construction ori work m such dwelling ho= or on the grounds or building appurteneat thereto shall not bcca=of such muployment be d=ned to be an employer." MGL chapter 152,925C(6)also states that"every slate a;-local licensing agency Shan withhold the issuancear renewal of a license or permit to operate a business or *D construct building;in the comutomvealth for any applicant ant who has not produced acceptable evidemair eomprmuce with the.insurance cover ge tequimd." Additionally,MOL chapter 152,§25C(7)states-Neither the commonwealth nor any of its poliiictft smbdivisions shall enter im..any contract for the perfanTan=of public wade until- ccepfable evidence of compliance wish fire insunmcx requir:rnents of this chapter have bean pr esm ted tn.the cohrttractitrg authority." Appricauts Please fill out the workers'compmmstion-afiidavit campL=ftly,by checking the boxes that apply to your situafion and,if necessary,supply subrconf:actor(s)name(s�addrese(es):said phone numbers)along with their certifim(s)of insurance. Limited'Liability Companies(LLC)or Limited Liability.Partnerships(LLP)-with no employees othertizan the members or partners,are not rsquired to early woticros'Ociitrpemsmion insmancx. Ifan LLC or-LLP does have employees,a policy is requi vi Be advised that this off da vh may be submitted to the,Departnerd of industrial Accidents for confirmaiian of iniammce eovasge. Ake•be sure to sign and date the affiidavk The armdavh should be returned to the city or tnm that the apprwaiion for the permit or License is being requested,not'tihe Departmant of Industrial Accidents. Should you have any questions regarding the law or if you are requip to obtain a workers' compensation policy,please-can the Department at the-nurn6w giftil below. Self-insured companies-should antes their soli insruanae Iicensc mrrrniier an re'appropi late IMM. City or Town Ot'ucisis Please be sure ihffi the affidavit is compleft and printed lop;ibly. The Departinent has provided a space at the bottom of the affidavit for you to fill out in tiro event the Office of Investigations has to coatacxyon r eprifing tihe applicant Please be sure to fill in the permit/license number which w-ill be used as a reference mmtbcr. In addition,an appika t that must submit multiple permit/liccnse appiiaetions in any given year,need only submit one affidavit indicmtirrgcurrent policy irrforrnefion(if necessary)and larder"Job Site Address"the,appiicaut should write"all locations in (city or toren)."A copy of he affidavit that has becn.ofirciak startzped or marked byre city or town may be provided to the applicant as proof that a valid affidavit is on file for fitart permits or licenses. A new affidavit must be Med out each year.Wheys a home owner or citizen is obtaining a lic-nsM: 'or ptrritnot elated to any business or commercial ventum (i.e.a dog license or permit to burn leaves etc.)said person is NOT,required fo-compiete this afiidaviL Tho Ofnc-of investigations would like to thank you in advance for your cooperation and shouldeoa have any questions, please do not•hesitate to glut us a eatL Tiro Department's address,telephone and fax number:. The Co=onw-adth of Massachusetts Dcpat�„�-nf of L mdusbiat Accid:;its 4f m oaf EnVestic.%fions " 500 Washixigton Stt=t Boston, MA 02111 TeL#617-727-49010 6=406 or I-977-MASSAFE Revised 5-26-05 Fax#617-727-774 www.zsass govidia