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Home My WebLink AboutBuilding Permit #166-15 - 75 CHESTNUT STREET 8/14/2014 pORTF/ BUILDING PERMIT °� `eD �bq�o TOWN OF NORTH ANDOVER ,03�th _ o I APPLICATION FOR PLAN EXAMINATION * ,� r� Dae Received Permit No#: tRi �y �SSgcmussc Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 7 5� � �s �f?v`f _ - _r Print PROPERTY OWNER �� 61 r �� Print 100 Year Structure yes MAP PARCELaU ZONING DISTRICT: Historic District yes no Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building X_One family KAddition ❑Two or more family [I Industrial ❑Alteration No. of units: [i Commercial i El Repair, replacement ElAssessory Bldg 11 Others: ❑ Demolition ❑ Other ❑ Septic ❑Well iI Floodplain ❑Wetlands ❑ Watershed District Ij Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: G0L?'&e lotd�17 M7L Identification- Please Type or Print Clearly OWNER: Name: C( e,!!-"��►'�-, �f` Phone: '' Address: C1.P 7�vt c S • Contractor Name- Phone: Address: . cwt C� - Supervisor's Construction License: _ Exp. Date-. Home Improvement License: _ _ _ _ _.-_ Exp. Date: _ ARCHITECT/ENGINEER 71iy w fY Phone:( ) f y,2-of Y�6 Rey) T 14.4-6?l r,0 Reg. No. Address: Al 6G I FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED O $125.00 PER S.F. Total Project Cost: $ S► vyd FEE: $ Check No.: 1-7 Receipt No.: 2'1 I NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund �--�� — � .Signature of contractor Signature of Agent/Owner _ _ r Location No. .� Date . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ �t Building/Frame Permit Fee $ C�[7. - � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 2 9, 0 0 Q6ui ldi ng Insp ctor . 1 i Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ TS ❑ Tobacco ales . Food Packaging/Sales ❑ Private(septic tank,etc. ❑ permanent Dumpster on Site ❑ I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM I PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS r' Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes I i Planning Board Decision: Comments i 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 i 1 ' Dimension a Number of Stories: Total square feet of floor area, based on Exterior dimensions. 1 Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No i 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 Date Time Contact Name ' Doc.Building Permit Revised 2014 I I 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 o£Ka ori�S y� TO"OF j90RM ANDOVER t X 0 OEF.ICE OF -BUMDING D • �c��°� :"7500 05goodSttaet$u�j��' �T` ` &g 2O,'Suite 2 36 7 p�R•1T7n'Y�,�y s``'ACEiu5�� • -North Ando-vex,IVlassaehusetts 01845 , GezaldA.Brown Telephone(978)698-9:54-5 Inspector ofBildings Fax (978)688-9542 HOMEOW-NER'LICENSE EXEMPTION B ►Ti�TG PFWMT APPLICATION • Pleaseprinf • DATE rOB LOCATZON. 'PS-- Number S.ireetAddress Map/Lot ' I�OAMCMNER �- Name. HomePhone Off_�0t'3— ��o\' Work Phone 'RESENT MAILING ADDRESS 1 5 C -------------- C:y lb 4l 84�� - Sfafw• _ v p Codo The current exempfion for'homeowners"was extended to to allow su;h homPo:r , nClLlde Owned DC�i2pled divelin�s to i�vo units or less 2nd nem r o engage an i3diviaual.forhire who does notpossess a license,provided that the owner acts as supervisor). Stafe3ulcling (Code Section DEFINITION OFHOMOWNER. Persons)who awns aparcel of land on which he/she resides or intends to reside,on which there is,or is intended to ' b�,a one or two familp structures. A.person who constructs more that�one home in a two yearperrod shall not be considered ahomeowner. The undersigned"homeowner"assumes responsibi Applicable codeslityfor cbmPliances with the State Building Code and other ,by laws,rales and-regulations. The undersigned"homeowner"certifies that he/she imdersfiauds the Town of Forth Andover Building Department minimum inspection Prooedures and requirements and that hefshe will comply with,said procedures and requirements, HOAMOWMMS SIGNATMW . Al'P.ROVAL OF BUiLD)NG OFFICIAL Revised 7.2009 'FOM HomeownersBxemption , BOARD OF APPEALS 688-9541 CaNISERSAnON 688-9530 530 =' Z3EALTH 688-9540 PLANNDTG 688-9531 Enter construction cost for fee cal - North Andover Fee Cakulation Construction Cost 25,000.00 m $ - $ 300.00 Plumbing Fee $ 37.50 ,- Gas Fee 100 comm. $ 100.00 Electrical Fee $ 37.50 Total fees collected $ 475.00 75 Chestnut Street 166-15 on 8/14/14 Garage Addition NORTH Town of ndover 0 = - C% h ver, Ma0 ss, V•S� �� '� COC NIC HI MACK �qs P#A rE D PPP`,`.�5 - ll BOARD OF HEALTH Food/Kitchen LD PERMI-T� �I'1�� Septic System THIS CERTIFIES THAT , ,,, ,,,,,,,,,,,,,,, ,,, BUILDING INSPECTOR has permission to erect .................. ... buildings on . .... .,� �'�. ..... .;i, Foundation � � . Rough to be occupied as ...... !N.. !��... � . .....qrpect ...... .� ........................... Chimney provided that the person acce In this ermI shaia eve conform to the terms of the application p p � g p rY 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. �A 1 -00� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTEW T Rough Service ......... . . .. . ..•..................... . ..... ...................... Final B ILDI G 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. The Commonwealth offfaswhuseits • , Office offfivestigateons 6`44 Washington Street Boston.,MA 02111 www-rnassgovldia Wgrl ex$'Compewation fusurmee Affidavit:BuildersiContractorofFIectriczans PI*berp App -cant brmatio-A Please.Prim I e zbly Name(BusinesslOrganizagon/Inda`.vidad): Cd 1 f Address: s1 S— �.fI Czty/SL �, e� . v t o Y5- Phone 4: l P s^ If?C/ i!/. Ara you an employer?Check the appropxiate)box'- Type of project(required): 1.Q I am a employer with__ __ __ 4. d I an a general contractor and I 6. Now c6nstruction F employees(lull and/or paz tune):� have hizedthe sub-contxactom em p ' z 7. Remodeling 2.[l I am a sole propxietor or partner listed on the attached sheet ship and`havena.employees These sul-contractors have 8. [(Demolition working forme in any capacity. workers'comp.insurance. 9. KBuilding addition [No workers'comp.insurance 5. ❑We are a corporation and its ME]Electrical repairs or additions xegaked.] officers have exercised.their 3.X.I am a homeowner doing allwork right of exemption pexMGI. 11..0.Plumbingxepairs or additions myself hyo workers°comp. c.152,§1(4),and wehaw no 12.p Roofxepairs instiranc�xe 'ed. employees.jNb workers' 1311 ovier comp.insurance regfted.] Anyapplicantthai checks boxojmust also Mouttbesection bel6wshowingfheirvrorkers'compensation.poligw-bimation. "i gerneovrners vrho submitthis affidayitindicating they 2Ye doing allworgandtheithire outside contractors must:submit a new afddayit indicating such. xContcactors that cbeokthis bol anust attached as additional sheet shovikgthe name ofthe sub-contmctors andfheir workers'comp.policy information. I am an empfoyar fliat isproviciing wo4kevis'compensation insurance forrAy eHTloyees Beroty i��iiepolicy ancija�r site in,fo�matior2. i Insurance CornpanyName% I'ol{cy#or Self�!M.11ic.#: Expiratiolawo. Tob Bite Address: CitylstateLZip: Attach a copy Gftewoxkers'compensaffonliolzcy tleclara-don page(showing-the policy number and expiratiou date). `ailuxe to secure covexage as xequixed.undex Section 25A ofMOI,o.152 cart lead to the imposition of criminalpenalties of a fm up to$1,500.00 and/or one�year inpriso�qnent,as wallas cKpenalties in the foam of a STOP WORD ORDER and a fn e ofup to$250.00 a day againstthe violator: Be advised that a copy ofthis statem.entmaybe forwardedto the Office o£ Investigations of the DIA.for insurance coverage verification. do/tetchy certE,fy u lie tains r�crpenalges of perfury tfiat#lie information�provid'ecl above is trae and eorareet, Sr. atur Rhone#. 100 ere J official use oily. Do not wMe in this area,to be eorglefed iy city or town ofciaf. City or Town: Permialcense# Issuing Authority(circle one): Z.$aaxri ofk�ealtlx ?.Builcl[xnglDepartrrzend 3.GiylTown Clerk 4.Electricalxnspector a.)'IurnbingInspector 6.Other - - Information and Instr Uctions Massachusetts General Laws chapter 152 requires all employers fo provide woxkers'compensation for Eck employees. Pursuant to flus stn =� statute,�,e��lsyee�s dc�incd as ,.,evcx,�person iiithe service of another under any corifract ofhixe; express oximpl A oral or wxitten." An employeils defined as"aur individual,partnership,association,corporation or otherlegal entity,or anytwo ormoxe ofthe Foregoing engaged in a joint enterprise,and includingthe,legalxepxesentafives ofwdeceased em to x.or the receiver o tt�isfee of~an indivzdua(,partnersb%p,associatiort ox other legal entity,employing empXoyeas. Sov,��evex the ovMor of a dwelling house having notmore than three apartments a ndwh-o resides thexe4 orMa occupant ofthe dwelling house of another who employs persons to do maintenance,construction ox repair work oa sud i dwelling house or onthe grounds orbui_lding appurtenant thereto shallnot because of such employment be deemedto bean employer" MGL chapter 152,§25C(6)also states that"every state or Ideal licensing agency shall withhold the Issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapfex 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions sliall enter into any contractfor the performance ofpublic workuntil acceptable evidence of compliance with the insurance requirements Of this chapterhave beenpresented to the cmtracting authority." Applicants Please fill out the workers'comp enation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and�honenumber(s)along With their certifxcate(s)of insurance. Limited Liability Companies(LLC)ox Limited Liability Partnerships UTP)with no employees othex thm the Members orpartners,aronotrequiredto carryworkers'compensatiozr.insurance. lianLLC orLLP doeshave employees,apolicyisxequired. Beadvkodthatfhisafixxdavitmaybe,submittedtotheDepartznentofl'ndustrial Acoidents foX confirmation ofinsurance coverage. Also be sure to sign and date the affidavit. the affidavit should Tie,retum6dtc the city or town that the application for the permit or license is being requested,not the D eTartment of 1•ndustrial-Accidents. Shouldyou have any questions regarding the law or if you are xoquired to obtain a worlters' compensationpolioy,pleasecalltheDepartaentatth. numbarltedbelow. SerineUiedcompaniesshould enter their self-insurance license number on the appropriate line. ' City or Town Officials Please be,sure thattheaffidavit iscomplete andpxintedlegibly. TkaDepartmenthasprMdedaspacoatthebottom ox the afGdavitfor you to fill out in the event fhe Office of investigations has to contact you regarding the applicant. Please be-sure to fill inthe pexcnit/Iicense number wldchwill be used as a reference number. 7n,addition,an.applicant that.i gust submitmultiple permit/license applications in any givenyear,need only submit one,affidavit indicating current P olicy information(ifnecessary)and under"yob Site Address"the applicant shouldwrite"all locations in (city or tows):':A:copy Otte,affidavit that has been of dally stamped or marled by the city or town may be provided to tb e applicant asp6ofthat avalidofCZdavit•zson e oxfuturepermits orlicenses. Anew afffdavltmustbeflledouteach year.Where a-Home owner or citizen is obtaining a license ox permit not related to any business or commercial venture (i.e.a dog license orpermit to burn leaves eta.)saidperson is NOTrequired to complete this affidavit. The Office of Tn-vesf gations would like to thank you in.advance for your cooperation and should you have any questions, please do not;hesifd�te to give us a call. The Departm.enf`s address,telephone and fax number. TheGo oumafthofS1�?�asnchwPlfs Do U(MoDt Q.£Zudu&Wa1 Accidents 69[)' 46ingtm Devised 5-26-05 FaX#617"727"7749