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Home My WebLink AboutBuilding Permit #223-15 - 793 FOREST STREET 9/2/2014 BUILDING PERMIT of"°oT"qti TOWN OF NORTH ANDOVER low32 y` ''- ° '° ° O I ., APPLICATION FOR PLAN EXAMINATION M Z a« Permit No#: _�_ Date Received &Oi �qS RATED SACHU`�� Date Issu IMPORTANT: Applicant must complete all items on this page ^ J� LOCATION 77 Pc;tJ S4 �t f-y��dw,,',/AA ,� Print .( PROPERTY OWNER /� V_ �• Cp %a t`oHo Print 100 Year Structure yes MAP PARCEL: ZONING DISTRICT: Historic District yes n Machine Shop Village yes no 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 0 Others: ❑ Demolition .9 Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: )Identification- Please Type or Print Clearly OWNER: Name: 7, X, Phone: u,*a Phone Address: 3 /-21M,501 4 Ql' vs Contractor Name: Phone: Address: Supervisor's Construction License: Exp. Date: Horne Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBASED,ON$125.00 PER S.F. Total Project Cost: $__ EGD ,CV FEE: $ O� Check No.: I (-) Receipt No.: NOTE: Persons contrireting with unregistere contractors do not have access to the guaranty fund Signature of A,gent/Owner Signature of contractor Location No. Date I . - TOWN OF NORTH ANDOVER ., Certificate of Occupancy $ Building/Frame Permit Fee $ �- Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# Gf ilf'• 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on I y Si nature COMMENTS ppcx �� \►�2 11� �c � G� Cr w� u v V� IOOt , HEALTH Reviewed on Signature COMMENTS 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 Call Email Date Time Contact Name Doc.Building Permit 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 Be Commonwealth offfassach.asetts * - �e,��rnera�a,�.��c��rs��c��.Acczc�e�� . , Qfflce offnvesfigations 60`0 Washrngton,S'treet .Boston,.tom 02111 vmmuss grrv/ciza Workexq'Comp exsaflon)(USuxance. davit:B�x�Sc�er��iCo��°ac�ox�lGlcc�x�exansl�'X�mbe�`� A4xaxta#on PZ e rczn �i Name,(BusinesslOrganisationlJn&idlld): ��e✓` d Llxtio Address: City1S tate,/ Ve Phono 0: RS .A.reyouanemployer?C eektb appropriatelOox: Type of project(rceguixed): �. [(I am.a general contractor and S F i.El l ama employer with_ 6, New cbnstraction employees(-LUHandloxPaxt time)T haveIiixedfhe sub-contractus 2.[] S a-m a soleprogietor or partner- listed on.the attached sheet:T 7. �Remodeling ship and`havena•employees These gat contractoxshave 8. [(Demolition worlang forme in any capacity. woxkers'comp.insurance. 9. Building addition tN'o work&comp.ansameo 5. ❑we area coxporaEaon and its 10.r]Electricalrepairs ox additions eguired.� offers have exercised.their S. 5 a�n a homeowner doing all work right of exemption p or MOL 11..[]Plum�bingxepairs ox additions myseLf U foworkexs'comp. c.152,§1(4),andwehaveno 12.Q Roofxepaixs in=ancereguixeq employees.WO workers, 13.0 Otbex comp.insuxancareguiredl eAnyapplzcantthac cl3ecksbox ZmusEalso llouithase�tionbeldwshowingtheirworkerecompensatioupolicy nformation. 7 Homeowners who submitthis affidaWtindicathgihey axe doing allworlt and then hire outside contractors must submit anew affidavit indicating such, xContracforsthatcbcekthisbo anustai#achedaaadditionalsheetshowingtheuameofthesulk-eoutracforsandtheiFv,orkers'comp.policginfomiaiion, �'rz�tcr�exnpraye�tht�i�p�oviciir�g�o�Xt'exs'corrape�a�ationinsr�rarzcefa�.�r�yern�royee� .$erot�i�t�2e�alicyrarar�jo.�,�ite ii2fo;�matio� . insumnce CormpanyName Policy 4 oxel ins.11ic.#: ExpiratonDate: rola Bite.A.ddresis: CitylState/Zip: Atfaehi,a cosy of tie�o kers'comment anon-policy aeclaxatzoa�page(siZowzng•tRep Izeyzimmbe�•and e�iratzon crate). p'azlure to secure coverage as reguixeclunder�ect%n25A ofl GD a.152 can lead to the imposition ofer a alpen.alties of inm zip to$1,500.00 and/ox one-year imprisonment,as well.as clvil.pewltzes in the form.ofa STOP W ORT ORDS.and a f me ofup to$250.00 a day againsttha violatoz: 13a advised that a copy ofthis statem.entmay be foxwarded to the Mae of• 7nvestigatzom of the WA for insurance coverage vexification. doXierebyeerzfj2 a tariox��oviriec�c�7oveistrueantico�xee, Si atzzre� Date: OjfjeiaZ Uga ajjry, vo nat wfite in this area,to be coigleted by city or town officiaf City or Town: Permit'ILicense# SssuingATMority(circle one): 1.Baaxcl of ealth?.BuilclimgDepartmerzt 3.CityfToym Clerk 4.Electrical Inspector 5.BumbingInspector 6.Other - 4 information and Instructions : -Massachusetts General Laws chapter 152 xeq*as all employers to pxovidewarkers'compensation fox them employees. Parsuant to this statute,an erawfoyee is defimd es"...ever p exson iii the service of auothex under any coziiract o hire; ' e�pxess ox•iroplied,oral orwxiften." An eigloy_q�is defn ed as"ati individual,partnership,association,coxpoxafioxt o�otrzex legal entity,or any two oxmore- ofthe f6xeg0ng engaged in a joint enterprise,and includingthe legalxepxesentatives of xdaceased elnplp�ex,.ox the, xeceiver orttusfee ofa-akdividuatpaz-kzership,association or other legal entity,employing employees, p(oweverthe owxtex oia dwellingh.ouseliavingnotmoxe thmfhtee aparfmants andwho xesides thereiu,oxtb occupantoMa dweliing h cuse of anather who employs poisons to do maintenance,consfraetiou oxrepair work on such dwelling house ox onthe grounds orbuilding appurfeumtthereto shaIlnotbecame of such employmentbe deemedto be an employer:" IV.I;GL chapter 152,§25C(6)also states that"every-state or local licensing agency shall withhold the is renewal of a license or permit to opexate a business or to construct buildingissuance or s ixz the comxnaxtwealis torn clay applicant who has not produced-acceptable evidence of compliance Wath the insurance coverage required." Additionally;lYICxL chapter 152,§25C(7)states`�Teitherthe commonwealthnox any ofits political sabdivzszons shall enterintoartycontractfor theperformanceofpublicwort until accepfablaevidenceofcompliancewith theinsuxance xegaixements oz this chaptexhave b eenpresented to the contracting authority," .t�pplzcants . Please fz11 out the waxkexs'compensation affidavit completely,by checking the bores that apply to your situation and,ii necessary,supply sub-confractox(s)nante(s),addresses)and�honenumbex(s)alongwith.theix certiCcafe(s)of insurance. .LimitedLiabitity Companies(LLC)orLimitedf iabilitypartnexsI ps(LLl')wifhno employees otliexthim the me,"bels oxpartners,axenotrequkadto canyworkers'compensationinsmx nce. Han ti C orLLP doeshave employees,apol1cyi9 xegaired, Be advisedthattbis afdavitmaybe snbmitiedto theDepa-iment of Industrial Accidents fox cMff mation ofinmrance coverage. .Also be sure to siga and date the aMdavi: 1he affidavit should be)xetamadto the city ox town that the app7iaation fox the permit or license is being regaested,not Me D4ariment of Industrial Accidents, Shouldyou have any questions regarding the law or if you are required to obtain•a*orkexs' compensationpoVey,pleasecafftheDepattmentattlienumberltstedbalow. gelfimWedcompaniesshouldenfexthezr sel-f~insurance license number on the appropriate line. 1 City or Town.Oncials h'leasebesuxefhatthe aydavitiscomplptomdpxintedlegibly- TheDepatmenthas pxovidedaspaceatthebottom orthe aiHdavzti'oxYOU to M1 out in the event the Office ofSnvestigaflonshas to contactyouxegaxdiugthe applicant. Pleasebe-surotoflin.fbepemuf/IlcenseuumbaxwidchwMbeused asaxexerence,number, Itl.addition thatm:ast submitmulti�ple permit/license applications is any givenyear,need only submit one ,aPPRcja ntazlzdavit indicat'ng cunent p olicy inzoxmation Vnecessaxy)and under lob,Site Address"the applicant should write"all l0aatiD in (city ax towzt)"A copyof%aafidaviGthathasbeenofficiallystampedoxmaPlic bythecityoxtownmaybepxovidedtothe applieant as prootthat avalid afrtdavitzs ou ale fox iufvxepermifs oxlicenses. .Anew aidavitmtistbe ftljed out each year.Where ah.ome ownexorcitizen is obtainingalicense oxpexmitnotrelafedto auybusiness orcommexcialvenfine (1.e.a.dog liconse oxpermitto burn leaves etc.)saidperson is NoTxecluiredto complete this affidavit. The OffZce aTnvesgigations would like to fhank you in advance fox your cooperation and qu should you have arty estions, please do zzo t hg1fdte to give us a call, , The Depa lment's address,telephone andftnumber, T'hQ CQM-JM4jjwoaltbt ofM� ae7 V pe e dkWa*.1al Acoide to Otte()MVe 3aVo...la TOL 1-a 7 Revised 5-26-OS Fay, 617"W?-774. t%O R TH Town of ndover * No. _ Z ti h ver, Mass, l COC 41CMtw1c. �•Q °R�reo �PP��S S U - BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ........ ...fir.. . �1. � ............................................ BUILDING INSPECTOR has permission to erect ............... buildings on ........ ... ... .. . ' ......... Foundation ........... .R........ Rough tobe occupied as ...........� ... ...�.. .,........... .aA.�......®............................................. Chimney provided that the person accepting this permit shall ih eve respect conform to the terms of the application P p p g p ry p 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 ?1PER• MIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S TS Rough Service ......................... . .............................................. Final BUILDING INSPECTOR I 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. 77. 5.00' i LOT A--1 43,583 S.F. Qi 10 00 TREE \ WELL to rn N \ \ / I 2 5 i i On. ` I I Z I"1 n ; �. Qi 1 i z ai i 24.5'1 BENCH MARK I = w : / I wl I I z I m NAIL IN 10" PINS / wi i ai ~ ELEV.=150.84 > i~ wl i I i ' wI I �1 l 1 / 11 l NI Im al �I 1= Iw C / —j w _ C40 ZI 1500 \GALLON SEPTiCk TANK bq i i �1 150 iia wi t lm wl c-'' Li Lj LZ DIST. BOX I I 0' 22,6, { 1 4-F�nNG 1 1 D� 004 I �� wNG Q 1 Al- o o f TOP FND. f a l C3 =152.33 i 2.21 37-76' i 6938' F c S, �. ,79, RE •, E�