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HomeMy WebLinkAboutBuilding Permit #398 - 8 WOOD AVENUE 12/16/2008 pORT►� BUILDING PERMIT �6 D TOWN OF NORTH ANDOVER 4 - APPLICATION FOR PLAN EXAMINATION Permit NO: 3�i Date Received r, ^DIV O I- �SSgcHus�� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION- Wady -TF / `� 06VF1Z-- --- Print PROPERTY OWNER fy (C^ ,, Print MAP NO: 7-3 PARCEL: 6)- ZONING DISTRICT: Historic District yes 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 Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: C r,4)R 3o E WADS lei RAMC-- `Two /V&i,\/ W14-u,5 /ORD / u 3/r�b 1 4,7 nl6 1�/c.t.. !-'U t�r�2a►�iT � ft P0Zrb(zwi. 19LU MglA)b W01-1 , Identification Please Type or Print Clearly) OWNER: Name: To c "Tv c (Ccf� Phone: s` ��l 3� cl' Address: 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:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ fin', © � FEE: $ 1 q Z Check No.: ' 4an a, Receipt No.: 1�-(0 NOTE: Persons contracting unregistered contractors do not have access to the guaranty fund ignature of Agent/OwnerV 7'4-7 Signature of contractor Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL u is ewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/S-dre'�!,)1—f_}. 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 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: Lobated 384 Osgood Street FIRE DEPARTMENT -Temp Dempster on site yes no Located at 124 MainStreet Fire Department signatureldate 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 L.--..... _ ......................._.—_.........................--- .- --- _......_._......_.—.._._.....__._...._ _.__..._....._ _ Doc.Building Permit Revised 2008 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 s ❑ 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) Li 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) o Copy of Contract ❑. Mass check Energy Compliance Report o 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 Application Revised 2.2008 E Location No. Date 4P44- a� MORTIq TOWN OF NORTH ANDOVER O�� No i�'�•t.O .5 .4issidK9 ♦ i • Certificate of Occupancy $ emus Et�' Building/Frame Permit Fee $ Ac? Foundation Permit Fee $ Other Permit Fee $ , TOTAL $ Check # 21761 Building Inspector t NORTN TOWN OF NORTH ANDOVER o `,`•• �� OFFICE OF F BUILDING DEPARTMENT + 1600 Osgood Street Building 20 Suite 2-36 �►'a�.,;. "� North Andover,Massachusetts 01845 1SSACM115�t Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please ixint DATE: JOB LOCATION: I WOE-,0 /V u Number Street Address MapJi of HOMEOWNERS TvG�Cr'�Z �`�� ��7 9 2c�� 7 2 7 Name Home Phone Work Phone PRESENT MAII.ING ADDRESS `� �''�� A-,C- I%C-?f AWr.6�(� lM/t Z�FIs y� 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=gap an individual for hire who docs 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 helshe 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 helshe understands the Town of North Andover Building Department minimum inspection proceduTFFICUI, and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATU APPROVAL OF BUILDING Revised 10.2005 Form Homeowners Exemption ROARDOF 1PPF:\I.S(,'tR')54.1 C 1.\S' � t)\6� - ;� C ):K .1I'I.. �S 9_.0 IIE.11..TH 08-9540 PL.L\.N[\G 688-9535 's 7'he Comm'nwe'zlth of Massachusetts ' Department of Industrial Accidents k i l7j' t .•Et,`' Office of Investig,atiom YPIII !� ti3 600 Waslzinpon Street e'R Boston MA 02111 ` I wN'K'.mass-g ov/dia 'Workers' Compensation Insurance.Affidavit: Builders/Contractors/E[ectriciia.ns/Plumbers ARPficant Information r Please Print Leoibiv Name (Business/Organization/individual): :r,,I:t�7 Address: /y k)o00Ec City/state/Zip: Phone#: Are you an employer?Check the appropriate box: l.❑ I am a employer with 4. ❑ I am i0nithi.1-attached ontractor and I Type of project(required); employees(full and/or part-time).* have ub-contractors 6. ❑New construction 2.❑ Ian a sole proprietor or partner- Iisted sheet$ ?• ❑ Remodeling ship and have no employees Thesenractors have working for me in any capacity. workers' comp. insurance, s' ❑ Demolition [No workers' comp. insurance 5. ❑ We are a corporation and its 9' ❑ Building addition required.] officers have exercised.their W-0 Electrical repairs or additions 3.[ I an a homeowner doing all work rig ht of exemption per MGL 1 I.0 P}umbinQ repairs myself. p _ p rrs or additions [No workers' camp. c. 152, 1.(4),and we have no insurance required.] t employees, [No.workers' 12.E] Roof repairs comp. insurance required.] 13.❑Other 'Any applicant.that checks box#).must alsoYili out the section below showing their workers'compensation pofiey information. riomcowners WhG SlliYlllti(1[[$a!%fdaVEi IElC1tCfl[tE'!_tile)%8i'E e oil.—tl�:r;;aa,=j[h Cil hire GlttSidE CUntraAlU CB ntlLtil auhmli a new atn to% lContEactors that check this box.must attached an additional sheet showing the name of the suD-ocn etor and their workers'comp,poi m i=rin such.i[mc:�ting Bach. rIfOn I am an employer that is providing workers'compensatiott insurance for my a to ees. Below is the policy information. p cy and job site Insurance Company Name: Policy#or Self-.ins. Lir.9: 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 51,500.00 and/or one-y(-,ar imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. Be advised that a copy of thin statement may be forwarded to the Office of Investigations of.th for insurance coverage verification. I do h by ce �'u er the pains and penalties of perjui);that the information provided above true and correct Signature: �- Date 2 r Phone#: O fnly. Do not write in this area,to be completed by city or town official : Permit/License rity(circle one): ealth 2. Building Department 3.City/Town Clerk 4. Electrical inspector S. Piumbing inspector . Contact Person: Phone 19- Information otnd Instructions Massachusetts General Laws chapter 152 requires all empioyers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as".-.every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity;or any two or more of the foregoing engaged in a joint enterprise,and includiri.g the legal representatives of a deceased employer,o the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartiit'ents and who resides therein,or the occupant of the dwelling house of another who employs personslto do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state o r local licensing agency shall withhold the issuance or renewal of a license or permitto 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 chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certific ate(A of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or.partners,are not required to carry workers.'compensation insurance. if an LLC or LLP does have_ employees, a policy is required. Be 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,afridavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents, Should you have any questions reg�rdinv the lam,or if you are required to obtain a wo;kers' compensation policy,please call the Department at the nmrnber h-`--d below. Sell insured companies should enter their —self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibiy. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the appii=t. Please be sure to fill in the permitJlicrose number which will be used as a reference number. In add'iti'on,an applicant that must submit multiple permitAcense applications in arty given year,need only submit one affidavit indicating current poiicy information(if necessary)and under"Job Site Address"the applicant should writs"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or Iicenses, A new affidavit must be filled out each year. Where a home owner 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. The Office of investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Departmemt of Industrial Accidents Office of Investigations 600 'Washington Street Boston; MA 02111 Tel. # 617-727-4900 ex-t 406 or 1-877-MASSAFE Revised 5-26=05 Fax#617-72.7-7749 wvmmass.gov/dia C �ORT#4 'q Town of a Andover , 0 ..4 mo4 'Ao '� dower, Mass., �� ' a COCHICHEWICK DRATED PPS` �� BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING.INSPECTOR THISCERTIFIES THAT.........734-<...... ............................................................................................... Foundation has permission to erect........................................ buildings on .........�. .. w.a..Q:d.....A.V-c ........................ Rough . to be occupied as. .... .I.� ......... /�r -�+.T".......... ...... �' ........ .. .... ,............ Chimney provided that the person accepting this permit shall in every respect conform to f 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 I PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRU STELECTRICAL INSPECTOR ARTS Rough Service BUILDING INSPECTOR Final Occupancy 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.