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HomeMy WebLinkAboutBuilding Permit #108-11 - 84 BEVERLY STREET 8/5/2010 BUILDING PERMIT F OORTH TOWN OF NORTH ANDOVER 32ottLPo6 6�° APPLICATION FOR PLAN EXAMINATION Permit NO:/0 Date Received 4 ArED Date Issued: � S- 0 ACHUSi IM ORT NT:Applicant must complete all items on this page LOCAT-ON :PROPERTY OWNER r . y ;. Pnn t -. MAP 21'0 = I'ARCEi_ - ' ZONING DISTRICT`- Htsfonc-Distract.: es Y no; Machine Shop;Village° yes o_ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition o or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg emolitio Other Others: Septic :Well : Fl- -d' Wetlands Water/Sewer = V Watershed'District _ . DESCRIPTION OF WORK TO BE PREFORMED: ------------------ a I ntification Please Type or riot Clearly) OWNER: Name: Phone: &--3_? Address: ��''��- SVeot 4,>< F-CONTCCTQR Name: }� v- Phone t _231 _. _ Address-.- _ Sugeniis -F8:06-nstruction:License - _ Exp. Da mIprovement License -Hohem _ Exp Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $_�(� Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature ofAgent/Owner �� T - Si nature of contracto -' Y" __.9 _ F_ Location �! No. Date NORTp TOWN OF NORTH ANDOVER . ,to , • O � 9 > ;AL ; Certificate of Occupancy $ s'ACHU.1 Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 0 232 / c� Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Swimming Pools Public Sewer Tanning/Massage/Body Art 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 i i 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 Drivewa Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE-DERTMENT -=Temp Dumpster on site, yes no P;A Located at 124 Mam-Street ,Fire Department signature/dafe - .COMMENTS• Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. I Total land area, sq. ft.: i 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.$10041000 fine NOTES and DATA— (For department use) I i i i i i ❑ Notified for pickup - Date Doc.Building Permit Revised 2010 `- 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 F ❑ 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 ❑ 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 2008 F ttORTH TOWN OF NORTH ANDOVER U� OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 North Andover,Massachusetts 01845 Sgc►+us 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: L - ev�� 5 TV-C c Number Street Address Map/Lot HOMEOWNERGIlS :2�(4� �nA�eJ\ ��a- 33?- l �� 6 Name Home Phone Work Phone 322 c� PRESENT MAILING ADDRESS Sek W-e r City Tok,m c+Mrw 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 requirements and 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 PLANT\TING 688-9535 The Commonwealth of Af'assachusetts Department o f Industrial Accidents Office of investigations ..600 Washing-ton Street Boston, MA 02111 WWW-MAffidavit:assgov/dig Workers' Compensation Insurance A Anplicant Informniion �t� Builders/Contractors/Electricians/Plumbers Please Print Lem-bly Name (Business/Ornization/Individuai): S • Address:_.. �- _ 4,A City/State/Zip: \ �( � Phone#: Are you an employer? Check-the appropriate box- ox-L❑LEI I am a employer with 4. ❑ I am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired ti• ❑Neu,construction 2.❑ I am a sole proprietor or partner- listed on the sub-contractors the attached sheet t 7• ❑Remodeling ship and have no employees These sub-contractors have working for me in any capacity. workers com , ' g' Demolition [No workers' comp. P insurance. g Building p insurance 5. 0 We are a corporation and its ❑ b addition required] 3 officers have exercised their 10•❑Electrical repairs or additions am a homeowner doing all work right of ex m set£ exemption P�MGL 11.❑Plumb ing repairs or additions Y [No workers'comp• c. 152,§I(4),and we have no insurance required.] t employees. [No workers' 12•❑Roof repairs Iii: s: ��U comp.insurance required.] 13.❑ Other °Y( of lova also at C::.�ILC ..en.�-.°.ariC.^. �ilorYreowners who suhmitthis affidavit indicating a^• ,.. comr atia the•are doing and thm hire o +Coatractoz?that check this box • , g aL in- urside conuac*mm n.; ate,=aed au additioaai sheet showing the name of the sub-c `.submit a new att�davit indi:acing such. onuacto,s and their workers'comp.poucy m f�tiou. I am an employer that is providing workers'compensation nsurance.f mor information. iy employees. Below is the policy and job site Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: Attach a copy of the workers' City/State/Zip: 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 ) ung up to$1,500.00 and/or one-year imprisonment,as well as civil penalties of a of up to $250.00 a da against pities in the form of a STOP WORK ORDER and a ane Investigations of the DIA for tinsurance coverage verifiised cation. t a c�Py of this s�t��t maybe forwarded to the Office of I do hereby certify under the pains penalties o.fP j�er ,thQt the information provided above is true and correct Siffiature01: Phone#: g -- �z Z Official use only. Do not write in this area, to be completed by city or town ofliciaL Cit3,or Town: Permitucense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk- 4.Electrical Inslumbin. inspector 5,P 6. Other b Inspector Contact Person: Information an- d Instructs ons Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute;an employee is defined as"...every peon in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,associaLtion, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise;and including t7Qe legal representatives of a deceased employer, or the receiver or trustee of an inaiviaual,partnership, association ox-other legal entity,employing employees. However the owner of a dwelling house having not more than three apartmL ents and who resides therein,or the occupant of the dwelling house of another who employs persons to do mainte;mance,construction or repair work on such dwelling house or on the grounds or building appurtenant-thereto shall not be=cause of such employment be deemed to be an employer." 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 operate a business or to c enstruct buildings in the commonwealth for any applicant who has not produced acceptable evidence of cavmpiiance with the insurance coverage required." Additionally,MGL chapt=er 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work um-t:fl 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-contractors)name(s), address(es) and phone number(s)along with their certificate(s)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' comp enation 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 stere to sign and date the affidavit The affidavit should be rcturncd to the city Or`uo1%,r a that the apulicauon for the pert or license LR bcdng requested,not th. -enent.of arrm Industrial Accidents. Should you have any questoon&regardin�b the law or u you are r. .2i-ed to obtain a workers' compensation policy,please call the Department at the number listed below. Self-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 legibly. 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 applicant Please be sure to fill in the permit/license member which will be used as a reference number. In addition;an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under`.`Job Site Address"the applicant should write"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 Me for future permits or licenses. 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 ne 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.faxnumber:.. The Commonwealth of Massachusetts DcPartmmt of Industrial Accidents Office of Inrestigations 500 wasltingbn Street Boston,MA 0.2111 Tel. # 617-72.7-4900 ext 4406 or 1-87-WLkSS AFE Revised 5-26-05 Fax 4 617-727-7749 V'VrW.mass._aov/dia NORTly I Town of And 0 . 11% .new y.":�I• I No. lof -aoll _- - - C, LAK dover, Mass., COCHIC HE WICK �0RA7E D P' �� 7v BOARD OF HEALTH Food/Kitchen PERMIT . T D Septic System a Q BUILDING INSPECTOR 1 > GA THISCERTIFIES THAT....... .��(...`.��. «�J.......... .L.�.....1:........................................................................................ Foundation has permission to erect........................................ buildings on . ..:,� ........ . ...ile ............... ... 5�f......�................. Rough F I+ to be occupied as .. ... n.:� ......,�. "' Chimney provided that the person accepting this pernfd shall in every respect conform 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU O 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.