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Home My WebLink AboutBuilding Permit #914-12 - 88 ELM STREET 6/19/2012BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ! `7 2 Date Received Date Issued: l� IMPORTANT: Applicant must complete all items on this page LOGATIO'.IVr . _EL ( << /�.YL`�D�. _. f�`� C _C _ T �..�. _ Print- `, PROPERTY'OWNER' (st .r MAI?'NO: PAR CE ZONING DISTRICT ` Historic District es. d noj - - —` ' e;Shop Village,, , es noa Machin TYPE OF IMPROVEMENT o m Residential Non- Residential New Building One famil TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One famil Addition wo or morefamil Industrial Alteration o. of units: .S Commercial Repair, replace Assessory Bldg Others: molition Other Septic Well Floodplain . V1letlands ;.' r Waterslied1Dist"ri6f-" ater/Sewer DESCRIPTION OF WORK TO BE PREFORMED: kc - (!f)14 �4otZ-FJ4 ,S e� Z�J�4 -F --"� Identification Please Type or Print Clearly) _ OWNER: Name: Address: 0 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: $ CSO FEE: $ Check No.:Receipt No.: �i -2�y3�f NOTE: Persons contracting wij� unlegiVered contractors do not have access to the guaranty fund r5gnature�of Agent/Owner G� .��'_ a_ pre of contractor 0 Location No. Check# �?31W 25434 Date 611 - TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL $ /Buil6ing 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 COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE REJECTED DATE APPROVED Reviewed on Signature Reviewed on Signature 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 Y y F.IREIDEPARTMENTa TempIDumpster-:onlsite' yes s x. r - . .v'°^'aw,°k..« fifi .:ate �-s rc^-•r -« -•.av- Iocated;at'124Mam Sfreet= �Fire�Department�'lsjgpa` " ture/datel a r 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 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 ❑ Building Permit Application ❑ Workers Comp Affidavit o 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) a 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 The Commonwealth ofMassachusetts Department oflndustriglAccidents Office oflnvestigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: BuildersIContractolr8fFIectdcians/Plumbe3rs Applicant Information Please Print LeaibIy Name (Business/Organization/Individual): l kwl, Address: /�T7 zFLtt S C Are you an employer? Che& -Ma 1. [] I am a employer with employees (fall and/orpart-time).* 2. ❑ I am a sole proprietor or partner- ship and. have no employees working for me in any capacity. [No workers' comp, insurance equired.] 3. Zama homeowner doing all work yself. [No workers' comp. insurance required.] t Phone #: 2 7 — =5 g.52 z( Kaye box: 4. ❑ I am a general contractor and I have Hired the sub -contractors listed on the attached sheet. x These sub -contractors have workers' comp. insurance. 5. ❑ We area corporation and its officers have exercised their right of exemption per MGL c. 152, §1(4), and wehave no employees. [No workers' coma. insurance reauired.l Type ofproject (required): 6. ❑ New construction 7. ❑ Remodeling 8. [] Demolition 9. n Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.[1 Roofrepairs 13.❑ Other "Any applicant that checks box#f mustalso fill outthe section bel6w showingtheir workers' compensation policyinformaiion. T Homeowners who submit this affidavit indicating they eie doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees Below is thepolicy awjob site information. Insurance Company Name:. Policy # or S elf -ins. Vic. #; Expiration Date Job Site Address; City/State/Zip: Attach a copy of the workers' compensation -policy tleclaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-yearimprisomnent, as well as civil penalties in the form of a STOP. WORK ORDER and a fine of up to $250.00 a day against the violator. De advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby cert&unffer fhe,pt,�ri' s and penalties of perjury that fTte information provided above is true and correct. Official use only. Do not write in flits area, to be completed by city or town official. City or Town:. PermiffAcense # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. PiumbingInspector 6. Other - - - Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...everyperson in the service of another under any contract ofhim,- 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 including the legal representatives of a deceased employer, or 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 apartments and who resides therein, or the o ccupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds ox building appurtenant thereto shallnot because of such employment be deemed to be an employery 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 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, §25CM states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic 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), addresses) andphone, numbers) along with their certificates) 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. Han LLC or LLP does have employees, apolicyis required. Be advised that this affidavit maybe submitted tothe, Department ofIndustrial Accidents fox confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit 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 regarding the law or if you are required 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 number 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 maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year. More 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 NOTxequired 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: Tho CQMMORWOaltf of Massaahusotts Deap.admmt o ffadustdal Acoldeits 9f�ee o�Xn,�estigati,Q.� - 6.0(i Wasbbgtoa Street Bacton,, M.A. 02111 `eZ, # 6x7 7-4 Q0 e t40 ox - 7 lY ASS.A. Revised 5-26-05 Bay, # 617;,727-7749 Gerald A. Brown Inspector of Buildings Please print TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 North Andover, Massachusetts 01845 Telephone (978) 688-9545 Fax (978) 688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERNUT APPLICATION DATE:—e-- JOB LOCATION: .`?� ' Number Street Address Map/Lot HOMEOWNER Name Home Phone Work Phone PRESENT MAILING ADDRESS, iq, S ` Cit_ Too=rn c+�+w . 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' ides or intends to reside, on which there is, or is intended to A be, a one or two family structures. 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 PLANNING 688-9535 p7 / X TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT "1600 Osgood Street Building 20, -Suite 2-36 North Andover, Massachusetts 01845 Gerald A. Brown Inspector of Buildings Telephone (978) 688-9545 HOMEOWNER -LICENSE EXEMPTION Fax (978) 688-9542 GUIDING PERMIT A PPLYCATION Pease print DATE: JOB L0CATION:_B6 F�. S 1 Number Street Address .IJONM0WNER r4 cc/ ,S Name PRESENT MAILING ADDRESS C=tv TO . n Map/Lot Home Phone ork Ph e d�c�S�rS `'`are ' Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings to two units or less and acts as supervisor). State Bu to allow such homeowners to engage an izicividual.foT hire who does not possess a license, provided that the owner Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Persons) who Qwns a parcel of land on which he/she resides or intends to reside, on which there is, oris intended to be, a one or two family structures. A person who constructs more that one home in a which there O shall not e considered a homeowner. be The undersigned "homeowner" assumes responsibility for compliances with Applicable codes, by-laws, rules and regulationsthe State Building Code and other. The undersigned `homeowner" certi,"ies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements requirements, and that he/she will comply with,said procedures and • HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688_9541 COINTSERVATION 688-9530A HEALTH 688-9540 PLANNING 688-9535 f pORT1, 1 Town of North Andover Machine Shop Village Neighborhood Conservation District Commission 1600 Osgood Strcct Nordi Andover MA 01845 cus Application For EXCLUSION From Certificate to Alter 0 For Items 9,10 or 11, provide the following documentation: Photos/drawings of existing doors, windows or siding, as applicable Description/Catalog Cuts of proposed materials to be used for doors, windows or siding Plan and elevation of reconstruction for Item I I Determination: This project is determined to be P�n' xempt 0 not exempt from review by the Machine Shop Village Neighborhood Conservation District Commission. Projects that are not exempt must complete the Application: for Certificate to Alter, available from the Building Department and be reviewed by the Commission. Determination made by: bL f-CON5sv Signature n Conservation / 2, J Date MSV NCDC Page 2 Current Chair: Liz Fennessy, 77 Elm Street, lizettafennesy@yahoo.com, 978-688-2915 KORTII . ` Town of North Andover �o +� Machine Shop Village Neighborhood Conservation District Commission 1000 Osgood Strcct North Andovcr, MA 01845 ss�cMuse Application For EXCLUSION From Certificate to Alter Certain alterations are excluded from review by the Machine Shop Village Neighborhood Conservation District Commission in accordance with the Bylaw. Applicants for exempt projects must fill out the form below and submit to the Commission Chairperson (contact info below). Date: t �- J. LJ Contact Name & Address: Project Address: 1?1 r4 - Project Project Description (attach additional pages, if needed): DO f t"!A rY n& i r S W c, n kW 11Y1 aft"Y ! -,J Q Exclusion From Review Requested For: ❑ 1. Interior Alterations existing conditions including materials, design and dimensions. ❑ 2. Storm windows and doors, screen windows and doors. ❑ 9. Replacement of existing substitute doors, substitute siding or substitute ❑ 3. Removal, replacement or installation of windows with new materials that are gutters and downspouts. substantially similar to the existing condition. ❑ 4. Removal, replacement or installation of window and door shutters. ❑ 10. Replacement of original fabric windows or doors with substitute ❑ 5. Accessory buildings of less than 100 windows or doors that maintain the square feet of floor area. architectural integrity with respect to form, fit and function of the original ❑ 6. Removal of substitute siding. windows or doors. ❑ 7. Alterations not visible from a public ❑ 11. Reconstruction, substantially similar in way. exterior design, of a building, damaged or destroyed by fire, storm or other disaster, 8. Ordinary maintenance and repair of provided such reconstruction is begun architectural features that match the within one year thereafter. MSV NCDC Pagel Current Chair. Liz Fennessy, 77 Elm Street, lizettafennessy@yahoo.com, 978-688-2915 E.q = J LLJ 2 LL O D O m (U u LL u ++ V) O LJ v1 Z Z m c O C LL t Q' c U LL O W CL H Z O Z J a t bA m LL O W CL N Z J v J LU � V N V) C LL Q U W (A Z Cal O C LL W Q W ui U. C m O Z � N +' d Y O N n O ° V Q% O• d � =a �• c � o r ,r �• Q L N ° �. V •l p ° h L -42- a v0 7E 2 Z O z W Ix a. LU H LU CL •ti LS I- i `IV