The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #555-15 - 89 BLUEBERRY HILL LANE 12/16/2014 L BUILDING PERMIT NORTH EC 16 w. Oq_r0 TOWN OF NORTH ANDOVER 0 - APPLICATION FOR PLAN EXAMINATION * , Permit No#: I Date Received �SSgArm cHusE��S Date Issued: 2 I P RTANT: Applicant must complete all items on this page LOCATION ! - Te int PROPERTY OWNER, ``'�.® �- f!:::::' q Print 100 Year Structure yes no MAP t . PARCEL: c ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial Iteration No. of units: El Commercial ❑ epair, replacement ❑Assessory Bldg [I Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ElWater/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identific ;on- Please Type or Print Clearly OWNER: Name: Abnon,� Phone: mf�S$ YyL3 tel Address: - / 2/ 00 Contractor Name: Phone Address: Supervisor's Construction License: _ Exp. Date: Home Improvement License:.-- _ _ - Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBAASjE�D ON$125.00 PER S.F. , Total Project Cost: $ oo FEE: $ �U " Check No.: �-J �y Receipt No.:C38 NOTE: Persons contracting�witu ' tered contractors do not have access to the guaranty fund Signature of Agent/Own Signature of contractor Location No. Date N` t . - TOWN OF NORTH ANDOVER • • ` " Certificate of Occupancy $T� ` Building/Frame Permit Fee $tn- ,L Foundation Permit Fee $ RKhN'iry'. Other Permit Fee $ �r TOTAL $ Check# Zu3u1 - Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPF'bF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools E Well ❑ Tobacco Sales ElFood Packaging/Sales 0 Private(septic tank,etc. El Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CC)NSERVATION 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: 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 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 o Building Permit Application a Workers Comp Affidavit Li Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work Li Engineering Affidavits for Engineered products j NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application u Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) u Mass check Energy Compliance Report (If Applicable) o 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) u Building Permit Application Li Certified Proposed Plot Plan u Photo of H.I.C. And C.S.L. Licenses u Workers Comp Affidavit u Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) u Copy of Contract u 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 roof of recording that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and p g must be submitted with the building application Doe:Building Permit Revised 2014 F NpRTM Town ® s _E j r G No. 66 6 _!-)*1 will &. 1 ) ver, Mass, C, h �A COC NICNl MCK01 �d D'qA E D PPr S U BOARD OF HEALTH Food/Kitchen PER T D M1,10 Septic System ,•�.�./� BUILDING INSPECTOR ' THIS CERTIFIES THAT ......... .. ................... M �. ..::........... ...• �"" ., ��0 Foundation has permission to erect . ...... ................. 'Idings on A......... Rough to be occupied as �.�.. ... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONT ELECTRICAL INSPECTOR UNLESS CONSTRUCTI T T Rough Service ................ ..... .............................................. Final BUILDING 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. i i Enter construction cost for fee cal - North Andover Fee Cakulation Construction Cost 4.0,,'000 X0,0 m $ - $ 480.00 Plumbing Fee $ 60.00 Gas Fee 100 comm. $ 1o0.;m J Electrical Fee $ 60.00 Total fees collected $ 700.00 89 Blueberry Hill Lane 555-15 on 12/16/14 I Kitchen Remodel Image(83).jpg https://mail.google.com/ /scs/mail-static/-�/js/k--gnaii.main.en.Cli... FOR REFERENCE ONLY Rendering is for quotation purposes only and is not a final representation of the completed cabinet design '7- "X 6 . ........... A .................... .............. Advanced Custom Cabinets QSchaller 11-14 Perspective 13P-0 R..d ................. .............. ........... Bnnto,�,NH Room 4 Current Date:Nov 20,2014 Php�qjpq:7 11-20-14 Roo Scale:NTS I of 1 12/16/2014 6:53 AM ne commonwealth of ffassachusetts - - Deparhnent o, Xnc�'r�s 'ir�lAcciclenis Office of-Investzgationg 600 Washington Sheet Boston,.2V.1A 02111 Uf www.mass govIdia Workers' Compensation bsurance Afadavit:Balers/Contrcactoxs/Ble�c��i�m[Pl e Whatdeb r AppXxcant information NaMe(Business/organNWAnffndividual.): Address' v� . /�Y � .-f-� �� Phone#:Y��C�i Ryr City/State/Zip: — Are you an employer?Checlirthe appropriate box: ' e of project(required): 1.Q I am a employer with4• ElI am a general,contractor and I 6. Q New construction. —�� -c employees(full and/or pax time).• have liixedthe subontractorshated on the attached sheet. 7. WRemodeling 2.Q I am a solo proprietor Orpartner ship and'hava no employees These sub-contractors have 8. Demolition working forme in any capacity. workers'comp.insurance. g. Q Building addition [No workers' comp.Insurance 5. Q we are a corporation and its 10.Q Electrical repairs or additions officers have exercise d their required.] right of exemption per MGL 11.[]Plumb9ngrep*8 or additions 3. Xamahomeowner doing all work c.152,§1(4),and webave,no 12,QRoofrepairs 3.[XI [No workers comp. employees.GNb workers' 3, Other iusurancexequhed.j comp.insurancexequired.] 1 NAny applicant that checks box#1 must also fill outthe section below showingtheir workers'compensation policy infozmation. i gomeowners who submit flus affidavit indicatingthey ire doing aaworlc and then hire outside contractors must submit anew affidavit indicating such. TContractors that cheAthis box must attached an additional sheet showing the name o£thesub-contractors and their workers'comp.policy information. I am an em.,proyer that ispr'ovidhig worker.'compensation ir�su�a�tce fov MY employees: Berow is thepolicy artcija i site information. Insurance Company Name:. ExpirationDate: policy#or Self-ins.Lic.#: Sob Site.Address: �acr/' City/State/Zip: atioxt� Attach a copy of the workers'compen Oolicy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A.of MGL o.152 can,lead to the imposition of criminal penalties of a fine up to$'1,500.00 and/or one7-year imprisonment,as Weil as civil:penalties in the form of a STOP WORK ORDER and a fine, ofup to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Officeof Investigations of the DIA for insurance coverage verification. ^ --i—do hereby cert f ur2trer pains- cl penarties ofperrury tliat tiie information provided above is tate and correct. � ,_._.._.. Date' 16 /L Si ature- phone#- Official use only. Do not write in this area,to be completer)by city Ortown officiaZ City or Town: Permit/License# Issuing Authority(circle one): ector X.hoard of Health 2.]Building Department 3.CitylTowzi Clerk 4.Electrical Inspector 5.Plumbing Insp 6.Other - 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 defned as"...every person in the service of another under any contract of hire,. express or implied,oral oxwritten:' An employd is defined as"an individual,partnership,association,corporation or outer legal entity,or any two ormore of the foregoing engaged in.a joint enterprise,and including the legal repxesentatives of a•deceased employer,or the receiver or frustee`of azi individual,partnership,asso ciation 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 occupant of tho dwelling house of another who employs persons to 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 deem.edto 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 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 commonwealthnor any of its p olitical sub div cions shall enter into any contract fbr the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have,b eon presente d to the contracting authorlty." 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),addresses)and phone numbers)along with their certifieate(s)of insurance, Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are notrequired to carry workers'compensation insurance. IfanLLC orLLP does have employees,a policy is required. De advised that this affidavit maybe submitted.to the Department of 1'udustrial Accidents fo;confirmation of insurance coverage, also be sure to sign and date the affidavit. he 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 Departmenthas 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 whiehwill be used as a reference number. In addition,an applicant thatmust submitmultiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(ifnecessaxy)and under"fob 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 id on file for future p ermits or licenses. Anew affidavit must be filled out each year.'Where ahome owner or citizen is obtaining a license or permitnot related to any business or commercial-venture (i.e.a dog license or permit to bmu leaves etc)said person is NOTrequired to complete this affidavit. The Office of investigations would like to thank you in advance for your cooperation and shquld you have any ciuesfions, please do not hesitate to give us a call. The Department's address,telephone and fax number: Tho Common w.ealdiofMo.asar vsPtf� PeTa,d=utOffaduddal.Ac.olde to Otter Qnetra 't4>a 6.00 Wakt.Wm f xee�t BWto-u,M-A.02111 49 WSAIE Revised 5 26-OS Fax 617"727"7749 bnuge(82)jpg bttpy:/bou).googlo \.mmiu.00.C|i' FOR REFERENCE ONLY Rendering is for quotation purposes only and is not a final representation of the completed cabinet design ' iz Advanced Custom Cabinets dSchaller 11-14 Perspective B-Mood,NH 11-20-14 Room 4 Cuffwt Date:Nov 20,2014 Scale;NTS � � lof| 12/16/20148:52&M --------------------- 4'6" 4' 18'x9'2" 9"x13'8° .._._....._13'11" 5'2 112" 19'4 142 } 1 1]'6" .. 13'6" °°rfj pyo TOWN OF NORTff ANDOV►R. OFBXCE OF .. ELUDING DEPARTMENT :1600 DsgoadStreetBullding20,Suite?36 7�5 R„moo�4��5 NorthAvdovox'Massachusetts 0.845 SRCHu5�. - Gerald A.Brown Telephone(978)698-9545 7nspectorofBi ildings - Fac (978)689-9542, . HOMEORNER'LICENSE EXEMPTION ' BMS G)?FPM- T APPLICATION 1'lease�rint . • DATE: rOB LOCATION: 6- 1Ii i Numbe rSheet dress 1l�Iapl�,ot yoAmo�x 1IA �� -655-y�23 Name. �C*1 c9 C�� ?O Z q . Home Phone WorkPhone PRESENT MAILING ADDRESS , A, t C t TL O% • vip Code The current exemption far"homeowners”was extended to?bchide ownep occupied&Velings to two units.Or Iess and 'cc)allow su;h ho meo:vers to engage an,�r'avadual-for hire'Who does notpossess a lice3ise,provided that the owaer acts as supervisor). Stafe30,ding (Code section 108.3.5.1) DEFINITION OFHOAMOWNER Persons)who Awns aparcel ofland on wbicli.lie/shU resides or intends to reside,on wbicli there is,or as 7nfended to + romsideedahOMamilystrucfures. ApersonwliaconstructsMora that-onehomeivatwoyearpmiodshall notbe considered a homeownez. The undersigned`hoimedwner"assumes responsibility forctbmpliances with the State Building Code and other Applicable codes,by laws,nu es andTagulafions. � The undersigned`homeownar"cextiRes that he/sheundeistauds the Town ofl�7brth AndoverBuilding Department xnmimum inspection procedures and reclttiremegts. ache/slie wzll comply wzth,said procedures and requirements, . ROMEOWMMS SIGNATURE .APPROVAL OF BUIC.D)NO OFFICIAL Reyised 7.2009 Form Romeowners Fsxempiaon '$O.ARD OFAPPEA7-8 688-954.1 CON5EKVA-RON 688-9534 - HEALTH 688-9540 PLANNING 689^9535 •