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HomeMy WebLinkAboutBuilding Permit #92-15 - 9 BEACON HILL BOULEVARD 7/28/2014 i NORT1y BUILDING PERMIT o` TtiEo b�ti TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received 4r, o4p,,h* q�reo� ( 6 I so Date Date Issued: L g IMPORTANT:Applicant must complete allitemson this page LOCATION' C4 Pri t tt 11 T PROPERTY OWNER \t�e R Print 100 Year Structure yes o MAP f PARCEL•: �ZONING DISTRICT: _ _ Historic District yes nd 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 0 Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: k C w s Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: 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 COST BASED ON$125.00 PER S.F. Total Project Cost: $ �U FEE: $ 30 Check No.: Aio Receipt No.: NOTE: Persons con ratting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner __ Signature of contractor Location 1 �il Lt?n No. Date L2-E ,t . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ '. C' Building/Frame Permit Fee k Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 319 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 Si nature �L'sY 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 signatureidate 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) -71 ri � 4 C-&W— L-M rz 4 e mss . ❑ 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 Li 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 mut be submitted with the building application Doc:Building Permit Revised 2014 NORTH Town of E : I, 4 ndover 0 No. — = - ® o h ver, Mass, h COC KIC"aWICK �.95 R�TEO I.Pp�,�S U BOARD OF HEALTH Food/Kitchen PERMIT T D N;: Septic System THIS CERTIFIES THAT .Ci . .. !Ls-z.I ..... .... BUILDING INSPECTOR has permission to erect .......................... buildings on ... .......`?.gic.�n,.. .�L.....lg �1......... Foundation Rough tobe occupied as .....C .. ....y�4.. ....... C-......................................................................,. Chimney provided that the persofl y respect conform to the terms of the application Final accepting this permit shall in ever 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TAR 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. �4 Y IRT a TOS'OF NORTH AND OVER OMCE OF BURDING DEPARTMENT 7gSSRcuas"`�5 Nb Ah.An.dovex,Massachusetts 01845�36 Gerald A.Brown Telephone(9 79)688-9545 hspeetor oBuildmgs . Fax (978)688-9542 HOMEOWNER-L'MENSE MA/h?TION Biz ING EENT AEPLICATION • P please�rint •' . DATE; JOB LOCA'T'ION: CL C C �j l5 f 1c), Numbez StreetAddress Map/Zot 1S02VEO-c NER 1�Ipk- ,6 &$$ ,j(Cj,_ Po f k0l, �i 7 Name Horne Phone Work Phone 'RESENT MAMCIADDRESS Stafw• lip Code The current exemption for"homeowners"was extended to chide owner-occupied dwellings to i�vo units ox;ess an_d to allow su;h h,omeo,��s to engage an?ldividual.forhire who doss notpossess a h cense,provided that the owner acts as supervisor). State Building (Cods Section 108.3.5.7) DBFINITION OFHOMEOVWV Persons)who awns aparcel of land on which.he/she resides or intends to reside,on which(here is,or is intended to be,a one or two family stmetures. A person•who constructs more that one home in a two h there o shall intended considered a homeowner. notbo The undersigned`-homedwner"assumes responsibility for compliances with the State Building Code and other .Applicable codes,by-laws,rales and zogglatioas, t The undersigned"homeowner"certifies that he/she understands the Town of North Andover Buzlding Depaifineng minimum inspection procedures and requirements and that he/she will compIy with,said procedures and -requirements, 110MEOWNI3RS SIGNATURE kPROVAL OF BU LDING OFFICIAL Revised 7.2009 Form$omeowners T3xemption '130,9RT)OFAPPBAT.S 688-9541J C01�'rSERVATTON 688-9530 r3EAL'�688-9540 PUNNING 688-9535 Twe Commonvealth gf tMlassachuse'us , DepartmentgflndifstriglAceld nts Office gflnve8tdgaflons quo 600 Washington Street Boston,.MA 02111 www.mass.govIdirz Workexs'Compensation hsuran.ce Affidavit:Bi7flders/Cont°actorolElectrcxexansiplibiubers Appfiean.t Idormation Please Print Lep-0 ., c Name(Business/Oxganization/i'n Mduat): Address: c,� Cxby/S tatetZip: /Vv 0l S kf 'hone#: �7 9 5 6 Are you an employer?Check the appropriate box: Typo of project(required): �. ❑I am a general contractor and.I ` 1,El I am a employer with 6, ❑New construction employee's(Mandlorpax-time).* have Wredthe sub-contractors 2.El am a sole proprietor or partner listed on the attached sheet. �� ❑ em odelittg ship and'havexlo employees These sub-contractors have 8. [(Demolition working for me filmy capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. 0 We ate a corporation and its 10.[j Electrical repairs or additions required.] officers have exercised.theix 3.El am.a homeowner doing allworlt right of exemptionporMGL 11.[]1'lumbingxepairs or additions mysON LEO Workers'comp. c.1.52,§1(4),andwehaveno 12.❑Roofxepairs insurance,required-1i employees..[No workers' ' H comp.insurance required.] 13.[�Other *Any applicaufthat checks box#1 mustalso fillputthesectioa bel6w showingtheir workers'eompensationpolicy information. Homeowners wbo submit this affidavitindlcatingthey Mie doingWworXmdthenhire outside contractors must subm t a new affidavit indicating such. TConfractors that check this bqF must attached as additional sheet showing the name of the sub-contractors and their workers'comp.policy information. ' I am are e�nployel'that isppovidixg workers'cornperasation zr�sr��rcrzee fotxny er�royee� Beroty i�thepoliey anci,�o��ir'e informadon. Insurance CompanyName:. Policy#or S eIx ins. Expiration Data: lob Site Address: S�M/—G/ C - ity/State/Zip: s Attacha copy of the workers,comp ensation-policy declaration page(showing the poltey number and expiration date). Failure to secure coverage as xequired.under Section 25A ofMGL o.152 can,lead to the imposition of criminalpenalties of a fine up to$1,500.00 and/ox one"year imprisonment,as well as civil.penalties in the form.of a STOP WORD ORDER and a fine ofup to$250.00 a day against the violator. B e advised that a copy of this statementmay be forwarded to the Office-of- Investigations fInvestigations of the DIA for ibsuxance coverage verification. .,do Hereby cert- under thepains and penaltles of per,mry that fIl e information provided ah V is tr a ande orrect - Si atvre: Date: 3 1 Phone# ( "is / � �� SZ6 2 Ociar use oltly. Vo not write in this area to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle ane): Z.Board of Health.2.BuildingDepartment 3.CityRovm Clerk 4.Electrical Inspector 5.Elumbinglnspector 6.Other - - . 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"...every person jI the service of another under any contract ofh%re,- express orimplied,oral orwxitten! An eWloyer is defined as"an individual,partnership,association,corporation or other legal entity,or any two ox more ofthe foregoing engaged in a joint enterprise,and includingthe legalrepresentatives ofa•deceased employpx,ar the receiver or-MWee of an individual,partnership,as§o ciation or other legal entity,employing employees. However the owner of a dwelling househavi agnotmoxa tbanthree,apartments audwho resides therein,or the occupant ofthe dwellinghouse of another who employs persons to do maintenance,constnmtiou orrep*work on such dweUdughouse or onthe grounds or building appurtenant thereto shaltnot because of such employment be deemedto be an employer." UGL 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 cons'ixuet buildings im the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MCTL chapter 152,§25C(7)stafes"Neither the commonwealth nor any of its political sub divisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of Us 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-confractor(s)name(s),addresses)andhononumber(s)alongwiththeir certifxeate(s)of Insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members orpartaers,arenotregniradto canyworkers'compmsationinsurance. If anLLC orLLP doeshave em ployees,apolicyisrequired. Be advisedthattbisaffzdavitmaybesubmittedtotheDepartmentofIndustrial Accidents for confirmation of insurance coverage. Also be sue to sign and date the affidavit; 'he affidavit should be xetuutedto the city or town that the application for the pexatit or license is being requested,no E.the Department of Industrial Accidents. Shouldyou.have any questions regarding the law or if you are required to obtaia a*orkers' compensationpolicy,please call the Department at the number listed below Self-insured companies should enter their self insurance Incense number on the appropriate he. City or Town uncials Please be,sure thattheaffidavit,iscomplete,andpriatedlegibly. The Department has provided a space atfhebottom of the affidavit foryou to fill out in the event the Office of Investigations has to contact you regarding the applicant, Please be-sure to jM in-the permit/lneense number whichwM be used as a reference number, In addition,w applicant thatmust submitmultiple pam-011cense applications in any givenyear,need only submit ono affidavit indicafing current policy information(ifnecessary)and raider"fob Site Address"the applicant shouldwrlte"all locations iu (city or tovrn):'A copy ottlie affidavit that has been officially stamped ormarked by the city or town may be provided to the applicant asptbofthat avalid affidavit.is'onMefor faturapermitsorlicenses. Anewaffidavitmustbeflledo-at each year.Where a home owner or citizen is obtaining a license ox 61mit not related to any business or commercial venture (i.e.a dog license orliermit to burn leaves efc.)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: Thi CQmmomw'ali of yaaarhvseAs - Depaxballt d Mdu dal,Atccidamts (?f Roo offmAkWo u'a d0 was tinggn stoaa BQsto , 021 It Revised 5-26-OS `ay, 617-727-7749 v�`�•z�,ass,g¢vl`c�a • North Andover MIMAP July 17,2014 105835-0037 I� I oss:�000� i 7 l a 1 i ! FS'B�;C;ON HE L,IB3LICD" R49 0s8 moms mss 8-0036? r 5 9EP,CON,FLIU�Q@4 BEAcoN►y ,�' f9IBE/4G0IJ; LnBLVD'. i aco�gild �038!B-001�; �Qt 9616EFCON`BILL BLVD 27!4OSG0�,QDTY w 10yBEii�`CO,M,H,`I�IJB,LVvD 0SW&00,012, ,05g�,r:B_Opgl. 0„58!B-0�,13 OSS�B-0015 058 -0009 ;22afBEkCON,Fl,I L;B-IV 058x6-0017' 058 -00 —Rail Line Wetlands Zoning Interstates 0 Exempt Lands �=Busine s 1 District _ 13Busine s 2 District Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, SR 0 Busine s 3 District Meters Data Sources:The data for this mapwas produced by Merrimack 0 113-i—s 4 District NORTH Tow Valley Planning Commission�MVPC)using data provided by the Toof - Roads ■G.—Business District Qf e e q North Andover.Additional data provided by the Executive Office of C,Easements O Planne Commercial Dev ? be+ts re s�0 Environmental AffairslM—GIS.The information depicted on this map is !7 Conido Development Dist ,; for planning purposes any.It may not be adequate for legal bounds Q MVPC Boundary O Conido Development Dist O T b y g g boundary definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER 0 Muniapal Boundary O Conido Development Dist �' �^ 9 MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING Industd 1 DISNU Zoning Oveday # t{ THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY Q Intlus[ri 12 District n * OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT O Adult Entertainment f i Q Downtown Overlay District OlndusM 13 District c _ l# ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF Historic District d lndustri ISDislrict '� THIS INFORMATION Water Protection Resitle ce 1 District �,9 '+•no��'� L`Reside ce 2 Di= SSACRUs�t ❑Parcels 0 Reside ce 3 District O Hydrographic Features de ce 4 Di inc —Streams 1”=50 ft de ce 5 District Fdece 6 District o e esidential District North Andover MIMAP July 3, 2014 d III 41, e A a avtt f � x^ ix.F t , VJO�3 00� � xz_ +P 'ir �eaC© � Interstates —I SR Horizontal Datum:MA Slateplane Coordinate System,Datum NADSS. --Roads Meters Data Sources:The data forth is map was produced by Merrimack pOR7i� Valley Planning Commission(MVPC)using data provided by the Town of l r EasementsO� t`�p r•,yO North Andover.Additional data provided by the Executive Office of 0 , MVPC Boundary ?e� +e O Environmental Affairs/MossGIS.The information depicted on this map is ❑Parcels 3 L for planning purposes only.It may not be adequate for legal boundary - S definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING t w"i • THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY •i +X OF THESE DATA,THE TOWN OF NORTH ANDOVER DOES NOT ✓F o� .K i IF ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF .J� ^o `� THIS INFORMATION CIA 1"=21 ft ^�°