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Home My WebLink AboutBuilding Permit #726 - 9 COBBLESTONE CIRCLE 4/12/2012Permit N0: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received /2Q�OL 0 p 7a�4�RAT�D �PPi'�� TYPE OF IMPROVEMENT PROPOSED USE Resi ential Non- Residential ❑ New Building Vbne family ❑ Addition ❑ Two or more family. ❑ Industrial ❑ bdteration No. of units: D Commercial Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ TSept�c5 WbI ®'Floodplain Wetlands 1lUatershed D strEct K 11�ater%Sew"erg � � � � 5 �4❑ . ,: .- ac rr«rvr�wiw. OWNER: Name: ARCHITECT/ENGINEER Phone: Address: Reg. No. 070 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: $ (Q00 .ZM Check No.: 224I'Z Receipt No.: 9 �- NOTE: Persons contracting wklh unregistered contractors do not have access to the guaranty fund Location (0 O" -SJ 017 le-,. No.�)a�! Check # 25178 Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ �`P Foundation Permit Fee Other Permit Fee $ TOTAL $ Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody Art ❑ Seng 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED - CONSERVATION COMMENTS HEALTH COMMENTS ❑ ❑ DATE REJECTED DATE APPROVED ❑ ❑ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/Sic nature Date Drivewav Permit Located at 384 Osgood Street AFIRE bEP . "'. - T Tern rDurn ster oh site z yes �3 ,,�. T »* xt,� Locatecl'at 124Main Street °°' l ire gpartmen gna siture/state 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 Doc.Building Permit Revised 2007 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/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) o Copy of Contract o 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: INSPECTIONAUSERVICES DEPARTMENT:BPFORM07 Revised 2.2007 • U Q 0 CD ■ L CD Z a, O y D � — I CD cm caCD 0 'C y 'E m m co CL � 3 pco ca o Cco a CL CQ ca O4-a CcC C3 'p .FL O co c �Z � C3 V! 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Brown Inspector of Buildings 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 PERMIT APPLICATION Pleasepnnt DATE: JOB LOCATION: Number Street Address Map/Lot HOMEOWNER - ame ome Phone Work Phone PRESENT MAILING ADDRESS Ne Col -f �,19J�&7 l A U vet City Town S w+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/sheresides 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 requir 2entsd that he/she will comply w'th 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 X A The Commonwealth ofNlassachusetts Department of Industrial'.Accidents Office of Investigations 600 Washington Street UV6 Boston, MA 02111 www.mas,. gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/JClectricians) Plumbers Applicant Information Please Print Legibly Name (Business/OrganizationAndividual): Address: City/State&ip: Phone #: Are you an employer? Check the appropriate box: 1. [] I am a employer with 4. ❑ I am a general contractor and I employees -(full and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3 1 am a homeowner doing all work right of exemption per MGL / l myself: [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling . 8. ❑ Demolition 9. ❑ Building addition. 10. El Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.❑ Roofrepairs 13.❑ Other *Any applicant that checks box A must also fill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new•affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. Aram an employer that isproviding workers' compensation insurancefor my employees. Below is thepolicy and job site information. Insurance Company Name:, , Policy # or Self -ins. Lie. #: Expiration Date:, Job Site Address: City/State/Zip: Attach, a copy of the workers' compensation policy declaration page (showing the policy number and expirations 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 $1,500.00 and/or one-year imprisonment,. 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. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. .1 do Itereby Mtn under the vains andpenalties ofperjury that the information provided above is true andcorrect. Official use only. Do not write in this area, to be completed by city or town offrciaZ City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. PIumbing Inspector 6. other Contact Person: Phone l et �L