HomeMy WebLinkAboutBuilding Permit #291-2017 - 90 APPLETON STREET 5/1/2018 BUILDING PERMIT of"°oT 6
TOWN OF NORTH ANDOVER ^ '°
o
APPLICATION FOR PLAN EXAMINATION
Permit No#: �l 0 f Date Received
�9SSACHUS����
Date Issued:
EN4PORTANT: Applicant must complete all items on this page
LOCATION, —�� . Ale� 14A..Al Al/e.
Print
PROPERTY OWNER 4 r,%nV>,
Print 100 Year Structure yes no
MAP PARCEL: ZONING DISTRICT:_ Historic District yes no
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
epair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
i]'SepfiF,_5 V11e l DFloodpJan 1Net1an:ds lNaters} ed D� R
DESCRIPTION OF WORK TO BE PERFORMED:
Tom; teat
Identificatis Please Type or Print Clearly
OWNER: Name: Q 16 Phonelik-2?3-t9 4
Address: t W04ff,
Contractor Name: Phone:
Email:
Address:
Supervisor's Construction License: - Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT.$92.00 PER$9000.00 OF THEeTOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
Total Project Cost: $ _'�, LJ/j,!! GFEE: $
G4 l33
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Sicrnafi irPrnf/�nPnt/nwnPr> c 4 ,T tiirP, finntra�tnr ° `
1
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.$10041000 fine
NOTES and DATA— (For department use)
® Notified for pickup Call Email
Date Time Contact Name
Doc.Building Permit Revised 2014
NF"f
ORT '9
own of _ 6Andover
No.
C;M
1 � i . y
o h ver, Mass,
COCHICNl WKK
s u
BOARD OF HEALTH
Food/Kitchen
PERMIT - T LD Septic System
THIS CERTIFIES THAT ........A.o+0w.#.ABUILDING INSPECTOR
. Foundation
has permission to erect .......................... buildings on ......4.0......l�. ' �'!�....... .r..
Rough
to be occupied as ......... .. .... ...... .�...................... ........ .... . .�....!�..... Chimney
provided that the person accepting this permit shall in every respect conform to the terms f the application Final
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
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit.
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR.
UNLESS CONSTRUCT START Rough
Service
........ .. .......e .....................................
"' 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.
TOWN OF NORTH ANDOVER
». OFFICE OF
BUILONG DEPARTMENT
{ 1600 Osgood Street,Building 20, Suite 2035
+L North Andover,Massachusetts 01845
Gerald A. Brown Telephone(978)688-9545
Inspector of Buildings, Fax (978)688-9542
HOMEOWNER LICENSE EXEMPTION
RUIDING PERMIT APPUCATION
Please print
DATE:
JOB LOCATION: 9-10
Number Street Address Map/Lot
HOMEOWNER 4772 S&l,41 13 t5 tj{-Sed.-/S �?I —9 73-5 89 y
Name Home Phone Work Phone
PRESENT MAMINCr ADDRESS 4990®� vc/ y QP.�7L
City Town State Zip Code
The current exemption for"homeowners"was extended to include owner occupied dwellings of one or two family
dwellings and to allow such homeowners to engage an individual for hire who does not possess a license,provided
that the owner acts as supervisor.
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 dwelling, attached or detached structures accessory to such use and/or farm structures.A
person who constructs more than one home in a two-year period shall not be considered a homeowner.(780 CMR
Section I IO.R5.1.2)
The undersigned"homeowner"assumes responsibility for compliance with State Building Code and other applicable
codes,by-laws,rules and regulations.
The undersigned"homeowner"certifies that he/she unde nds the Town of North Andover Building Department
minimum inspection procedures and re e ents and he/she will comply with said procedures and
requirements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Revised 8.2015
Form Homeowners Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
The Commonwealth offfassqehusetts
. .: Dgartment ofkdusiWalAcctd'ents
tr -1 Congrass'shvet,Suite 100
_ -goston,.A 02. 14 20. 7 f
avww mass.govfdia
c� kers'Comp,xtis,flonlnsuxance.Affldavit:$ifflders/ContractorslEZeetxczaxtslPXrmnbexs.
TO IM Fff M)VnM ME I"=&T G AUTCfORTry Please Print Lepbl
&pphcant Worma-.on
Name (Business/ftaaizationllvdivzdual):�'/�7/� AIZZ?4
Address:
city/state/zip: w i ,/1 � �2�—,
Arayou an employes? Checlze ap�xopriaie box,
Type of projeet(regired):
• to ees fu7landlor arttime).* 'J,• � eW co7is11Ttctl.On
1.E]I am.a employervdi L s emp Y ( p
2.ElIamas01epropdeb:=orpaEnershipandbavenoemploYeesv�orkingiormein $. Remodeling
any Capacity.END wo_&mY comp.insurance regutred.] 9. ❑Dem.01ition
3n I am a bom erdoing 4 worlsmysel+IND workers'comp.susoranee requited.]t 10 El$uilding addition
4_ amahomeowno:rmEvMbehiringcontraeiorstocondnotall-wo±onmyproper1Y- Iwo. 11: Electrical rep airsoxadditions
ensure that all,o kadois either have woad'Compensation insoimiee or are sole
propzietorsarzoeployees. 12 QPlumbingrep airsoradditions
5.�Iamageneralcor�iactorand IhaYeluzedthesub-contactors listedon$eaiEacbedsbeei l3:��Ra epairs
1 esesnb co�ractorshave e�pl7gL andhaveworkers'comp.insuraace. 14.F]Othex
6.E[We areacorporat3n and o cershave exercised tlleiiught Q eoemptionperMCL a. „-
e. o workers'rn �.insasanee raq�ed]
152,§I(4),and--ehaveno-.e,mploY., .LN
:pmyapplzca ha ehecl�sbax l mmsi also II outtbeseCiionbelowshowiagtheir arkam'compensauonpolicyifomoauon-
3�nmeown¢s mho s�;;;i avitindicaLngthU are doing all vorkaad thenhire outside coutraetors must submit anew a$idav>i aadiCating such
?GoDiacfons fat r�eckTb s b in al#[!an additonal sheet showing the name of the sttb conuactors and she whefiher oxnotibose eniities have
employees.Ifthe sub-ctracrors 7e emplflYses,�ieymnst provide their worlrs'comp.policy number.
I a are efriployer t1i at as pYovicing-pvo o, ,V employees:'Below zs thepolicy arad.jog site
infomnadorL
Iusurance Companp Name:
E�pira�onDate:
Policy or Self ins.Zia.f#:
City/state/yip:
lob Site Address:
ttach a copy oftheT7u?'&exs' conpeMa-donpolicy doeLvadonpage(show-tagthepolzeynnmber and expiration"date.
Failure to s eoure coverage as required under MGL G. 152, §25A is a criminal-violation punishable by a fine up to$1,50 0.0 0
andlor one-year iuzprisonmes r as jod as civil Penalties in the form of a STOP WORK ORDER and a fmv ofup to$250.00 a
day against viola-�or_A c of this statement may b e forwarded to'i ie Office of iavestig�tions of the DIA for iusaraace
coverage v c on--
Ido here 'e t/ Waitaes of perj�� that the to ofmagonNoWded abov is rye cid c �ect
t' Date: .0e
sigmaafore.
Phone#:
Q fficial use orcry. Do not�vrzte in this amae to he comPleted by city or to_Wn officf.aL- /
City or Town: ??ermitlLicense#
hsuiug,Autho-TRY(Circle One): ' eetor 5.12I ambSngXnspector
1.l3oarct of 13ealth 2.-B i ding Department 3.CIWy owu Clerk 4.D+lectricat 7nsp
6.Other
Phone#:
Contact Person:
Information and Instructions
Massachusetts General Laws chapter X52 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute an em ra ee is defined as"...eve erson in the service of another under any contract bf hire
P Y ry p Y
express or implied, oral or written."
Au employer is defined as"an individual,partnership,asso ciation,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 as individual,partnership,association or other legal entity,employing empl6yees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of anotherwho 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 b e deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shah withhold the issuance or
renewal of a license or°permit to operate a business or to construct buildings in the comrnonweahlx for any
applicant who lias not produced acceptable evidence of compliance with the insurance coverage required"
Additionally,MGL chapter 152,§25C(7)states`Neilh-erthe commonwealth nor any ofits political subdivisions shall.
enter into any contract for the performance of public 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),address(es)and•phone.number(s)along with theircezttfcate(s)of
insurance. LimitedLiability Companies(LLC)or LimitedLiability Partnerships(LLP)withno employees'otherthauthe
members orpartners,arenotrequiredto canyworkers'compensation insurance. If an LLCbrLLP does have
employees,a policy is required. B e advised that this affidavit maybe submitted to the Department of-Industrial
.Accidents foi-confirmation ofh=ance coverage_ Also be sure to sign.and date the affidavit. no 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 ox if you•are xegAired to obtain a workers'
compensaticA policy,please call the Department at the number listed below. Self-insured companies should•enter their '
self-in sruraiice 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 whichwM be used as areference number. Iu 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`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 maybe provided to the
applicant as proof that a valid affidavit.is on file for future permits or licenses. Anew affidavit roust be filled out each
year.Where a home owner or citizen is obtaining a license or p ermit notrelated to any business or commercial venture
(i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Dupartm-ent's address,telephone and fax number:
The Comnaonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston,Na 02114-•201.7
Tel.# 617•-727-4900 ext.7406 or 1-877-MASSA.FE
Fax#617.727-7749
Revised 02-23-15 www.m-ass.gov/dia
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.Buildinguildm Permit,
t
2014
�t `hl BUILDING PERMIT of NORT}� q
TOWN OF NORTH ANDOVER
32 h.ti ll h '6 O
APPLICATION FOR PLAN EXAMINATION �
nOi yb
Permit No#: / 7 Date Received
SS CHusB
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION /1 ,J�lli�U�/ le.
Print
PROPERTY OWNER %C i 0 L —, 1 i 5
Print 100 Year Structure yes no
MAP PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
0 Addition ❑ Two or more family ❑ Industrial
0 Alteration No. of units.- ❑ Commercial
epair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
VIS Sep i Ll ll'J 1] Floorpla'n ®1Weands D' Was}iea Distric
4pWatel/S`ewer �- _
DESCRIPTION OF WORK TO BE PERFORMED:
�f�_oN�.Ut� CHIC L
I G�
Identificatigig Please Type or Print Clearly
OWNER: Name: x. 19 J,Yk J�D� �L\ s Phone: l-k-223-59 `f
Address: `1'Gt UJB( ( �ItS,
Contractor Name: Phone:
Email:
Address:
Supervisor's Construction License: - Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT.$92.00 PER$1000.00 OF THE70TAL ESTIMATED COST BASED ON$925.00 PER S.F.
Total Project Cost: $ ! FEE: $ r�
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
�r xtiti �i ..>� ...rw.-• i.+... .,�, . ,r,. r:i:..
i it.,
SinnaturPrnfl/�nPnt/nwnPr �r�,r
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
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
4. 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
OTE: 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
46 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
2012 I ECC Energy code
Engineering Affidavits for Engineered products
OTE: 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 2014