Loading...
HomeMy WebLinkAboutBuilding Permit #118 - 91 MARBLEHEAD STREET 8/11/2009 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page t LOCATION q1/ Mt:A. A� C- � 0fi �' Jar IR14, 15 ,,te�tr Print PROPERTY-OWNER_ ' �q,vr)rti 602 _ , Print MAP NO: 9 PARCEL: 410 ZONING DISTRICT:, Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residen ' Non- Residential New Building One famiy Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) a OWNER: Name:/'A�vr3,n 0A , cue r-,Q- Phone• X1 -36 `7—` -Ac Address: / (ell=dSt<< o CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date.- Home ate.Home Improvement.License Exp. Dater 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: $ O, F 1 EE. $ e Check Nod? / Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner ; ignature of contractor Plans Submitted Plans Waived Certified Plot Plan Stamped Plans 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 ❑ 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 o 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) ❑ 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: Doc.Building Permit Revised 2008 TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/MassageBody 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION 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 i i 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 i I i ❑ Notified for pickup - Date i._......._...................._.._..................._.................._..............__.........................................................................._._.............._...........................__......._._.. __..-....... j Doc:.Building Permit Revised 2008 Location No. Date ,9/ "0RTN TOWN OF NORTH ANDOVER 1 Certificate of Occupancy $ ' Building/Frame/Frame Permit Fee $ scMust 9 Foundation Permit Fee $ Other Permit Fee $ /y TOTAL $ Check # ! 223"1 Building Inspector The Comrnvnraealfh of Massachusetts f ! DeParnne"y of Industrid Accidents i 0.,}tce, of Investigations 600 1f,"ashin on Street ' Bostart, MA 82111 WWW-rnas..�uv/dia , V�orkers' CompeQsation Insiera.nee A Mdaviiw BuRders/ContractorsMectriciants/PiQmbers A p iicant nforffiati Ian • Please Print LeQibt N13IDE (Business/Orgsmi2ation/Individual); Ad&ess: S r City/Stat:/zip; Phone 4-. rt 0 i 78reytaployer4Cbet It.tbe appropriate hoz: mployer with 4. ❑ 1 am a Q Type af'Project(requite; e-.s(full and/or * contractor and Ipart-time). havo lz ed the sub-coTtt:acors 6 New construction. ole.proprietor or partner. listed ori the attached sheet.3 7. ship and have no employees' ❑.Remodeling These sub-contractors have working for me in arty capacity. workers' comp.insurance. 8' (�Demolition [No workers'comp. iasruance 5. ❑ We an a corporation and its 9- ❑Building addition required.] offtae:rs have exercised their 3. I am s homeowner doing all work right10'❑���repairs or additions of exemption par MOL 11.E]Plumbin myself[Mo•workers'comp. c, 152, §1(4),and we helve no g repairs or additions Insurance-required.]t .emplayees:[No workem? 12•❑Roof repairs gyp. imLmm=requireq I3.❑.pm� `may applicant that alecks bob#!most atso fm out the section wow showing theirworkent'ii t Homeowmets who sobmit this of davit indicating they ars dol an omi>�saticyn policy information, tCoatraetors that cheek this box reuse mS w'o�'end then hila ourside eonoacters m ig submtt a new afndavit imd' sa additions]elect ahowi .the name df them ioahns siecit t-cm+tractors and Eimir wort'cc., r: ;i;, tian. I an enpioyer flat is o�ao "P•Fo.. �forrosfeorL :tn�attg:rpa.N� Cari�rersaffon fnsuratrceforirty '--- ninve� b w.is fix P-. ,,mei jok site . Insurance Company Name: Policy#or Self-ins.Lie.#: Ste Expiration Date: ob Si Address: . Attach a copy of the workers' coot peuisat�ou policy deeFarat ioo �e showing Failure to secure coverts a as Pah ( c.the policy number and expiration date). g required tender Section ZSA of MOL C. 152 can lead to the imposition of criminal penalties of a fine up tr,$1,5DU DO and/or one-year irnprisonm Of up to$250.00 a ; e well as civil Penalties in the fnrrn of a S7L�P WORK ORpi R and a fine day A against i the violator. Be advised that a copy of this statement may b-forwarded to the O�trcr of Investigations of the D1A for insurance coverage venin"cation. I do hereby cerfiJy u er the pias ee P * °fPe*7 J*at the information provided above is ftne Si rrure: and aonrd Phone#: o fficial Only. Do not write in this area tb bt[xintplet�! .�'/, or town.a �'J fI+�aL ne Permit/Licease Issuing Authority(circle one): Health 2.Roeidiug Deparf�ent 3.City/Tvwn�Cierk 4. Electrical Iuspector 5. Plnmbino Ins pector ealt: Phone#: Information a nd Instructions Massachusetts General Laws chapter 152 requires all emp 3 oyers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"..:every person in the service of another under any contract Aim, express or implied,oral or written." An employer is defined as"an iridividualr partnership,association,corporation or other legal entity,or any two ormore of the'foregcaing engaged in a joint enterprise,and includi"g the legal representatives of a deceased employer,orthe =t:aiver artnrstee•of an individual,partnership,associatioin or other legal-entity,employing carployem'I=iowemthe own=x'of a dwelling house having not morn than three apartments and who resides therein,or the occupant of the dwelling house of another who employs parsons to do mai ee,construction orrepair work an such dweifinghouse or on the grounds or building appurtenarn therein shall not b-..cause of sucb employment be damned to be an employer." MGL chapter 152,g25C(6)also states that"every state o►r local licensing agency shall withhold the issuanceor renewal of a license or permit to operate it business or *a construct buildings is the commonwealth for any appricam who has not produced acceptable evidence o,f compliance with tlie.iusurance coverage required." Additionally, MOL chapter I52,§25C(7)states."Neither the commonwealth nor any of its political subdivisions shall enter intp any contract for the performance of public work until-acceptable evidence of compliance with the insurance ioqu immed.of this chapter have been presented to the c xr&acting authority." Appiicenfs .. Please fill out the workers'campensation-affidavit completely,by checking the boxes that apply to your.situation and,if necessary, supply sub-contractors)mmne(s),addrMKes):arsd phone numbers)along with their certificate(s)of insurance. Limited'Liability Companies(1,LC)or Limited Liability.Partnerships(LLP)with no-employers otherthan the members or pa tn=,an not mquired,to carry workws'cc>rnpensatran insurance. Van LLC or LLP does have empioyees,a policy is regiurad. Be advised that this affidavit may be submitted to the Depwtnmrt of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The aftrdavit should be.returned to the city or town that the application for the permit or license is being requested,notilhe Dopar mpm of Industrial Accidents. Should you have airy questions regar-ding the law or if you are required to obtain a workers' compensation policy,please-call the Department at the nurmber.listed below, Self-insured companies should enter their self-insu lunc1ieensc number on t1'se*approp%i8te IMM. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The De partrnent hasprovided a space at the bottom of the affidavit for you to fill out in the event the.Office of lnvestigatiom has to contact you regarding the applicamt Please be sura to fill in the peumit/Irconse numberwhrcb w-M be used as a ref rence number. in addition,an a0piicant that must submit multiple permft/license applications in any given yiar,need only submit one affidavit indicating current policy:information(if necessary)and under"Job Site Address"the appiieam should write"all locations in (city or town)."A appy of-the affidavit that has been officially sfarnped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for futwe permits or licenses. A new affidavit must be filled out each year. When a home owner or citizen is obtaimng a license; or permit not related to any business or commercial venture (Le. a dog license or permit to bum leaves etz.)said poison is NOT.regnircd to complete this affidaviL 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. The Commonwealth of Massachusetts Depariment of IM&Stzial Accidents Mc a oEf Lnvestigut~ions 600 Washington Street Boston, MA 02111 TeL #617-7274900 r:=406 or 1-9.77-MASSAFE Fax#61 7-727-7741 Bruised 5-26-(15 WWW.mass.govidia Y µORTH TOWN OF NORTH ANDOVER A�° OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 North Andover,Massachusetts 01845 9SSAC64 5E� Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978) 688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please print DATE: C7—l�-�(�� 9 JOB LOCATION: q ' V\At,C" S�^ c Number Street Address Map/Lot HOMEOWNER 0CQ.�yn/U 1'\V__'P'VNQ C01 --aM-1 5Lj(_ 7$1co Name Home Phone Work Phone PRESENT MAILING ADDRESS q j tAAlck,r-IO+-C.k,,j S h Aor-ov\ A A)V<�e"_ 9 t�) City Town State Zip Code The current exemption for"homeowners"was extended - p to ded 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 resides 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 requireme s and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption I BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 r1ORTH T0VM Of Afidover T CN O '- LAKE dover, Mass., O 9 COCMICNEWICK 7�AoRATE0 OPa,��� `S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ! � �.. ...... ... .f.:�ti.�1►.......... ..�'.�....060�%. ....................................�.j.�..�..,.,......:.................................. Foundation has permission to ere ......... buildings on.11......M.A ...6.6 ........ �A............ Rough mO�L �1� Ow to be occupied as...... ... .�.�.�ik"...... j.II C�....d .C.�R ..... Chimney provided that the person aLceptmg this permit shall in every respect conform to the terms of the application on file in Final 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 CONSTRU STARTS Rough \....•.. Service \`_ . .. ............... ..... PECTOR Final Occupancy Permit Required to Ocmpy Building GAS INSPECTOR 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. SEE REVERSE SIDE smoke Det.