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Home My WebLink AboutBuilding Permit #808 - 915 JOHNSON STREET 5/24/2013TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: /.0 lDate Issued: dc �/ J PROPERTY OWNER& MAP WD.- RCEL: Date Received ANT: Applicant must complete all items on this pag Print? 100 Year Old'Structure,' 60NING'0.IS;kRICT; ._ Histonc,District Machine: Shop: Village, yes'.' no= yes no 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 C-- epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ❑ 1Nell ❑Floodplain Wetlands; ❑ Watershed`District� Water/Sewer , RIPTION OF WOR}( TO BE PERFORMED: Please Type or Print Clearly) OWNER: Name:— Address: �'`T' , )7,A CONTRACTOR, Name: Phone-. Address: Supervisor's.Construction License:. Exp: Date: Home Improve.ment,License ARCHITECT/ENGINEER =xp: D:ate: Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PEAR $,1,000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ !'/, zo FEE: $ Check No.: Receipt No.:;C">�A NOTE: Persons contractilt with Pu is a ed contractors do not have access to the guaranty fund Signature of Agent/Own Sig iature of contractor. Plans Submitted ❑ lans Aiv d ❑ Certified Plot Plan ❑ Stamped Plans ❑ C x Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE.DISPOSAL Public Sewer ❑ Tanning/MassageBodyArt E]. _ 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 PLANNING & DEVELOPMENT ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE APPROVED El - Reviewed Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decisionlreceipt submitted yes . Planning Board Decision: Comme Conservation Decision: Comments Water & Sewer Connection/signature & Date Driveway Permit bPW ToNvz ]Engineer: Signature: Locateo 3u4 usgooa street FIRE DEPATMi EIVT - Temp Dumpster on site yes no Located at '124 Main Street Fire Depart.rheiit 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, roast 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 B Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The fohlowing 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 D 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) 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) ❑ Building Permit Application Q 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 apps al 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.Bui!ding permit Revised 2012 LocationOX 1.j 0 hhC.SPk7 19,T— No. 9.,- r /No. 9 Date Check #� 26438 TOWN OF NORTH ANDOVER A Certificate of Occupancy $ Building/Frame Permit Fee $TK Foundation Permit Fee $ Other Permit Fee TOTAL $ i Building Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 91500.00 m $ - $ 114.00 Plumbing Fee $ 14.25 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 14.25 Total fees collected $ 242.50 915 Johnson Street 808-13 on 5/24/2013 Bath Remodel V ml WN rA O J x L G O (;oE L \ LL N (n U V1 O z 04 Z m C _0 LL S d' C U C LL O V z Z �' t o K C LL O W Z u v J LU t 0 d' V Ln G LL cc 0 ui Z c7 t o d' C LL z CW a W LUO 25 LL N m z N +' Q Y {n G CL U) cn :a U) 0 as rn m p CD S .r_ N d s 0 2 Z 00 G to Z W w CL w H W a. H W W 19 W N 0 o �s Cc CL a; �a o N V a L N A: C as (D o S •+ E c .: 0 c L (� v H C Q' J c� > G CL U) cn :a U) 0 as rn m p CD S .r_ N d s 0 2 Z 00 G to Z W w CL w H W a. H W W 19 W N TOWN OF NORTH.ANDOVFR OFFICE OF BUILDING DEPARTMENT .:"1600 Osgood Street Building 20, -Suite 2-36 • North .Andover, Massachusetts 01845 Gerald A. Brown Telephone (97$) 688-9545 Inspector of Buildings - Fax (978) 688-9542 HOMEOWNER LICENSE EXEMPTION BMDING PERMIT .APPLICATION Please print . DATE: J013 LOCATION: 171,51— Number Number Street Address 'i. I/ ITOMEOWNER Maplot Name Home Phone Wo Phone PRESENT MAILING ADDRESS 4;CKI Zip Code The current exemption for "homeowners" was extended to h-iclude owner -occupied dwellings to fivo units or less and to allow subb homeovmers to engage an individual for hire wno does not possess a -license, provided that the owner acts as supervisor). State Building (Code Section 108.3.5.7) DEFINITION OFHMMOWNER PersOn(s) who gwns 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 yearperiod 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 andregulations. The undersigned "homeowner" certfies th t he/she tm rs ds e To n of North Andover Building Department minimum inspection procedures and q ements a th requirements, a / e comply with,said procedures and HOMEOWNERS SIGNATiiRR /o[�ti. APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption BOARI) OF APPEALS 688.9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 The Commonwealth ofMassachusetts Department of IndustriglAccidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electrricians/Plumbers i� City/State/Zip: /��-% ��- Phone C%?�'Z' 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 3AI am a homeowner -doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.[] Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other I%ny applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. i Homeowners who submit this affidavit indicatingthey are doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Policy # or Self --ins. Lic. M. Job Site Address: Expiration Date:- ! City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder 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 wellas 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. X do hereby cer fy under t /JaVspenaldes ofperjury that the informationprovided ab�ove�zs true and correct. 0:...._.. __. 11D.� � L�. natP. S-kZ�/ l 3 Phone #: Official use only. Do not write in this area, to be completed by city or town official. City or Town: PermitUcense Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town CIerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - -