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Home My WebLink AboutBuilding Permit #435 - 94 BLUEBERRY HILL LANE 1/7/2002 BUILDING PERMIT TIORTH 0 0, 6 ' 6 TOWN OF NORTH ANDOVER Fr. A op APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received i-7-0 ATED Date Issued: IMPORTANT: Applicant must complete all items on this page 7 4' LOCATION ` 77-77, 77 nnt NER' PROPERT--Y. �)Q,W 'rin 'jCt1 IC oj�str --R 0 Cyes MAP�N __ZONIN G- ,D4,ST,' Mac'hirib Shop V611age- es _y TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Ad�fion Two or more family Industrial Al�er Commercial No. of units: Repair, replacement Assessory Bldg Others: Demolition OtherSepticLL -at 'Wetlands _Distrii Ct _:Watershed te�sb 1Nate ed, _j'O d plain "We'v" r/Se DESCRIPTION OF VYORK TO BE PREFORMED: Identification Please Type or Print Clearly) Phone: 7?T.zZ_/7,"7 90� OWNER: Name: 1 Address: hb: Phone 7 C I FOSS TM Supervisors. 0hstrbtirLo ,'s EDa e ., N: EX date P� ns M eb_..�'Lice __ e Horne Jmr,' ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.,$12.00 PER$10010 0 OF THE TOTAL ESTIMATED COS ASEDON$125.00PER S.F. Total Projdct Cost: $ FEE: $ 7 '- Receipt No.: Check No.: /a NOTE: Persons contracting with 7e iste d contractors do not have access to the guaranty fund U DER, Signature o 0 AUti - Signature of contractor Location / 'ek!�tt A No. Date NO •D D TOWN OF NORTH ANDOVER Of .. ;.�N F 9 !Y + ; ,41 Certificate of Occupancy $ MUtBuilding/Frame Permit Fee $ sAGs Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # S T Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans i i 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH 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 Located at 384 Osgood Street y . > ,FIRE Teriip Durnpster on site yes =no Located at 124 M oy Street 4 ek Fire,Qepartrnent.signature/date ,. �y � `~ =: x Wt C:C)NINIFNT� 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 ❑ Notified for pickup - Date 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 i L3 Workers Comp Affidavit L3 Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o Floor Plan Or Proposed Interior Work j o 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) 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 ❑ Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o 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 ii must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 I A NORTIy Town of 3 s No. dLAK o �` dover, Mass., �. A- COC MIC KE WICK V 7d�OOATED P -`C 7�7 BOARD OF HEALTH PERMIT T , D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..... . ... ......iso......... r � it is too...............................d/64, ..... .... ...................... ...�... Foundation has permission to erect.. buildings on . .... .. ....... ...... ............I....................... Rough . 3a Ch' e to be occupied as .... ... ....../� .�/� tmn y provided that the person accepting 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 CONSTRUTS Rough ................. .............. Service BUILDING INS Final Occupancy Permit Required to Occupy 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. p°RTp TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT +�Cott r 1600 Osgood Street Building 20, Suite 2-36 �.,;>:,;.::�•�� North Andover,Massachusetts 01845 sswc�t Telephone(978)688-9545 Gerald A Brown Fax (978)688-9542 Inspector of Buildings HOMEOWNER LICENSE EXEMPTION Please print DATE: JOB LOCATION: Number Street Address MaPIA HOMEOWNER 7&/fr_ 9 //"� �11 Name Home Phone Work Phone PRESENT MAILING ADDRESS !� City Town State 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$ection 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 requirements aLAi that helshe will comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING CIAL Revised 10.2005 Fom Homeowners Exemption BOARD OF APPEALS(M-9541 CONSER\'_1TI0\638-9530 HEALTH 08-9540 PL.1.\vING 6S8-9535 I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street r` Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricans/Plumbers A [icant Information �^ Please Print Le 'bl Name(Business/O=' Address: ` City/State/Zip: Phone.#: Areyou an employer?Check the appropriate box: r . 1.[1 Type of project(required): I am a employer with , 4• ❑ I am a general contractor and I ,, employees(full and/or part-time). have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have g, []Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp.insurance.$ 9. El Building.addition , required.] 5. We are a corporation and its ME] 3officers have exercised their Electrical repairs or additions I am a homeowner doing all work 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL insurance required.]t C. 152, §1(4), and we have no 12.[]Roof repairs employees. [No workers' 131-1 Other comp, insurance required.] *Any applicant that checks box#1 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: 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 required under Section 25A of MGL a 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify un er th pains a pe es of perjury that the information provided above is true and correct Siatur`e: Date: Phone#: Of7useny. Do not write in this area,to be completed by city or town official CitPermit/License# Issity(circle one): 1. lth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Co : Phone#: