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Home My WebLink AboutBuilding Permit #1008 - 94 BLUEBERRY HILL LANE 6/4/2015 I �- Qs NORTF/ BUILDING PERMIT 66�tIED ,E,9ti0 TOWN OF NORTH ANDOVER go - p APPLICATION FOR PLAN EXAMINATION Permit No#• Date Received � °qArEo�P"�•c5 gSSAC HUs�� Date Issued: I' PORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER dl ✓ 0 P int 100 Year Structure yes no MAP PARCEL ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Resid ntial Non- Residential ' ❑ New Building One family El Addition El Two or more family El Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other --_ ------ ❑ Septic ❑Well El Floodplain El Wetlands 0 Watershed District 0 Water/Sewer - DESCRIPTIO 4 OF WORK/TO BE PERFORM D• i } entification- ase T pe o Pri t Clearly I OWNER: Name: �� Y� d Phone: �'7 Address: _ L Name: Phone: r's Construction License: Exp. Date: Exp. Date:rovement License: 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: $ 42 Ll�x FEE: $ Check No.:—, / a ZZ Receipt No.: S NOTE: Persons contracting with un egistered ont actors do not have access to the guaranty fund f — Pnt )r V Location (� No. Date Y . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ f Foundation Permit Fee , Other Permit Fee $ TOTALPF $ Check#�U 2 � Building Inspector J , Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swiumning Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ElPrivate(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on Signature COMMENTS Toning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes tanning Board Decision: Comments Conservation Decision: Comments I Water& Sewer Connection/Signature & Date Drivewav Permit DPW Town Engineer: Signature: - r ,ya ,,. _iF;IRE DEPAT.iMET w T;empD, usteronsife' r Loc_atead 384 Osgood Street rnpRN � ttLo a ateat,124YMainiStreet Fire�De- artm `� /a . r, Y� kCOMMENTS; 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 N® DANCER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$1oo-$1000 fine NOTES and DATA— (For department use) I ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 IF J - I Building Department The following in is a list of the required forms to be filled out for the appropriate permit to be obtained. i Roofing, Siding, Interior Rehabilitation Permits i 4 Building Permit Application w , 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 do 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) 4 Mass check Energy Compliance Report (If Applicable) 4. 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 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 IECC Energy code Engineering Affidavits for Engineered products II dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit OTE: A p 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 1 F NORTH Town of s _E ndover No./66&_ h , ver, Mass, COC NICHlWKH �� AERATED S U BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ..............*�..�. �ll+.R....... ....1.. �.!!!!�®..................... ................... �+ Foundation erect buildings on $.I has permission toe .......................... g ...�...... ......... �w�........ Rough tobe occupie i.. .. ............................................................................ Chimn y provided that h . e perso ccepting this permit shall in every respect conform to the terms of the application Final e 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 ONTHS ELECTRICAL INSPECTOR . UNLESS CONSTRUCT S TS Rough Service ...........I... ..................... ..................................... 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. � NORT1i Town of E .,o ndover o : : - to No.®66&' IT h 1" ver, Mass, COC KICKt WICK V A04ATED S U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT .......... -�i . �ll+w.......�� .../.. �'�" 6 I ... Foundation has permission to erect .......................... buildings on ...�...... ......... ....... Rough to be occupie0heperso i.. .... ............................................................ ............... Chimney provided that ccepting this permit shall in every respect conform to the terms of 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 ONTHS ELECTRICAL INSPECTOR . UNLESS CONSTRUCT S TS Rough Service ........... ... ............... ....:..................................... 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. Q 11�af/ L -;---7 VA - AS On N' ,�1O�z-��, � tL salt H S S d^bbl F'SSa,n.9 �,a�� .)s 4,ge — Sk1M ri-ur1 Ole �rS'rr1�ry Z �� Inrjyy S�N)(y (qv t'dtj 1 4A 1=x-- �— d..-.--' °""""""'"-�,-� t�►��ice'--"""� ®r 0i � ti To "OF NORM AND OVEP, ONCE OF •' -UMIDJCt G DE'MT'.InjW • ' �Q� °".� :'Z6DD OsgoQclStree•EBuzlding�q,•S�tzte?36 _ 7'ra�R3}7�n FBP�y.(CJ Ncrzth Anaovex°Massachusetts 411845 Gerald A.Brown Telephone(9781688 9545 lnspeutoroi Buildings - Pax (978)688-9542 HMMWE MMR LICENSF F-YP-MPTION ' BTND)NGPE 's` Olnr ICATION Pleaseurinf . . DATE- :Lilly p Number StreetA dress ma p/Z of . - IXOMEO ER lut-/V ' Name. Horne Mom Wbrkl'llone -PRASENT MAU iNG ADDPXS A s d . • {�.`taN.• - . zip Code The current exemption for"-homeoW-n_exs"teas oxtencted fo:baG7ude owner occupied cfivelugs to tvo units oX Iess attd fo a11ow su�1n 1?omPo;?ners to engage an i1dz�}d,1a1•forhi, -Wj o o7oes notpossess a 1 ce31se,provided that the owner acts ass P5zvisor). 8iatoDuRding (Code Sectlorl 108.3.5.1) D MILTION OFHOMEOWNER Persons)tubo awns aparcel ofland on which I.e/shexesiaes or intends to reside,on which there is9,or is i fended fo + be,aoneortWofamilysfzuctuzes. Apersonwlzoconstrictsmorethatoneltomeinatwayearpershallnotbe considered ahomeowner. Tha zmdersigned`komedwnex"assumes responsibiIityTorcomplia c;es wifh•he State Building Codea-adotter .Applicable codes,by-laws,Mas andTogulations. ` 'The undersigned"homeowner"carffRes that he/sheuuderstaudstTieTotxtnOfNDTIhAadoverBuild%ngDe�,nt .mznimum inspection procedures and requirements and that lie requirements, /size will comply with;said procedures and HOAMOWMR5 SIGI�IATORE .�P.ROV'AL 0P BUff- OF'F`ICIAL Revised-7.2.009 1~OTm Homeomers Bxdnpfion - )30ARD OF'APP.BA7-688-9541 CON ERVAUON 688-9530 BEA.LTH688-9540 PLANNING688✓9535 i The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/ I ectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Please Print Le 'bl A licant Information Name(Business/Organization/Individual): o Address: /�` y`��l e r� _ /,4,/4 �llil w,- Phone#: City/State/Zip: TNew the you an employer?Check the appropriate box: Ty (required); em to ees full and/or part-time).* 7. tr' ion 1.[-11 am a employer with P Y 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling capacity.[Noworkers'comp.insurance required.] 9, ❑Demolition 3.el a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 B ' ding addition q._ I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11. Ele trical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 12_ Pliuribing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.,❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 14.❑Other 6.❑We are a corporation and its.office rshave exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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. 'compensation insurance for my employees. Below is the policy and job site I am an employer that is providing workers 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 MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify r the ins an pen a of perjury that the information provided above is true and correct. Date: Si nature* Pho e#• 7 S/ Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#: Contact Person: