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HomeMy WebLinkAboutBuilding Permit #825 - 99 MARIAN DRIVE 6/7/2011R i Permit No: pate OVER TOWN OF NORTH ANO MINATION APP LIGATION FOR PLAN EXA � Date Received oR ANT: xMP� i C� PARL�L:�v—►- MAp i And dg Permit of APPeals of recording all it mss N OF1pRK TO BE pEggO E : DESCgIrTI� CONTRACTOR Address:----' ervisor's Construction License: SuP EXp_ Date: phone-.- Home Improvement License: GINEER Reg• N°' S.F. ARCHITECTIEN ON $125.00 PER 1000.00 OF THE TOTAL ESTIMATED COST BASED Address: 12.00 PER $ FEE' v ULE: BOLDING PERMIT: $ � FEE SCHED t N° : Receipt uarantJ'fund Total Project Cost: $ - u actors do not have access tot e g istered contr _ r °';, contracting with unreg _ Check N ___.T . _= pian tureofcontractor7 L Plans Submitted ❑ Plans Waived ❑ TYPE of SE"TRAGE DISPoSA� certified PLc,t Public Sewer _ — -- Well n Building Department following is a list of the required forms to be filled out for the appropriate per to be obtained. The Roofing, Siding, Interior Rehabilitation Permits Application Permit ❑ Building ° Workers Comp AffidavitLicenses ❑ Photo Copy Of H.I.C. And1Or C.S.L. ❑ Copy of Contract Floor Plan Or Proposed Interior e°ed products o issuance of Bldg PE ° Flo Affidavits for Engineered rior t ❑ Engineering vire sign off from Fire Department p NOTE: All dumpster permits req C( HEA COMA, Zoning I Punning Boar( Conservation DE water & S ewe DPW Tory, n Eng Lo� �EpARTME Fire De at 124 Mail Aartment sig COMMENTS - Addition Or Decks Application Permit ❑ Building ❑ Certified SurVeyed Plot Plan Affidavit ❑ Workers Comp ❑ Photo Copy of H.I.C. And C.S.L. Licenses inkler Plan An( ❑ Copy Of Contract Plan Of Proposed Work With Spr ❑ FloorlCrossectionlEleSaif Applicable) � ble Hydraulic Calculation ( ort If Applicable) check Energy Compliance Report issuance of Bldg ❑ Mass ch Ineered products prior to ❑ Engineering Affidavits for Eng ster permits require sign off from Fire Dep NOTE: All dump New Construction ( Single and Two Family) Permit Application ❑ Building Proposed Plot Plan ❑ Certified Prop ❑ Photo of H.I.C• And avS.L. Licenses Sprinkler PIS ❑ Workers Comp Affidavit in Plans (One To Be Returned) to Include ° Two Sets C Buillding (If Applicable) Hydraulic ❑ Copy of Contract Compliance Report ❑ Mass check Energy Engineered products rior to issuance of E ❑ Engineering Affidavits for Eng Department p permits require sign off from Fire Dep All dumpster p the decision from the Boar �j®TE. One copy and proo required the Town Clerks office mus mof Deeds. In all cases if a variance or special permit was req et this recorded at the Registry appeal period is over. The applicant must then g that the app P application must be submitted with the building PP Doc: Doc.Building Permit Revised 2008mi @NED. TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: A Date Received — b- -L - Date Issued: __ r IMPORTANT: Applicant must complete all items on this naize i Ve Print Qp MAP NO/O'7• � PARCEL: ZONING DISTRICT: I `01� Historic District yesn Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Others: ❑ Repair, replacement ❑ Assessory Bldg ❑ Demolition ❑ Other ,Septic Well ❑Tloodt"in �❑ tWetlands � xUUatershed District . ❑::Water/Sewer "h, iUFCW 11UN UP W U K TU BE PERFORMED: CONTRACTOR Name: Address: Supervisor's Construction License: Home Improvement License: ARCHITECT/ENGINEER or Print Clearly) Exp. Date: Exp. Date: Phone: Address: Reg. No. Phone: FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ �i� FEE: $ � Check No.: J-76- Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 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 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 2008mi j Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ 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 PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on DATE REJECTED El COMMENTS DATE APPROVED El • 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 Located at 124 Main Street Fire Department signature/date COMMENTS 1 yes ION, 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 Doc:.Building Permit Revised 2008 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 WofkCers' Compensation Insurance All davit Name Please Print Location: 2/0� City 411 ZZA"' P tfi PRI , 1k Al Phone # �% �" �a��- 2— I am a homeowner performing all work myself. Q2,00" I am a sole proprietor and have no one working in any capacity 0 I am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone # Insurance Co. Policv # Company name: Address Ck. Phone # Insurance Co. Policv # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,500.00 and/or one years' imprisonment.as weU_as_dvil.,penaRiesin theelam dASTOP WOM ORDER..and.a.flne of..(3100.00)_allay agairiat.me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under th„pajs and penalties of perjury that the ti above is true and correct. Signature ����y� ` -���%�KK Date ell 3 Print name Z—/,Q r,10% � / Lam, Phone # Official use only do not write in this area to be completed by city or town official' City or Town Perm' icensi ng ❑CheckYimmediate response is required ❑ Building Dept ❑ Licensing Board Selectman's Office Contact persona Phone #: ❑ Health Department ❑ Other U) m m m m y m v m C2 y C � 'O O Cie CD C" � Z CA CLO r c CLE = CO) nc= -0 O O v CD CDCL O r CD CD a C co y� Qv y �Q CD CA O CD O CD O CCD e. luj cn cn n O z cn �l cn 2 C\ Ile - cm O Z O O to O a m m O N C CL 0 m c?100. = Z y UL O CO) am CO)o C) cc mIt cc, �, M==r -0H —4 —� 0 0 N O y —I O O = m 1 O 1 O N m �. 'R O : c - � 0 z C • I: 0 N C9 • m ? 7 � CL CD m N O m a,3 C N rte, •• d !Co: C Q CL �mto � m � N y O CO) . D CD to a C 3 y m 0 -� v 0 dm: m C CD oma: 0-: cam• C") n 0 0; � o �o o =' � co Cf) 0- d cn o � w � CA H w C/) ;n oda Cr1 It M 7d ;n A x r� r ro tri � e'- n 7d arc x ql CL W tz 7d cn . cn C/) A. x a 1 0 c The Commonwealth of Massachusetts Department of IndustrialAccidents WOffice of Investigations 600 Washington Street Boston; MA 02111 www.mass.gov1dia Workers' Compensation Insurance .Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legib Name (Business/Organization/Individual): Address: cl`G! d4el -I/N o L/ City/State/Zip:/1J6XY /41-,_6dV62 Mil 0/9-y Phone #: P - Are you an employer? Check the appropriate box: 1. ❑ 1 am a employer with 4. ❑ 1 am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I 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 3/W I 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.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. EjRemodeling 8. ❑ Demolition 9. ❑ Building addition 1011 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.E Other !;'Ile *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 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 Name: Policy 4 or Self -ins. Lic. 4:. 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 required under 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 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. I do hereby certify under trains andpenaldes ofperjury that the information provided above is true and correct. \ /t-/ I,'e----- ,5r7�- 6 /S- - /2S & 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 CIerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone F µoRTM ��rO TOWN OF NORTH ANDOVER 2QEtt Leo nb O� OFFICE OF *v BUILDING DEPARTMENT 1600 Osgood Street Building 20 Suite 2-36 SAGHUS North Andover, Massachusetts 01845 Gerald A. Brown Telephone (978) 688-9545 Inspector of Buildings Fax (978) 688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please print DATE: -/7 / (/ JOB LOCATION: Number HOMEOWNER Name /L Ate Street Address Map/Lot `_--/4l ► q (2,4 Home Phone i7?--,os-,� PRESENT MAILING ADDRESS /1,6q,_-/' , / Work City Town S+wte 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 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. 11 The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE ./L APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 685-9535 2 STORY W.F.D. X99 a' 150.00' S05000'00"E f_ MARIAN DRIVE NOTE �— DH (FND) '260-25' ll (DH SET) , N14 03 00 w ti pct AREA=56,900 S.F. f o =1.3062 AC. ,cv co z i DH (FND) DECK —SCREENED PORCH R�69. tK SBDH (FND) r SITE IS SHOWN ON TOWN OF NORTH ANDOVER ASSESSORS MAP #107 LOT #47. SEE E.N.D.R.D. BOOK #12398 PAGE #20 FOR SITE DEED. to d- N 0) N co C.� i� 6/1/11 DATE PLAN OF LAND IN NORTH ANDOVER, MASSACHUSETTS DRAWN FOR WILLIAM Mc NAMARA 99 MARIAN DRIVE NORTH ANDOVER, MA 01845 SCALE: 1"=60' DATE: JUNE 1, 2011 0 30 60 120 180 MERRIMACK ENGINEERING SERVICES 88 PARK STREET ANDOVER?, J1SSACHWAIJ :^ 01810 PHONE (878) 475-3556 PAX: (878) 475-1448 EMAIL• JIMUNG®AOL COQ!