Loading...
HomeMy WebLinkAboutMiscellaneous - 18 GROSVENOR AVENUE 4/30/20184 APPUCATION FILL -D cm: -3 9'gS DECISION CUE ON: N O G # N O . Q co o < o m z _ Q 0 (� C3 m o z c -�1 m 04, d % MDE IM U.S.R. 0 Moa 73-2 113 o 1. qll TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS NOTICV March Notice is hereby given that the Board of Appeals will give a hearing at the Town Building, North Andover, on .... MPn d 4y ..evening...... the 8th . day of .....April.......... . 19.851, , at7:.39'clock, to all parties interested in the appeal of .............. KENNETH..KELUY ..................... requesting a variation of Sec.. 7.,. , Par , . 7. 3. . of t eoning By Law so as to permit.. re lief..from . the. rear.. se.tback req.uirement...to.allow. .the..cons truct.i.4n..of..an addition....,,,,..., .............................. ............................................... ...... on the premises, located at.. l8, ,Grosvenor . Aven ie .............................................. ...... By Order of the Board of Appeals By: Frank Serio, Jr., Chairman Publish: Citizen: March' 21 and . 8 1985 Send bill to: Kenneth Kelley 18 Grosvenor Ave. No. Andover, Mass. 0 r y . r • Z TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS NOTICV March Notice is hereby given that the Board of Appeals will give a hearing at the Town Building, North Andover, on .... MPn d 4y ..evening...... the 8th . day of .....April.......... . 19.851, , at7:.39'clock, to all parties interested in the appeal of .............. KENNETH..KELUY ..................... requesting a variation of Sec.. 7.,. , Par , . 7. 3. . of t eoning By Law so as to permit.. re lief..from . the. rear.. se.tback req.uirement...to.allow. .the..cons truct.i.4n..of..an addition....,,,,..., .............................. ............................................... ...... on the premises, located at.. l8, ,Grosvenor . Aven ie .............................................. ...... By Order of the Board of Appeals By: Frank Serio, Jr., Chairman Publish: Citizen: March' 21 and . 8 1985 Send bill to: Kenneth Kelley 18 Grosvenor Ave. No. Andover, Mass. 0 Legal Notice TOWN OF NORTH ANDOVER BOARD OF APPEALS NnTIrE t �10RT1� F � p ' CMUS�� March.19, 1985 Notice is hereby given that the Board of Appeals will give a hearing -at the Town Building, North Andover, on , Monday evening, the 8th day. of April 1985, at 7:30 O'clock; to all par- ties interested in the.appeal of KENNETH KELLEY requesting a variation of Sec. 7, Par. 7.3 & Table 2 of the Zoning By Law so as to permit relief from the rear setback requirement to allow the construction. of an addition on the premises; located at 18 Grosvenor Avenue. By Order of, the Board of Ap- peals. Frank Serio, Jr. Chairman Publish N.A. Citizen: March 21 and 28. 1985 P27 KDEME i/3: ��Q1ttORlrt�'�p i X6 f• C.� AVAIL i�'1 •,S' O4 _ ,'s gc'tiu9 . APR 16 f 32 AN 105 TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS NOTICE OF DECISION Any appeal shall be filed within (20) days after the date of filing of this Notice In the Office of the Town Clerk. - ------ ... Date .... ..April 1.8.,..19 8.5.. . Petition T o...... 2.0.-.1.8.5 ........ . Date, ' Ht wring .. AP r i Petition of .... .KENNETH . KELLEY ..................................................... Premises affected ..l$. Grosye.nor _A.venue.............................................. Referring to the above petition for a variation from the requirements of the ... Z oni n.g . By.. Law ... Se.ction...7 , ..Pa.r.agraph . 7-3. and. Table. .2 ..................................... so as to permit .. re li.e f. f rom . the. .rear. se tback . requireme nt . to . al low . the . ... co.ns tructio.n . of . an . addi.tio.n . to . an . existing . dwelling ................ . After a public hearing given on the above date, the Board of Appeals voted to .. Grant... the .... . an ............ and hereby authorize the Br ilding Inspector to issue a permit to ..const.ruc.t. a .14.'.. x .3.1 .. addition. to. the..rear.bf. the..eki.sti.ng dwelling for the construction of the above work, based upon the following conditic is: That the plan be revised to meet the Board's r 2quirements. Signed Frank _Serio,. Jr..., . Chairman ........ Alfred, E. Fri.zel.le.,..Es.q..,..Vice. Chairman Augustine, W, . William .J...Su.11i.van............... Walter_ F ...Soule ................... . Board of Appeals RECF'ivFo Any appeal shall be filed DAH!F_1- pJG "°"';�ti° within (20) days after the date of filing of this Notice NORT!' ���CUVER p in the Office of the Town iIM • PR Clerk. CHU TOWN OF NORTH ANDOVER MASSACHUSETTS -- BOARD OF APPEALS April 18, 1985 Mr. Daniel Long, Town Clerk Ke,neth Kelley Town Office Building 18 Grosvenor Ave. North Andover, MA 01845 Pe ition No. 20-'85 Dear Mr. Long: The Board of Appeals held a public hearing. - n 'Monday evening, April 8, 1985 upon the application of Kennetn Ke'ley. The hearing was advertised in the North Andover Citizen on Ma,.ch 21 and 28, 1985 and all abutters were notified by regular mail. The following members were present and voting: Frank Serio, Jr., Chairman; Alfred E. Frizelle, Esq., Vice Chairman; Augustine W. Nickerson, Clerk; William J. Sullivan; and Walter F. Soule. The petitioner seeks a variance from the provisions of Section 7, Paragraph 7.3 and Table.2 of the Zoning By Law so as to permit relief from the rear setback requirement to allow the construction of an addition to a dwelling on premises located at 18 Grosvenor Avenue. The petitioner testified that the proposed addition will be 14 feet by 31 feet and is needed for a growing family. It will be 27 feet from the rear lot line, where 30 feet is required. No opposition was voiced at the hearing. Upon a motion made by Mr. Soule and seconded by Kr. Frizelle, the Board. voted unanimously to grant the variance Li requested, with the condition that the plan be revised to meet the Board's re- quirements. K v Kenneth Kelley, . 18 Grosvenor Avenue Petition No. 20-'85 April 18, 1985 Page 2 In granting the variance, the Board finds that Section 10.4 of the Zoning By Law has been satisfied. Specifically, the Board finds that the slight deviation from the requirements of the By Law will - not create a detriment to the nieghborhood'-and that desirable relief may be granted without nullifying or si48stantially derogating from the intent.and purpose of the B•tr Law. Jw (Plan to follow) Si. cerely, BOA ,RD OF APPEALS _ C - Frank Serio, Jr., Charman .. A i u Datel 4...4 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............. t . has permission to perform r:: *.-._ ..................... � p a . ................................. winingIn the building of ........................................................... at ......;- �............. , NorthfAndover, Mass. Fee'�CJ............. Lic. No.( r 5. ........ !..�.. �1'' �.--- r ................ 'ELECTRICAL INSP`H6TOR Check # � 7Q3_ v VV 5469 �— The Commonwealth of Massachusetts u"`� PW" No. Department o/ Public Sa/et ' Ooowpancy A F« Cr eckoo - BOARD OF FIRE PREVENTION REGULATIO 527 CMR 12:00i L3/90 wr• lfa.nr) APPLICATION FOR PERMIT O PERFORM ELECTRICAL WORK All work to be performed in acco anc with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMA N) Date—_ ��' R p L' The unoersfgned applies for a permit 10 perform the electrical work described below, To the Inspector of Wires: Location (Street 8 Number) %i bS 1, ..4 f?, Owner or Tenant 0C Owner's Address Is this permit in conjunction with a building permit: Yes ❑ No (Check Appropriate Box) Purpose o1 "Building Existing Service Amps Utlllty Authorization No. _ Volts Overhead C3 Undgrd ED No. of Meters New Servl�e Amps _ / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No of L,gnf,ng Outlets NO Of L,ghl ng Fixtures No of Receptacle Outlets No of Sw,fcn Outlets Nc of Ranges No of D�spo Sats r Nc Of D,snwasners 11 No of Dryers Nc of wafer Healers KW Nc 'C(o Massage Tubs O'HER No. of Hot Tubs Swimming Pool No. of Oil Burners No. of Gas burners AboveIn. grind. C]omd. No of Air Cond. foiat tons No of Heal Total Total Pumps Tons KW Space/Area Heating KW Healing Devices KW No. of No. of Signs Ballasts No. of Motors Total HP No. of Transfprmers Total KVA Generators KVA No. Of Emergency Lighting Battery Units FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained —""—'— Detection/Sounding Devices Municipal Local ❑ Connection ❑Other Low voltage wiring NS,-RANCE COVERAGE Pursuant to the requirements of Massachusetts General Laws r a.e a c„uenf .,acw ry Insurance Policy including Compleled peralions Coverage or its substantial equivalent. ^aye s„ormneo ,al,o proof of same to this office. YES gyp% L7 NO ❑, /a_ na,e cnecKeo YES, please indicate the type of coverage by checking the appropriate box. s ;.SRANCE ❑ BOND [9 OTHER ED (Please Specify) � R �'/J 'D /A �N v Vis'.^ a ec value Of Efeclncal Work s r On c Slar. a 9 S'gne _nOer ane penalties of perjury / tiAr�E 1 D l { AJ /A / VIA r / iii n .. //1 � YES ©ANO ❑ j2 -3r -a - (Expfrelfon Dale) ce^see _ ',,-3 ( C/ A�1 LIC. N0. ________^ / ) 9 r Signature � �Tal caressLa ? � �} IN S .----- LIC. NO. Q ZGS`�/ T�K I 6-e4-1 l� LIP B�17. 4/7� � Cr:',ER i All. Tel. No./ - S NSuRANCE WAIVER I am aware that the licensee dopa not have the Insurance coverage or its substantial ''� c, Massacnusens General Laws, and That my signature on this OQuivalenl as -:) , 7Permit application waives this requirement. e- :`-J Agent ❑ (please Check one) S'gna•ure 01 Owner o, Agent) Telephone No. PERMIT FEE s J Location No. Date Z6 „°RTS TOWN OF NORTH ANDOVER 10. s t ; ; Certificate of Occupancy $ MuS Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL Check #,_�! %9 1 If i 7744 `—'Building Insp i TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVAT& OR DEMOLISH A ONE OR TWO FAMILY DWELLING .. do der BUILDING PERMIT NUMBER: - 001 DATE ISSUED: y b Lo SIGNATURE: Building Commissio for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: V t'52, Map Number Parcel Number 166, 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frorria ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Regaired Provided Required Provided 1.7 Water SupplyM.G.L.C.40. 34) 1.3. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 077TT"t: es 2.1 Owner/of Record 1�L Name (Print) Address for Service Signature Telep ner 2.2"Ow er of Recor . 1v,ame Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Lictnsed Construction Supervisor: i Address Signature Telephone Not Applicable _ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone 00 M z 0 v n m 0 z M 90 0 a_ r M r r- SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 2! Workers Compensation Insurance affidavit must be completed and submitted in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... 0 SECTION 5 Description of Proposed Work check sll a cable New Construction ❑ Existing Building ❑ Repair(s) ❑ this application. Failure to provide this Alterations(s) 0 1 Addition 0 Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: " I SECTION 6 - ESTTMATF.n C ONSTRUCTMN CnCTc I will result Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building ®G O (a) Building Permit Fee Multi lier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee x tbl 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 O G a Check Number v11 is V TV III rim tMv l11V1q 1V DL' I,VLYICLIS1L.l) WtiC;Pl OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT /1 t/ _ /GL'�it.�e� ���� as Owner/Authorized Agent of subject property Hereby authorize 1�26 66z�' 71— to act on Mt f tiro by this building permit application. Si nature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION { r> as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name of Owner/. NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS 1' 2' 3 RD SPAN DIlv1ENSIONS OF SILLS DINIENSIONS OF POSTS DB ENSIGNS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE i �I Z w O w lz a v � o H C_ y a 4 •��- :mm a U • = 67 O l Q V W W O N cm aa A a C � o w° a Cl) .' w° ao' U c w Q. ob w U W ao' w C7 o ao' w a a cA o cn o cn O FM4 { > � o E a s c H C_ y •��- :mm • = 67 O l Q V W O N cm I m a C � .' �N o O FM4 E N ISZ H O H cp m co m o cm C C s m _ r.. 0 Z O 0 y ECD E 03 O CD C3 CO)cc O V Its CLCOD O cc C cc CL COD E CM C co m m 3� L CL 0 CL cma C J cc Z s CD CLCO2 C s c H C_ y �t :mm O co N cm I m C � .' m �= c H LO too m o :av` N O m _ oQ L om m >Z O ` O cO n H Z m y C m40 w w o3 :a H E- W O as ui c «- W H N a.=_ C W E v�60iH CL V m� O� c coo CL ID o �- =`=3 = w =.2aO..m E N ISZ H O H cp m co m o cm C C s m _ r.. 0 Z O 0 y ECD E 03 O CD C3 CO)cc O V Its CLCOD O cc C cc CL COD E CM C co m m 3� L CL 0 CL cma C J cc Z s CD CLCO2 C North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: 4-1— 7 4_5 /;�r K81 -e v, / M (Location of Facility) � � ls�'�l rtr � C,d I Signa a of Permit A plicant ate NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector TOWN OF NORTH ANDOVER AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142 A requires that the "reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units ... or to structures which are adjacent to such residence or building" be done by registered contractors, with certain exception, along with other requirements. Type of Work: 5 �'' C* leiEst. Cost Address of Work/,X, Owner Name: Date of Permit Application: �Z� �CG1 I hereby certify that: Registration is not required for the following reason(s): For office Use Only Work excluded by law Pemit No. :fob under $1,000 Date Building not owner -occupied _Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FIND LINER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Da Owner Name H coo n NORTH ANDOVER BUILDING DEPARTMENT 120 MAIN STREET NORTH ANDOVER, MA 01845 INSPECTOR OF BUILDINGS ELECTRICAL INSPECTOR GAS INSPECTOR Board of Appeals Town Office Building North Andover, Ma. Gentlemen: ti April 89 1985 Relative to petitions before your Boardq I have the following comments to make: 1. Petition of Robert G. Franz: Dr. Franz was referred to your Board since an in-law apartment requires a Special Permit from the Zoning Board of Appeals. 2. Petition of Miele Realty Trust: The petitic. ter was refused a building, permit because the building lot d..d not have the required area. TEL. 888-8102 3. Petition of Malcolm Norwood: Mr. Norwood w& refused a building permit because his proposed addition did not have the required setback. 4. Petition of Kenneth Kelley: Mr. Kelley w s Tefused a building permit because his proposed addition did not ave the required setback. 5. Petitions of Provost & Lundquist: No comment. Very truly yours, CHARLES'H. FOSTER INSPECTOR OF BUILDINGS . r CHF: of C1 "oir y Town Clerk: 00 Received �� o� .-. * s tt eEIVTOWN OF NORTH ANDOVER MASSACHUSETTS � ty' • Date: , --_ ANI 70 L COMA BOARD OF APPEALS ,S ....... Time �►OR � C SR{( S'4cHustt Nati VR This application must be type,4ritten MAR �g APPLICATION P*94#C#8SF1FROM THE REQUIREMENTS OF THE ZONING ORDINANCE Applicant Address /re . as�eer 1. Application is hereby made -91 (a) For a variance from the requirements'of Sectior, Paragraph _/ and .Table_ of the Zoning by -Laws. ' P (b) For a Special Permit under Section Paragraph of the Zoning By -Laws. c) As a party aggrieved, for review of a decision made by the Building Inspector or other authority. 2. ) Premises affected are land li and building(s) /t numbered Street. Premises affected are property with frontage on the North ( ) Soutn ( ) East ( ) West ( ) side of Street, and known as No. Street. Premises affected are in Zoning District and the premises affected have an area _, of ►aT 5 0� square feet and frontage of l� feet. 3. n.- rershi p Jame and address of owner (if joint ownersh-p, give all names): Date of purchase Previuus Owner. Ae/ "'1" 0/�Q.��S ) If applicant is not owner, check his interest in the premises: Prospective Purchaser Lesee Other (explain) 4. `ize of proposed building: 'r6 front; feet deep; :ie ight:__stories; feet. (a) Approximate date of erection: /,X -/(b) Occupancy or use of each floor:_ !c) ype of construction: 00 c/ 5. -ize of existing building:feet front; Hei ght :_,-*Z stori es ; feet. (a) Approximate date of erection: /1?7 (-b1 Occupancy or use of each floor: rum 7 feet deep; (c) Type of construction: 005:�. 6. ;ias there been a previous appeal, under zoning, on th.se premises? If so, when? 7. -Des cri pti on of relief sought on this petition /3,6y<,e "/44-d 8. Deed rYcorded in the Registry of Deeds in Book Page or La,id Court Certificate No. Book Page The principal points upon which I base my applica_�ion areas follows: (fust be stated 'i n, detai 1 ) /k ' Sec. 1 APPLICATION FORM incidental expenses* Petitioner's Signature Every application for action by the Board shall �e made on a form approved by the Board. These forms shall be furnished by the clerk upon request. Any communication purporting to b -i an application shall be treated as mere notice of intention to seek relief until such time as it is made on the official application form., All in- formation called for by the form shall be furnished by the applicant in the manner therein prescribed. Every application shall be submitted with a list of "Parties in Interest" which list shall include the petitioner, abutters; owners of land directly opposite on any public or private street or way, and abutters to the abutters within three hundred feet of the property line of the petitioner as they appear on the most recent applicable tax list, notwithstanding that the land of any such owner is located in another city or town, the Planning Board of the city or town, and the Planning Board of every abutting city or to -in. * Every application shall be submitted with an ap,lication charge cost in the amount of $25.00. In addition, the peti.ioner shall be respon- sible for any and all costs involved in bringin the petition before the board. Such costs shall include mailing an' publication, but are not necessarily limited to these. LIST OF PARTIES IN INTEREST dame Add.-ess /i Q'6 -t- -.✓ �iC.s/.4•C �!� f=� FAQ /G .0 (/ elly --,;, C_�e_ v (Use additional /o` j;, /70 x-/ j 8 o -e 2 e%•c- ,3v�r d2 y01/ sheets if necessary) i✓7l d �v%y%L�� Ql Ile ca ro SaNw6D /l -2S--IS- Permit No#: 11 Ln 'I Date Issued: IM] LOCA+ sl; Q N PROPERTY O MAP` _._ PARCEL:.ZONING QIS.TRICT: _ .Historic Distract Machine Shon BUILDING PERMIT NORTIi oFtt,.Eo TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION y T 1m Date Received �,9� C ED TANT: Applicant must complete all items on this u�r no yes n ves no) TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic O`1Nelli Q Floodplain, ❑ Wetlands, Weitershed'®istrict DESCRIPTION OF WORK TO BE PERFUKIIIIEU: I' ACCL t l - Please OWNER: Name: a JCI c or Print Clearly Address: YbV no Contractor Name_11 _ .Phone: Email: Address: Supervisor's Construction License:_ _ Ex; . Date: Home 1`mprovement License:._ , -__ Exp.- iDate: 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: $ 415�p FEE: $ Check No.: 6F Receipt No.. NOTE: Persons con ratting with unregistered contractors do not have access to the guaranty fund ;Sign Viae of Agent/OSignature ofrcontractor. _ 0 Plans Submitted ❑ Plans Waived.❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Taming/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Pennanent Dwnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH t COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: 84 Osgood Street FIRE DEPARTMENT TempH;Rumpster onsite ,yes_,___ Located 3no N4 ;l±ocatedlat 124tiMa;n•Street� FreDepartinent �i'gnature/d_ate .. _ _ _ MENif 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 2014 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 o 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 ❑ Floor/Cross Section/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 gOTE: 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 VOTE: 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 Clerics 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 Locationly,Q No. 7 ' Date Check # TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $_ Other Permit Fee $-- TOTAL -TOTAL $ e)-e� Building Inspector s I In co Wass x a W LL o z oc 0 LU z cc LU 0LLJ z 0 � W 0 C OC z z z Z Q U a z O coW cu u ai co O J O W N "a O LL Y Q N C LL hp d' C L U ro O LL11 L 3 O C O = Ql y O LL on O OC C LL 0 v O •� i 0_ CD a Q c 0 E Q L N " I. E a) 02 eve O ci L � 3 m � O' J N . • � L y 'a O O "a 'a N d Q • r+ t .O 0 0 z rL _ y 0 0 ' tmg = 3 .> ..: 0 L- = QCLm m T E CA 0' = C -- F- 0 CO) LLJco = C -a— O O , � N = U) "!R ,F t = O LU •E �, C.> N 0-0 CO 0).5 =N m O = I- . Q. 0 U E a� CL a� m O 0 N as t 4- O z O Q J O 2 z m CD z cri WN I.f a. W H W CL O U W :a U) Z 0 m r H O V U . O U CO U) LLJJ v O z W a W a W ac LL L.: d U) m m z W CL U) c i N ar 0 E N Gerald A. Brown Inspector of Buildings TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street, Building 20, Suite 2035 North Andover, Massachusetts 01845 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Telephone (978) 688-9545 Fax (978)688-9542 Please print DATE: it I 1 15 JOB LOCATION: 1'D SVC' Y1 G1 U`� Number Street Address Map/Lot HOMEOWNER� e y /F,� 7' VJ Name Home Phone 9T8'- g 8'6 03 I Co Work Phone /v JA PRESENT MAILING ADDRESS 1 ZC LM. s V e n o Y Ay< o v ,( UL 0 1 � q § City Town State Zip Code The current exemption for "homeowners" was extended to include owner occupied dwellings of one or two family dwellings and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. 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 dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. (780 CMR Section I IO.R5.1.2) The undersigned "homeowner" assumes responsibility for compliance with 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 andis and that e will comply with said procedures and requirements. , X HOMEOWNERS SIGNA APPROVAL OF BUILDING OFFICIAL Revised 8.2015 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 The Commonwealth of Massachusetts zDepartment of IndustrialAccidents 1 Congress Street, Suite 100 Boston, MA 02114--2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERNIITTING AUTHORITY. Name(Bttsiness/Organization/Individual): Address: 10 U I CL)V CV X I J n ( City/Stafe/Zile: I Are you an employer? Check the appiopriate box: n1 1.❑ I am a employer with employees (full and/or part-time).* 2.❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3..� I am a homeowner doing all work myself [No workers' comp. insurance required.] t 4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors -bade employees and have workers' comp. insurance.# 6.Q We are a corporation and its officers have exercised their right of 'exemption per MGL c. 152, §1(4), and we have no. employees. [No workers' comp. insurance required.] Type of project (required): 7. [] New construction 8. [] Remodeling 9. ❑ Demolition 10 ❑ Building addition 11.❑ Electrical repairs or additions 12. Plumbing repairs or additions 13. Roof repairs 14. ❑ Other *Any applicant that checks box 41 must also fill out the section below snowing mein woncers compcusativn policy information. t Homeowners who subriiif 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. Ifthe sub -contractors have employees,'&t must provide their workers' comp. policy number. I am an employer that is pioviding workers' compensation insurance for• my employees.' ,below is the policy and joh site information. Insurance Company Name: Policy if 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 S'T'OP 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 ertify der the pains a enalties of pet jury that the information provided above is true nd correct. �. ,,a+P. 11 11 9 I FD 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): i 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other 11 Contact Person: Phone #: 11 Information and Instructions Massachusetts General Laws chapter 152 requires all employers 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 bf litre, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant ofthe dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill- out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -'contractors) name(s), address(es) and -phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents foi- confirmation of insurance coverage. Also be sure to sign and date the affidavit. The af'.fiidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if yo'u'are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should'enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia