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HomeMy WebLinkAboutBuilding Permit # 6/9/2015 BUILDING PERMIT oyKY"`�..,° TOWN OF NORTH ANDOVER _q // APPLICATION FOR PLAN EXAMINA ' Permit NO: Date Received LAINo Vo 44rav Ovo Date.Issued:_JpY11K1_:21 hor— ,S US JMP6RTXAT: Applicant must complete all items on this page ffil Ell .............. str,Mc ws DT� r//,Nes m VeRS111,11111 yes, ON Off"'F11,1V VAP"/,/ rr TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building One family El Addition 11 Two or more family El Industrial J(Alteration No, of units: El Commercial El Repair, replacement El Assessory Bldg El Others: El Demolition El Other -0, 4 at pie "d M OP3, Q', /Fs Identification Please Type or Print Clearly) OWNER: Name: _L)c ks Phone: Address: Al, I ARCHITECT/ENGINEER. ........ Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ks,90;66 FEE: $ &"� Check No.: `__1 A7 -Receipt No.: z7_7771 NOTE: Persons con ractin ith , rrgistered contractors do not have access to guarantyfund Signature e rA, `6p h ractor' Plans Submitted El Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans El TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art L] Swimming Pools 11 Well ❑ Tobacco Sales 11 Food Packaging/Sales 0 Private(septic tank,etc. ❑ Permanent Dumpster on Site Ll THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT F1 F1 COMENTS 137K I E 17EJ M I ED DAFEAFPKUVED CONSERVATION F1 COMMENTS V, 4"'"' 0 rt'r� DATE REJECTED DATE APPROVED HEALTH El El 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 %A®RTH mi'%Idover ' i 'own ot to ® 91#ki3O' 18)r t h ver.1 mass O LAKE 7 COCKICHEW/CK RATEDP Addmftk� PPp��y S U BOARD OF HEALTH ERMIT �T L Food/Kitchen Septic System w1 THIS CERTIFIES THAT , , , BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on .. . ......C.Pr"09.0w................. .................... .� Rough - A g to be occupied as ............................. .... . .. .. ... ..........111P �� 4�•1�+. ..... ....." .'............................ chimney provided that the person accepting this permit shall in eve spect 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 VIOLATION of the Zoning or Building Regulations voids this Permit. Rough Final EXPIRESPERMIT I OT S ELECTRICAL INSPECTOR UNLESS C C ST � TS Rough nay i Service .......... ....... ... .. .............................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® 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. i e , / S� CA A11DEN S TREE T 5/8%ROD SET) 5/8"1.ROD(SET) 75.00' f � LOTS 62, o 63, f 64 LOT` 67, 112, -.� 113, 114 PLAN ,OV195 PLAN 4V195 LOTS 66, ^' 69, 1O, } t I 518'%ROD 50.00' O �, CA (F) 1,,,i PIPE(FD) o = PLAN f195 LOTS 5, 66 0 PLAN 1195 l V 1.43' TO I.ROD(FD) "/.ROD(SET) 2 O' /J 5/87.ROD(SET)� 1/2"LROD(FD) 1 I PRINCETON .S TREE T SKETCH OF HANCOCK DArE, Survey Associates, Inc. 3/7/12 OF LOT STAKING 185 CENTRE STREET, DANVERS, MA. 01923 1N VOICE (978) 777-3050, FAX (978) 774-7816 SCALE-. I " = 30' 1/019 NORTH ANDOVER, MA mooll NO. 0 15 30 60 16827 F.•�Lmd Prcyacfs R2�16627�dwg� 16627wa.dwg Mar 07,2012—8:21 om �tide�£3Ib'R2'�''t4'^�idl'�A5S,S4.`!'.T$�ff804Si��R'i REGISTERED LAND SURVEYORS NAME DEBORAH M. ZA ZOUR WORCESTER, MA 01690--1723 LOCA770N 11 CAMDEN TREETt °4 PHONE* 508 -752– 5 — 0 FAY: 508-752-8895 QRTH�I� } A DivIallon of H. S, T: Geoup, Inc. SC LE 1 F 30 _ DATT 01 --19-12 co REI GIS Y NORTH � ,wm%,Am 5631/92 vruuKAMM, a tosm ALL. 4�� 1 95 No g� 00i 5` ' Haar tt arz�s(�tee Petr Festa t ThvNvi .'00 a ar USE S�z nso. t�3s 3 C �t►t�6m-02-�-9 a C�}�cr of qq����cyyyy�� ppyyo�y�� .OR TO RAW,g j ; .{1. - r , pryp ���q� a ��-p 1e�q qp�y...�. 6fr bYXu�V'a'n 4+H9tI V3+V hT.,PIL B i p� "tel �p9`a +t` F 1'4lbV[{'C'YWifH1 4Vi'-04!W3�W9 FLI A�`� f?° J,4a Ri NOT Y RoLt m 1J46m C�RtANT RMS on � G'a�SffA+9T" !A Y$Pi 04 C+�3iRt?!.�St� &vl B oars fa.z �.A s�ram� ,. eJ , RM tuancss mms � , � �. v $@q:� �4YiSk�9 Wr'CARt t7 f 84 5 YFf�77m Mmtra �fi@YdYa tib eS Y le�dl7£�tA!A`RQA i TO Rs.�R�'3C2Y SEB, � PRINCETON STREET CERTIFIED TD FIRST FEDERAL SAVINGS BANK ;f CL ,{ 1�k`tl n�;���# } TS a', �t�a� rSizR CAMDEN STREET SRQUMMG OnM2,R dd&VU ESCROW SEFt+t3irES MATH Dy.,rip North Andover MIMAP May 28, 2015 0{ti V it s Gam I . ' r � I INerstales '.. —SR Horizontal Datum:MA Slateptane Coordinate System,Datum NADB3, - Roads Meters Data Sources:The data for this map was produced by Merrimack HORTF� Valley Planning Commission(MVPC)using data provided by the Town of ¢'r Easements Of jt e q,yb North Andover.Additional data provided by the Executive Office of, MVPC Boundary yo +p O Environmental Affairs/MassGIS.The information depicted on this map is Parcels 3 L for planning purposes only.It may not be adequate for legal boundary F A definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING M THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY 4L i OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT r ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION �gSSAC14U 1"=66ft �E North Andover MIMAP May 28, 2015 85.0-0002 y� W 085.0-0012 cy !600 � 085.0-0009 � O 085.0-0008 15"LE IhdKaTC1h1 T 085.0-0004,22 CAMDEN ST ��� 085.0-0045 085.0-0024 NI 2C1 CAMDEN ST 15 CAMDEN S ^i 085.0-0005 085.0-0007 ;"� 25 CAMDEN ST 14 CAMDEN ST 222 PLEASANT ST e 085.0-0023 Goe 085.0-0017 "15 CAMDEN ST 085.0-0014 228 PLEASANT ST 22 PRINCETON ST 01 1� 11 CAMDE�� ST085.0-0022 � 0850-005 850-0047 ' ci 085.0-0021' ^s> R4 085.0-0030 ,,, 085.0-0037 227 PLEASANT ST 085.0-0036 085.0-0046 242 PLEASANT ST 085.0-0029 246 PLEASANT/ST 01` 085.0-0032. �I s rte' 9 PRINCETO ST 235 PLEASANT ST 085.0-0043 N 0-0031 24.1 PLEASANT ST 085. 085.0-0038: 085.0-0006 254 PLEASANT ST 085.0-0049 Cyt 326 OSGOOD ST ,- 58 PARK ST 085.0-0041 085.0-0040 085.0-.0050 251 PLEASANT ST 262 PLEASANT ST Rail Line Wetlands Zoning Interstates .. Exempt Lands Busine 51 District — Busine s 2 District Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, I — M Busine s 3 District Meters Data Sources:The data for this map was produced by Merrimack Busine s 4 DistrictNORTM Valley Planning Commission(MVPC)using data provided by the Town of Roads ® Gene" Business District �� t,lG r q North Andover.Additional data provided by the Executive Office of FI! Plenum Commercial Dev ,lt 6�N� Environmental Affalrs/MassGIS.The informaUon depicted on this ma is *Easements Corrido Develo menl Dist = 't'T � O p y MVPC Boundary j. p G for planning purposes only.r may not H adequate for legal boundary Corrido Development Dlsl 6 --• "` M definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER Municipal Boundary W Carrico Development Dist f` 'p MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING Industri I1 District THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY Zoning Overlay �! Iodustri 12 District �Adult Entertainment OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT Lal Indu'M 13 District r []Downtown Overlay District * a � * ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF IH0 Industri i S Dislricl 9y Historic District Reside ce l Dislricl l o44, �PPtq� THIS INFORMATION ©Water Protection "� Reside cel District 'SSACNUS�' ❑Parcels Rasiden ce 3 District Hydrographic Features de ce4 Dislricl 1"=66 ft de ce 5 Dislricl -- Streams pde ce 6 District „dge esidential District The Commonwealth of Massachusetts Department of Industrial Accidents y 1 Congress Street,Suite 100 Boston,MA 02114-2017 "r www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Ley_ibly (Business/Organization/Individual): t' �,g r 4 Name d� ' � 4 Address: City/State/Zip: ldrvl , l�" ° Phone ... Are you an employer?Chock the appropriate box: Type of project(required): l.❑I am a employer with employees(full and/or part-time).* 7. F]New construction 2.F-1 I am a sole proprietor or partnership and have no employees working for me in $. []Remodeling any capacity.[No workers'comp.insurance required.] 9. F1 Demolition 3.4 I am a homeowner doing all work myself,[No workers'comp,insurance required.]t 4.Q I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will 10 ❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.[]Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.n 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.[ p 6.0 We area corporation and its officers have exercised their right of'exemption per MGL C. 14. Other IJ,d"° - 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#I 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. tContractors 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 atm an employer that is pr'ovirlirrg ivorlcers'eoniperisation insurance for ruy eniployees. Beloit/is the policy and job site � information. Insurance Company Name: i Policy#or Self-ins.Lie.#; 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. Ido hereby under•th p ins and penalties ofperfury that the information provided above is true acrd correct. Signature Date: u . Phone#: P'1 ill ' ?,..CRY,. Offlcial use only. Do riot mite in this area,to be completed by city or'totvr:official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2,Building Department 3.C]ty/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone M 0ORT11 TOWN OF NORTH ANDOVER 16 0 OFFICE OF 0 BUILDING DEPARTMENT as 1600 Osgood Street Building 20, Suite 2-36 "Ano North Andover, Massachusetts 01845 S US Qerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE: - JOB LOCATION: 2 Number Street Address Map/Lot HOMEOWNER I�jlzn Lj lb 94-112AP-1fill"1�0i- 11 9, Name Home Phone Work Phone PRESENT MAILING ADDRESS s-:'kA/J--- 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 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. 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 APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535