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Home My WebLink AboutBuilding Permit # 6/11/2015 0eRoTIiA q� 0UIL®I IT 4 tit TOWN OF NORTH ANDOVER ao APPLICATION FOR PLAN EXAII/IIN 1_I' N # � 'h n � Permit NO: Date Received Date Issued: w�` IMPORTANT: Applicant must complete all items on this pa,ge LOCATION .0 ��r �� '�. �. i9fi�t'✓I � ��i � � Print PROPERTY OWNER C Print MAP NO: PARCEL. .ZONING DISTRICT: ,, Historic District yesno Machine,Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Res' ential Non- Residential ❑ New Building VOne family ❑Addition ❑ Two or more family 11 Industrial D Aiierabon Ivu. UI units. _i l,Uiilruie ual ❑ Repair, replacement ❑Assessory Bldg ❑ Others: 11 Demolition ❑ Other F-1 0-4ir. ri1AI^11 nCI,. „4 r,1 Pia rii'1AI-0-w 4- n 1A1,+^ 1,^A Ilii.*,:,4 U VG-t.7,t14, I- V,wI II L! 1 I%4W%AF,"1J I 1-1 V VGa61AAi JU0 t_4 V V.GA4GI,JIJG,A V1+.7.0 11,1 11 Water/Sewer �—fy,,ur,t) L �— Identification Tease'Type or Print Clearly) OWNER: Name: (�A,C�0 Phone: Address: CONTRACTOR Name: Phone: Address: Supervisor's Construction',L:icene: Exp. D te: Name Improvernent:License: Exp. Date: 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: $ ILIZIL LO FEE: $ 349,6�1c Check No.: Receipt No.: '� 1 NOTE: Persons coiftraMni With unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner �rll k " 2 rte__Signature of contractor .. Plans Submitted Ll ' Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ [Private ' "F SEWERAGE DISPOSAL Sewer ❑ Tanning/MassageBody Art ❑ g Pools ❑ Swimmin P ❑ To Sales ❑ Food Packaging/Sales ❑ (septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM i PLANNING & DEVELOPMENT Reviewed On Signature_ COMM ENTSA P"1 CONSERVATION Reviewed on I Si nature` COMMENTS .. Q ° HEALTH Reviewed on t Signature COMMENTS f 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 ©sgood Street �,�° �" M'MEN i• ( r 77rtrt�,'�i l��'�l�l �;� �� Lp,��,, t1®RT#1 -Town of ®ver ® • `T 4 LAKE h ver, Mass,TL �� 15 A CoC"Icnew.c. y1 S V BOARD OF HEALTH Food/Kitchen rERMIT T D Septic System � 1 THIS CERTIFIES THAT i� , .1� ..., 8 �4 \.! BUILDING INSPECTOR ......... ... ... .................. .......... ............... C ... has permission to erect buildings on 0... . ,,,,• ,•, ••„•, ,,, Foundation .......................... ....... . ....... . �/ P Rough 4 11)lit to be occupied as .........�.1�1. .. ...... .. .... ..... Chimney ............................... Chimney provided that the person accepting 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT I IN 6 MONTHS ELECTRICAL INSPECTOR LESS C NST CT S T Rough Service .............. .. ......................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Islay 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. Iwo m I ffATOW BE Auk OM am Ida 7 OWnerr JENNIFER ROSS REGISTEREDLAND .Book sheet Lot(s): Dame: 12113r2W3 cadruwe of Twe Assessor's Mav BITE Lot Cedes 71-aa MORTGAGE INSPECHONPL" Scale i,i"%--W 90 BOSTONSTREET, NORTHA"OVER, MA LOT 4 o� LOT 3A LOT 7 45,000 SO. FT. a0 o Z11 N/F LOT 3B o ✓n —7<< L ' GOODHUE a "• to 1 E #90 20 -_ BOSTON STREET CERTi"CA7701V CBRTWV T07HE ABOVE ATPQRMY,RAM"M THEIR TITLE RMMM(:E COMPANY THAT TBE MAIN BU"ING,FOUNDATION OR DNVELUNGWAS Bti COM jMCE VMM THE WCAL ZONING BYLAWS IN EFWCY WHENCONSTRUCrED(WITHRESPECf TO UCTURALSLMM(XREQUIREPAEMONLY)ORISEXEMPYFROMVIOLATIONENFORCEMENTACTIONUiDERMASS GENERAL W TITLE VH,CHAAFI'E 4 A,SECrWK 7. FLOOD DEMPbMUMN BY SCALE,THE DWE[7aIGSHOWNHIMEDOES NOTFALLWnUNASPE IAL FLOOD HAZARD ZONE ASDELINFATEDONAMAPOFCOMMUNITY ff 250aX-009F ASZONE X DATED7-3-21)12BYT IE NATIONAL FLOOD II.TSURANCEPROGRAM "OF s orae stone Plot Plan Service,LLC NEIL qcc P.O Box 1166a t m KELLY -i Lakeville,MA 02347- CDNo_35036 Tel:(800)993-3302 Fax:(800)993-3304 �L- PLEASE NOTE:This inspetSon is not the r of an insMffmtsuney.The strttdta>rs as shwrrt are approodrnate only.Art' ed survey would be rerpraed for an acctaele dete nwnation of bt kit locations,encooact—rd%properly kne dimensions,fiaroas and lot configuration and may refied craerent kdonaafion than shown here.The land as shown is based on client famished iriformation only or assessor's map& occupation and maybe subjedto further oul-sales,talmg%easwmts and rights ofway. No responstG'ltly is mdended to the landowner or surveyor,or oocupanL This is merely a mortgage inspection and is not be be recorded. TO"OF-NORM ANDOVER oFIFICE OF y'ti 6&qtr k, a p ' 36 n:'ZS0D'QsgoottxeeE$uzldip•20,- itxfio2•-36 • Q.p cccacvc xe,?? `�. 831X➢F4�.[� North Audover,Massaahusetta Of 845 Gerald A.Brown � � Telepli.one(978)688-9545 1•nspeetorof:Buildings Fax (978)688-9542 HO- EaWNER MCBME BYEM.PTION 33MDINGrEpM- T")?LjCATf0N • T'leasepr?nE ' DME: SOB LOCA�dON,, 46, Numbor SlxeetAddzess Map/�ot ' IMMEQ TBR 0,j��n 6 (r-� a7 —Cl y—3`1Dmama. Homo Phone Woriz??kono TR SENT M TL1NW ADDRESS '' • ` ✓�.`i�n'�1 A,r�bUc�-rte � • TAe current exempfion dor �omeo�v�zexs" vas extendod to iaoJ zde owner occtipied divellugs to tvo units•or;ass and fa a'low sur,h hom Po mexs to engage an.?udiviaaaldf r hire w':no does a. a limnse,provided that the owner acts as supexvisor). SiateBuizding (Code Seotion lo8,3.5.1) DEMITZON OFROMEOW.N R , Pexson(s)wha towns aparcel ot'land on vrMCT.I.e(sTzeresiaes or intends to reside,on which thore is,oras intended to be,a one or two f'au ily sfructures. A persoxttvlto constructs zuorefbat onel�omein attvo-yearperxod sha71 not be cansadered ahomeowner, The undersigned"ltonteownez"assumesxasponszbilifyloz compliances Wiffi the StatuBuilding Codeand other Applicable codes,by-laws,mics andzeg lationg. Tlaeundersigned"h.omeownex"ceMes that lzelsheunderstands flie Town ofgortb.AncioverBuilding Deliattznent Manioaum inspection procedures and rogalrements and fhathefshe will comply with.;sand procedures and requirements, , APPROVAL OE,J3WDWG OFFICIAL Revised 7.2009 y Fonnnomeowners Exemption , )3OARDOFAPPEAT2688-9,541 CONSER'4'.rSUON6869530Yn DEAT.TH 688-9540 Pi.AMJNG 689-9535 The Commonwealth of Massachusetts Department oflndustrialAccidents I Congress Street, Suite 100 F Boston,MA.02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERNHTTING AUTHORITY. Applicant Informationnn Please Print Legibly Name(Business/Organization/Ind�ividual): 5r)icy- J7 Address: City/State/Zip: ,/441�- okgH Photle Are you an employer?Check ttie appropriate box: Type of project(required): 1.F1 I am a employer with employees(full and/or part-time).* 7, n New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. F1 Remodeling any capacity.-[No workers'-comp.-insurance-required.] F1 Demolition 3.yam a homeowner doing all work myself[No workers'comp.insurance required.]t 9. [� 4. I am a homeowner and will be hiring contractors to conduct all work on my property. I 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.E]Plumbing 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.insuranceJ p 6.F1We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 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. fi 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 thisbox 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 workeis'comp.policy number. Iain an employer tlirit is pi oviding workers'compensation insurance for my employees'Below is the policy and job site information. Insurance Company Name: 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). k'ailure 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 WORD 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 DTA for insurance coverage verification. I do hereby �cerrtify underthe-palinns and penalties ofperjury that the information provided above is true and correct. Signature: iT � G�'�/ Date: 044 6t i h Phone#: 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 Contact Person: Phone#: