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Home My WebLink AboutBuilding Permit #442 - 55 Water Street 12/1/2006 z TOWN OF NORTH ANDOVER r10RTh APPLICATION FOR PLAN EXAMINATION o #6 6 o O 9 Permit NO: 4,/ Date Received& 444� + s Date Issued:—,&—/- 04:� �99SACHUS��g — - - - - IMPORTANT: Applicant must complete all items on this page LOCATION 55 L_J G,f'e-r S/' Print PROPERTY OWNER 3US q17 1z oP7 f C( r? Print MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑New Building ❑ One family ❑Addition %Two or more family ❑ Industrial VAlteration No. of units: ❑ Repair, replacement ❑Assessory Bldg ❑Commercial ❑ Demolition ❑ Moving(relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED /- 2 •9�'�r h COin 51r c$ ��Id a r r U tiP cv L✓ Cr Oki i Do- r 4. Identification Please Type or Print Clearly) OWNER: Name: S Us!�4 v) F C3 fn f--r it-) Phone: `17 F`(8 3 Address: SS CONTRACTOR Name: Phone: q75, ' y6f d(��L/ Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ 0C]o'.OC) FEES '44/191-00 Check No.: // y Receipt No.: dr Page I of 4 i TYPE OF SEWERAGE DISPOSAL Swimming Pools ❑ Tanning/Massage/Body Art ❑ Public Sewer Tobacco Sales ❑ Food Packaging/Sales ❑ Well ❑ Permanent Dumpster on Site ❑ Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons eontractin witl nregistered c ntractors do_not have access to-the guaranty fund Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived LJ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS _ DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS FIRE DEPARTMENT - Temp Dumpster on site yes . no Fire Department signature/date 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 Building Setback( Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: i NOTES and DATA— For department use Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created 1MC.Jan.2006 i 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 Li- Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work i Addition Or Decks ❑ Building Permit Application ❑ Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report'(If Applicable) 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 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Page 4 of 4 i Locations No. Y`� Date l A MCRTh TOWN OF NORTH ANDOVER F 9 Certificate of Occupancy $ s�•Mus<� Building/Frame Permit Fee $ C Foundation Permit Fee $ Other Permit Fee $ ` TOTAL $ Check # ` f , 19847 �Q Tv� 3F V Building inspector The Commonwealth of Alassachusetts Department of Industrial:l ccidents Office of Investigations 600 Washington Street Boston, ,VL4 02111 1. s.,. www.mass.gov/dia yt' • Workers' Compensation Insurance ,affidavit: Builders/Contractors/Electricians/Plumbers l , r kpplicant Information Please Print Legibly Nallletllusincss,Urganii;tlit�ttillulividualY. � L°,�� gi, f o14,fX,tnC Address: City;State Zip: 4J 4m ioueii, 17.E o)5(Li5 Phone#: ct7,S (o e3-06,4`4 Are you an employer?Check the appropriate box: Type of project(required): I.❑ I am a employ er with 4. ❑ I am a general contractor and 1 p y 6. E] New construction em to ees full and,'or part-time).* have hired the sub-contractors p y ( p 7. E] Remodeling 2.❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees 'These sub-contractors have 3. ❑ Demolition workers' comp, insurance. addition working for me in any capacity. 9. Building [No workers'. comp. insurance 5. ❑ We are a corporation and its 10. Electrical repairs or additions required.] officers have exercised their p 3. 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.[No workers' comp. c. 152,31(3),and we have no I2.❑ Roof repairs insurance required.]' employees. [No workers' 13.❑ Other comp. insurance required.] — any;applicant that checks box r?I must also fill out the section below showing their workers'compensation policy information. y Ilomeowncrs 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 suh-contractorsand their workers'comp.policy information. I /am ern employer drat is providing workers'compensation insurance for my employees. Below is fire policy anal job.vire information. Insurance Company Name:-----_ - ------ —__--- -----'__-- Policy :i or Self-ins. Lic. .'f:—_----_ -- Expiration Job Site Address: CityState,'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 NAGL c. 152 can lead to the imposition of criminal penalties of a tine up to 51,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP 1k ORK 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 DLA for insurance coverage verification. I do hereby cerdy' u4der the pains r t d penalties of perjury that the information provided above A true and correct. 1i* �nr►hlre: nate: �� --- 1>ljichd rase only. !?u;;ut,mite n t/1i.►«r-+,a,lu he•r,mp/elcd b{ int nr rnwn+�1Jiciul. (7:ty or T+)w n• ?i;rmit/License# !ssuing Authority(circle one): I. hoard of Health 2. Building Department 3.City/Town C!erk 3. E!ectrical Inspector 3. Plumbing Inspector 6.Other f orlt�ct I':r,+,a: Phone#: _. ._ 40RTH Town of 0 fsil-i Andover No. 9/ zoo IL CO, 0 dover, M LAKE ass., COC MIC HEWICK %- 0"V?A'rE 'IT 62 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......... VA.^. . ...........F'A. ........................................................ Foundation has permission to erect........................................ buildings on.SC.....L%x4ev%. .....0%lb.......................... Rough to be occupied as.. W-mci#vj...............Z*...4-0.1............................................................. Chimney provided that the person this permit shall in every respect conform to the terms of the application an file in Final 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 �S� PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR MONTHS UNLESS CONSTRU Rough .................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Der. TONVN OF NORTH ANDOVER e3 OFFICE OF BUILDING DEPARTMENT • 1600 Osgood Street Building 20, Suite 2-64 North,\-ndover �Ac U5 , Massachusetts 01845 Gerald A. Brown Inspector of Buildings — Telephone(978)688-9545 NSE EXEl"OPTION1 Fax (978)6,SS-9542 HOMEOWNER LICE Please print DATE:_.. JOB LOCATION: Number ----- Street Address Nllap/Lot HONTEMYNER. �ZS,4im Api�_4.f �1 - - (I Name Home Phone <?tL- �W) V25--Oyy Work Phone PRESENT MAILING ADDRESS IVO, 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 doe - acts as supervisor). State Building (Code Section 108.3.5.1) s not possess a license,provided that the owner 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"homeoivner"certifies that lie,'.she understands the Town of North Andover Building Department .,.r with".""'.P,( minimum inspection procedures and requirements and that hc,,'she will comply tvith said procedures and requirements. 110�IEOW--.\'ERS 'if(3N,,ki'LRE-- APPROVM.OF BUILDING OFFICTQ