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HomeMy WebLinkAboutBuilding Permit #58 - Exception 7/26/2007 pORT11 BUILDING PERMIT 0 1-TUS0 06q~o oa TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ~ '° Date Received • /� �9"e" PPS,`5 Permit NO: ,r.o 9SSAC Hl1S�t Date Issued: IMPORTA i nt must complete all items on this page LOCATION 0. P nt PROPf=RYY OWN .. forint a:. MAP NO: PAICEL: ZC7NINCaDISTICT: HISTtJIIC C?1STIIGT ys no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ,%Addition IXTwo or more family ❑ Industrial ❑ Alteration No. of units: 2-- ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg .❑ Others: ❑ Demolition ❑ Other Septi (SW I 1 F oodpla n `t Itl/ tla ds 04Watershed District CI Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: C r>"c.-t- Y© ' X I Z ' -Fme -s-�ao� Identification Please Type or Print Clearly) OWNER: Name:�j e- -f Phonne:97 -97 0 q Address: (© �', ���� �` �� . ►-1��Over' W CONTRACTOR Name � � 4,Phone. , 4 x Address: N ti.. , Supervt or's Cc ns r`crctio cense � "E p. Date: " - 1k, 4h Home Improvement License. Expo IJate 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 Co : $ 1 3�� FEE: $ 30 Check No.: ��ZO Receipt No.: 7,a q{ g& NOTE: Persons con ratting .. nregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor Location No. DateG -O �oRTM TOWN OF NORTH ANDOVER F 9 + Certificate of Occupancy $ Building/Frame/Frame Permit Fee $t 30 s�CMust 9 Foundation Permit Fee $ z Other Permit Fee $ TOTAL $ Check # 2 O 204 ,:) u _ --- Building Inspector 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATI ����1�� COMMENTS S1 D/1 t I - DATE REJECTED DATE APPROVED HEALTH ❑ ❑ 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 FIRE DEPARTMENT&_?emp Dum�psteron.,site y . s no., Located at X124 Malo Street `ire Department signatur %date 4 of OMMENTS imension umber of Stories: Total square feet of floor area, based on Exterior dimensions. otal land area, sq. ft.: i LECTRICAL: Movement of Meter location, mast or service drop requires approval of lectrical Inspector Yes No ANGER ZONE LITERATURE: Yes No GL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 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 u Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit.Application o Certified Surveyed Plot Plan o Workers Comp Affidavit u Photo Copy of H.I.C. And C.S.L. Licenses a Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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) u Building Permit Application L3 Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 NORTH o 0Andover No. �8 - �` C o dower, MaSS., T O LAKE COCHICMEMCK V 7�S RA T E D P'' C7 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THA ?.D.e!w^-0d ........... ........ .........&... .. .....0................ ................ Foundation so has permission to erect........................................ buildings on jal..`... ..........46...'..... .............................. Rough to be occupied as..... ... ..t.L.......000-6.4.......A ................................. i .............................. Chmn y e provided that the person accepting this permit shall in every respect conform to the terms of the application on 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 i PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUTS Rough y 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. IF_sEE REVERSE SIDE Smoke Det. o+ pORTM 1 TOWN OF NORTH ANDOVER �� .•�:`�°'`���uc OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 *�•''�:,;,::�`�� North Andover,Massachusetts 01845 1ss�c►ws�� Gerald A.Brown Telephone(978)688-9545 Fax (978)688-9542 Inspector of Buildings HOMEOWNER LICENSE EXEMPTION Please mint DATE:--) - JOB LOCATION: CG 5`_ W°le r Number Street Address IMapJLot HOMEOWNER J�co ✓1�� 1-(Ockfe_y Name Horne Phone // Work Phone PRESENT MAII,ING ADDRESS le) + Al CIdUf City Town State Zip Code The current exemption for"homeowners"was extended to include owner-oocupied 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 helshe understands the Town of North Andover Building Department minimum inspection p and that helshe will comply with Said procedures and requirements. HOMEOWNERS SIGNATURE n APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homeowners Exemption BOARD OF APPEALS 688'541 CO.NSERVXRO`688 9530 HEALTH 698-9540 PLANNING 688-9535 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations a 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information f Please Print Legibly Name(Business/Organization/Individual): U C a n n2. R j nc.O e_y Address: 1 M �- City/State/Zip: n�6\X r Are you an employer?Check the appropriate box: Type of project(required):. 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6• ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. E]Demolition working for me in any capacity. employees and have workers' insurance.t 9. ❑Building addition [No workers'comp. insurance comp. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.P�l I am a homeowner doing all work officers have exercised their 11.El Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.❑ Other comp. insurance required.] 'My 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#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 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 herebfeerdfy under th pains andpenalties ofperjury that the information provided above is true and correct. Si ature: a ' Date: U _ Phone#: 97 -Q?? 5 o Oficial use only. Do not write in this area,to be completed by city or town official iCity or Town: Permit/License# ssuing 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#: !N k � Co Meo31"t� J c�bc>ve. ct�0 rkA— i I _ _ 2,x g Fc�xmrc1 oc. dovb�e. zX �2 �- I I • I I � � I I � � I � 1 ' I I � f� �k 61e. 2xi2 3� �o cemenfi i I I 1 ' I � I I ! I � I �' I I I � I ' I l l l l + I I '• I I I I l I I , I I I � I ! I � ! I ' I i I ' � I I � ! I I , ' � • ' i 1 , I I + i CERTIFIED PLOT PLAN LOCATED IN NORTH ANDOVER, MASS. SCALE.I"=40' DATE.6/5/2006 Scott L. Giles R.P.L.S. Frank. S. Giles R.P.L.S. 50 Deer Meadow Road North Andover, Mass. 1� k LOT 2 14,2 75 s.f. PROP.24'DIAMETER SWIMMING POOL N v v O 23' 26' O 1 W U w deck U LOT 28+/ 25'+/ 0 PARCEL 26 LOT 3 DECK O PARCEL 28 11• ll' _ Q 6.5' I EXIST. UPL Q o DRIVEWAY II J #10 #12 J 20' 17.25' 17.25' 18' � 73' EAST WATER STREET I CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE THE OFFSETS OF THE BUILDING INSPECTOR ONLY SHOWN COMPLY o AND SUCH USE IS FOR THE WITH THE ZONING BYLAWS OF 0.13DETERMINATION OF ZONING S ti 872 NORTH ANDOVER CONFORMITY OR NON-CONFORMITY l"E �0 WHEN BUILT WHEN CONSTRUCTED. ''�(LAIM � G �