HomeMy WebLinkAboutBuilding Permit # 4/1/2016 ,AORTH
BUILDING PERMIT
TOWN OF NORTH ANDOVER
¢ u, A
APPLICATION FOR PLAN EXAMINATION
Date Received
Permit No#: `< 4ssgcwusF�
Date Issued: t '
IMPORTANT:Applicant must complete all items on this page
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non-Residential
❑New Building One family
ddition [i Two or more family [I Industrial
Alteration j No.of units: ❑Commercial
❑Repair,replacement ❑Assessory Bldg ❑ Others:
❑Demolition Ei Other
eaD�s rtct
DESGRIPTIc).N nF WORK TQ BE PERFORMED.
-� {E
Ide tification- Please Type or Print Clearly
OWNER: Name: Phone: L { Y
Address °
KKR
ARCH ITEGTIENGINEER Phone:
Address: Reg.No. _
FEE SCHEDULE:BOLDING PERMIT:S12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost:$ _FEE:$
)-� Receipt No.: �
Check No.: p
NOTE: Persons contracting with unreai eyed ntraetors do not have access to the guaranty fund
S gnature;of Age_nt(Owner nature of contractor
Plans Submitted Plans Waived❑ Certified Plot Plan 0'--- Stamped Plans
Fe
SEWERAGE DISPOSA
I
er Tanning'Nla sage,Bad�ArItEj SFiinuning Pools� Tobacco Sales Foofl Paekaging`Sales ❑
Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF-U FORD
PLANNING&DEVELOPMENT Reviewed On ?` 1r. Signature_
COMMENTS I i` '--
_77-777
CONSERVATION Reviewed on 1jr z1( Signature` 3
COMMENTS
` 'HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals:Variance,Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Wafter$Sewer Connection's�naeure&Date Driveway Permit
DPW Town Engineer:Signature:
_ Located 384 Osgood Street
3103
ENTS\
T o w n o 2 NORTy Andover
o -
®. -JAt * � � -I I eat
* R� h A,R ver,Mass,
ry,9s R/1TED Pea,�49
t1 BOARD OF HEALTH
PERMIT T ILD Food/Kitchen
�j Septic System
THIS CERTIFIES THAT � • A?� •�"r ... 1 .N.... �.I. BUILDING INSPECTOR
...11711.. Fx. ....F.®�.% ® ......... Foundation
has permission to erect..........................buildings on....... ..... 5*e YMIw
�,w,/ ,pm @ F.�Q�'' \ ...................... Rough
to be occupied as.71/.`..�.. 0...... ........ .........:1r1......................, 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 EXPIRES 16 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION STARTS Rough
/p Service
.................... .. ................................ Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to 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.
NORTH TOWN OF NORTH ANDOVER
3S o}z,�to�agHOG g g�7OFFICE OF�-y y�
p BUILDING DEPARTMENT
,a r 1600 Osgood Street,Building 20,Suite 2035
Not Andover,Massachusetts 01845
�SSncHusE1
Gerald A.Brown Telephone(978)688-9545
Inspector of Buildings Fax (978)688-9542
HOMEOWNER LICENSE,EXEMPTION
BUIDING PERMIT APPLICATION
Please print
DATE: 3 it f
JOB LOCATION: y1.;?, 7 _
_Number Street Address Map1ot
.y<,�v �i�✓G<L
HOMEOWNER �C/
NAo Hom hone Work Phone
PRESENT MAILING ADDRESS / !¢110
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 super visor.
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 110.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 Build g Department
minimum inspection procedures and requirements and that hel e will e ores and
requirements.
HOMEOWNERS SIGNATUR
APPROVAL OF BUILDING OFFICIAL
Revised 8.2015
Fo—Homeowners Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
The C0nrrrzonlvealt7i ofMassaehuseffs
Department offadustrialAceidents
Z ea#gress Street,Shite 100
Boston,MA 02114-2017
au .
www mass.govtdia
' Workers'CompensationlnsuranceAffidavit:Builder�ZConb:actors/.C��leehiciansZPlumbers.
TO BE FMFD WITEITM PERMITTING AL 'THORI?'X. Please Print Le•bI
A "Iicantlnformation e
YG ! GQ
Name(BusinesslOrgaviaationttndividual} G
Address: ` z-
City(Slate(Zip Phone#•
... Type o£prolect(Tequne l);
-Are you an empI yer�Checicfhe aggropriafebvs:
em Iv cos fiilland/orpartf(me).` 7. ❑1V'ew��diinstrucfion
I.QZ am a aaPIayorwith - P y' { g- ❑Remodeling
2.❑Z am a sole prapdetoror partnersfnp and have no employees working forme in
any capacity.lNoworkexs'come,insurance required.] 9•❑Demolltioii
3.Q l am ahomeowner doing all,workmysol£[No workers'comp.insuraneerequired.]t 10 Q Building addition
am afiomeownor andwill ba hiring contractors fo conduct all work onmy property.twill I1❑Electrical Tep*s or additiops
en me that all ontmor�rfhorhaea f;orkers'compensafion insurance or areso]e
12 bingrepairsoradditions
proprietors wrthno employees.
5"❑I am a general contractor andllave hiredthe sub-conf[acfors listed ontfia attached sheet.
I3:0 Roofairs
These sub-ces roaa as have employees_dhavaworkars'comp.lean once t 14. Ofherxep
6"❑WoareacorporatioFiand iFS officers have exeroisedfheirrightefexemption ger MGL c. ��f
152,§1(4)andwshave ao employees:[No workers'comp.insurance required.] F
-Any applicant that checksbox#1 must also£dloutthesectionbelowshowingtheirworkors'compensationpolicy7nformatios'
tGot.
ntrzofora that ch cktlus hozam�ustaritached'an.additional shee�sFrowingthename offlre sub-contraefors and state whetter oFgot£hose nfiti gave�
policy number.
employees.If the sub-,oi&efors fiave employees,they mistproside their workers'comp.
'compensation insurancefor my empZayees. Below is thepalacy and Job site
X am an employer that is providangworkers
information.
Insurance Company Name:
P.xpirattonDatot
policy#or Self-ins.Lie.#:
/Wt9 �vf
effi/G City/State/Zip:
Job Site Address: 1 by the olio number and expiration date).
1 iAtfachacopyof ewotikexs'compensationpoheydeeIararroupnge ,..,.. g policy
Failure to secure coverage as requited under MGL G.152,§25A is a criminal violation punishable by a foie 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 8no ofup to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Invest gat ons ofthe DIA far assurance
coverage verification.
ormation provided above is true and correct.
Xdo/ter•ebycert un derthepainsandpen y! �
_ Date:
� Si atare-
_�Phone
F
Official use only.Da notwrite in this area,to be completed by city or town offteial-
Permit/License#
City or Town:
Usuing.Authority(circle one):
1.Board of Ffealth 2.Building Department 3.City/Town Clerk 4.Electrical inspector 5.Plumbing Inspector
6.other
Phone#-
Contact Person;
o•
q�
CONSERVATION DEPARTMENT
Community Development Division
NEGA'T'IVE;DETER ffNATION OF APPLICABILITY
SPECIAL,CONDITIONS
1 Oak Avenue,North Andover
At the March 23,2016 public hearing the North Andover Conservation Commission(NACC)voted
to issue a Negative Determination of Applicability to construct a deck with roof and open deck
(both on sono-tubes)and replace an existing wood fence with a vinyl fence a=itbin the 100-foot
Buffer Zone to Bordering Vegetated Wetland(BVW). The project will conform to the following:
Applicants/Owners: Tracy Frazier and Alan Bingel
2 Stoney Brook Lane
Salem,NH 03079
Record Documents: Request for Determination of Applicability Form 1 and supporting
materials,submitted:March 11,2016
Plan dated Match 10,2016
Prepared by Scott M.Cerrato,RLS.
24 Pleasant View Drive,Exeter,NH 03833
Titled:Proposed Plot Plan 1 Oak Avenue
North Andover,Massachusetts
SPECIAL CONDITIONS:
1. Prior to the start of work the applicant will ensure that the site contractor has reviewed the
Determination and is aware of the wetland resource area and the limits of the proposed work.
2. Wetland markers will be placed on the new fence spaced evenly at 30'intervals(5 markers—3
round/2 square). Markers are available from the Conservation Department($2 round/$3
square).
3. Once the work is complete,all disturbed areas will be stabilized with loam and seed or other
methods approved by the Conservation Department.
4. Upon completion of the approved project and site stabilization(grass growing and ready to be
mowed),please contact the Conservation Department for a final inspection.
1600 Osgood Street,Suite 2035,North Andover,Massachusetts 01845
Phone 978.688.9530 Fax 978.688.9542
Web:http://wwsv.townofnorthandover.com/Pages/NAndover&IA Conservation/index
N/F
TRUSTEES OF RESERVATIONS
ANDOVER STREET
MAP 59 PARCEL 26
BORDERING VEGETATED1 WOoa
WETLANDS 32.1' I LOT AREA
WFBB 5,248 S.F.
W
I LL�
11 m PROPOSED 'i'
WFBB w� �I a� DECK
ED
1Lo r '0i 15.6' � NIF
z �I' HON ✓IN CHANG &
wF64 �' 15.7' 21! o BEVERLY SIRA SSNER
NSF " yl 3 OAK AVENUE
TRUSTEES OF RESERVATIONS ' �- a m o
� 7 ;�7 MAP 59 PARCEL 53
ANDOVER STREET
MAP 59 PARCEL 26 ( 81�I�
3 ` ` EXISTING'','
VDWELLING,;1
�A ;
S�
a. \ 4L
wF6z o
52.00'
i,
WFBI
OAK AVENUE
(PRIVATE — 40' WIDE)
BORDERING VEGETATED
WETLANDS
WFo 1 o WfA2
.AL
WFA3
ZONING SETBACKS: R3
PLAN FRONT YARD 30'
SIDE YARD 20'
GRAPHIC SCALE REAR YARD 30'
10 0 10 20 40 RECORD OWNER:
1" = zo' TRACY L. FRAZIER
BOOK 14017 PAGE 239
OF MASs9�,y
� SCOTT �s
M.
CERRATO
No.50049
FESS\oap� SCOTT M. CERRAT®
�qNO SURNProfessional Land Surveyor
24 Pleasant View Drive. Exeter,NH 03833 . 781-775-3724
l HEREBY CERTIFY THAT THIS PLAN IS BASED PROPOSED PLOT PLAN
ON AN ACTUAL INSTRUMENT SURVEY MADE ON THE
GROUND IN MARCH 20 6 AND THE STRUCTURES
DEPICTED HEREON ARE LOCATED AS SHOWN. 1 OAK AVENUE
NORTH ANDOVER, MASSACHUSETTS
DATE IGNATURE MAP 59 PARCEL 27
MARCH 10, 2016
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