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HomeMy WebLinkAboutBuilding Permit # 5/16/2016 BUILDING PERMIT 0, Dr J1 ��o TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION y0y P bs' � �f_ a r �� cn:cnc mH 1� � � / Date Received Ir�9"7TB9�®d N®#ft. J ,�: �SSus�� Date Issued: IMPORTANT: Applicant must complete all items on-this page LOCATION r4F® Q0rVFteq-' t?"VJA 6, I5 Il at,0 o- Print PROPERTY OWNER 14 V�--"Ye e Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Ile Historic:District yes o Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ew Building [Mne family ❑Addition k rwo or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other g 1 _ 1'1 k1w,' ' l "` f ,> Flootl Main ,r. Wetlar cis s ❑ Watershed District ❑ Septic ❑ I r, x '?- :w `` ww ^"�^ `.l "'$ t p ".='€tvf f �. ...a r„ r ra,`;r,�i 'kzr',r 'a r w,.7x?,�,.. "'x 3r . .� ✓; �l/�. C 'rw�s''i;r .:�. a`';,,�," l,� � DESCRIPTION OF WORK TO DE PERFORMED: f�(J n V 41 'dry Top_ V 1*1�•�S/ �7 m 4ow w- Identification- Please Type or Print Clearly OWNER: Name: K�5/L,'vn�, l-�-c . Phone: Address: /o �`c d ve- &o S;:�. e 41't-a3e Contractor Name::Ra j;&m ivr. C. 0sc�-o®o Phone: Sod_ ;L8 _q4, (o Email: Address: &,F d.0 {''.'Ll.a�-� �.�4�C. Na Irv,. aveoe, 'Mn-- d)1,0gC Supervisor's Construction License: C 5� cn:, .3-o ;L— Exp. Date: IJ, ly 1/4, Home Improvement License: Exp. Date: ARCHITECT/ENGINEER �14-� G°r4 �� Phone: 72o - JL 2o -toy r Address: AV1.10"IR, VVL IA , 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: $ 15_' Ozv FEE: $ lam• Check No.: Receipt No.: NOTE: Per, o contractin wit U ister d eo tractors do onhhaweac to e nar fzty and qhat reti T L Plans Submitted ❑ Mans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ [Public YPE Or SEWHRAGE DISPOSAL — —Sewer Swunmin Pools Tanning/Massage/k3odyArt ❑ell ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Pennanent Dwnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY --- — INTERDEPARTMENTAL SIGN OFF - U FORM PLANN11NG DEVELOPMENT Reviewed On L,., Z�� C<� Signature_ r- COMMENTS ( r. ,. A CONSERVATION Reviewed ani::. ature COMMENTS �. ' w S„..d � ��. ,.. �.n4„t^..�.. "'`.n, � 4„.t J`..'-1,.(A HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water Sewer Connectiorn/S Date Driveway Permit DPW Town Engineer. Signature: �iREy4®EC�ARsTM NT :,-,Temp0umpster on site yes, 3800 Street Located Osgood Sti �.Locates!at 1 Mi Win:Street NORTjj Jut.duver OL. ,- �► O -�v Ad o ver, d SSS `(S 'Q coCMICHEWIC1t U BOARD OF HEALTH rERMIT T Food/Kitchen 1)... Septic System 5 THIS CERTIFIES THAT....... ....L..:. .......1..:%�?��:...;�!�c', BUILDING INSPECTOR has permission to erect.......................... buildings on / G(/r�/' �� Foundation G ��� �_ Rough to be occupied as ......� � ���� y .............� ................... ................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of tapplication e 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 IN 6 MONTHS ELECTRICAL INSPECTOR LES CIO ARTS Rough Service BUILDING INSPECTOR Final ccupan GAS INSPECTOR y Permit e�yuired 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. The Commonwealth of Massachusetts Department of 1'ndustrialAceidents d 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dna Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le 'bl NaMe (Business/Organization[Itidividuual): Address: /0 tit°�T�'Gs�- Z%.V OE; City/State/Zip: Phone#: C? 7 FA —.3 Lfl Are you an employer?Checktlie appiopriafebox: Type of jest(r�•equired): 1.❑1 am a employer with ! employees(full and/or part-time).* 7• ew construction 2.Q I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remo delhig any capacity.[No workers'comp.insurance required.] ❑Demolition 3_F]I am a homeowner doing all work myself.[No workers'comp.-insurance required.]t 9. 10[]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.P Electrical repairs or additions pro''fetors with no employees. 12,[]Plumbing repairs or additions 5.0I anA a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have emesployeand have workers'comp.insurance.t 13. Roof repairs 6.F1 We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 152,§1(4),and wehavenoein. yees,[No workers'comp.insurance required.] r:. *Any applicant that checks box#1 must also fat out the section below showing their workers'compensation policy information. T Homeowners who siiliniif tris affidavit indicating they are doing all work and then hire outside contractors must s4bmit 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-coritrhefors have employees,they,must provide their workers'comp.policy number. ; ,Tam an employer that is pi•ovidiiig workers'compensation insurancefor my employees.'Below is the policy and job site information. Insurance Company Name: A C G—, ev- Policy#or Self-ins,Lie.#:_6e,9(0 01. V S — OCr pa(0;L `9' i Expiration Date: Job Site Address: 7� - City/State/Zip: D Vµ@o{�e r Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiation date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a rune 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$250.00 a day against the violator.A,copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. .ado hereby certify under thepains andpenaldes ofperjury that the inforinationpro vided above is true and correct. Signature. � — Date: Phone#: Official use only. Do not write in this area,to be completed by city or toren official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityl'I'own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: NOTICE a NOTICE0TO EMPLOYEES EMPLOYEES sq$bow The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS I Congress Street, Baits 100, Boston, Massachusetts 42114 — 2017 617-727®4900 — http://www.state.ma.us/dia As required by Massachusetts General Law, Chapter 152, Sections 21, 22 &30, this %vill give you notice that I (we) have provided for payment to our inured employtses under the above mentioned chapter by insuring wrih: ACE GROUP NAME OF INSURANCE COMPANY P.O. BOX 1450 -- MIn"I "DAR® NI 02344-1450 ADDRESS OF INSURANCE COMPANY (GS621J6-OG23626-9-i 6 r 0B-i 5-1 5 TO oB-1 5--1 6 POLICY NUMBER EFFECTIVE DATES W M P ROBERTS INS AGENCY 1060 OSGOOD STREET NORTH ANDOVER MA 01B45 -- NAME OF INSURANCE AGENT ADDRESS PHONE# OLD SALEM VILLAGE OF NORTH HEPATICA DRIVE & ANDOVER CONDOMINIUM TRUST; MAYFLOWER DRIVE ® NORTH ANDOVER MA 01845 EMPLOYER ADDRESS EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE MEDICALTREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of ° employment to furnish adequate and reasonable hospital and medical services in accordance: with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services 4� provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS 011918 W20PIG16 TO BE POSTED. BY EMPLOYER Massachusetts -Department of Public Safety Board of Building regulations and Standards LUldi llru l(l.CtUll Jilpll-d5U1 License: CS-075302 BENJAmiN C OsoOD ' f 69 Old Village Lade North Andover PJA 018 5 is 1 Expiration Commissioner 1210412016 ' -- -- '---------------------- --------------------------.------------L------- ........-------------- ------------------------------------------------ ----........... House z` 16-15 Fron t Eie va tion �� 3/16"= 1'0" ©cror�v^rcwMv mwu,v eu,ny,e R..x.., Dmwrng dare; Colonia! Drafting March 25, 2016 978-902-0131 Scole applies!or Il x 17 drmving E— 0, o/onmtdmfIkg.eom two ................. _......................................................................:; ............................. :...........................:.............................. .......---................... :............----...........................................-....-........:...................-........ Left Ele va tion Rk7h t Ele va tion 0 House 76—75 I`�° ",...�., Drawing data: Colonial Drafting Back Elevation March 26, 2016 978-902-0131 S-1a cppli s(a,IW7 drawing £—mule olon�dmfIb7y.eom 20 20,-10" 5'-6" 5--6" 10'-4 .......... .. Precast concrete Bulkhead ............ ............................ .................................... ..................................................................................................... ........ ..................................... .............................. .. ......................................... .. .................. ................................... ...... r Rod.,Mitigation' Rod.,Ult1gotibn '4 : V-01, 5'-0" 5'-0" 5 _V, • '4 10 3 112-d1o. Column -qd UP mo, . ................. . •.... ..... • 4 4' 5'-0" 4'-9" 4'-9" ......... PocketBeom ------------ A S'w x 6*dp x 9,toll ........................................ 4�1 Lally d1ov rZOOOdplumft'g, 4 reqV) 4 0 req'd 4L 'Y 4'-6' 22'-0" W Co,.Fd,. 20'W.x 10'dp. "t'g. wIth dompproot7ng p ................................................. .................. .......................... 11-0., 15'-6" 32'-0" Duplex j 16-15 OUT Foundation Plan " �C Drawing dotd., Colonial Drafting March 25, 2016 978-902-0131 Swte applies for 11 x 17 d-wng .1-0draffIng.—M 21'-4.W' 20'-11 V:" 3th" 20'-11'n' 11'-1049" 11•_0'• 10'-4m." 5'-0" 10'-1 V" 5'-f0" 5'-10" 10'-1W, 7'-5- 8'-0" 6•-�� I I q Dining ii Kitchen O'III II 5K-1i0tcey hrinoDining Fn/sh O xIl 57Auo.61M layouN0 l pry Gpsum rWallboardGysum 791 e/-X11 d on Garage side on Garage side—lb en Garage 3-10" 7'-6" 244" 3-6" 5'-102A. " 3-6" 29" T-6" Garage _._._._----._._-_.—._ O / \ LIL 61 pN Corage/House ©�s En try En try ©0 ,o o Goroge/House mu� 20 /nte (m/n.) a Entry Door o min 20 minute(m/n.) +'I r:: n_o_ Aro rating Closet Closet i0 N N O 16'x 8'Goroge Door �. va 9'x s'Coroge Door with 7ronsom window 4'-6" 11'-4+'/w' 11'-4+/." 4'-6" with Transom window is M Living Living V-3'6-a' 11'-0" 11•_0'• 22._0.. 4'-6+� - 14'-6" 12'-6" b o I � 'v •' 1'.y. ],_S.x L._9. 1 r e:y.]._S.x 4'_B. 2'-6" 2'-9V." 2'-9V+" 2'-6" 5'-0" 2'-6" 2'-9" 15'-10V" ate" 15•_10+/." 32'-0" Duplex zj 16-15 ���.P� First Floor Plan Drowing dote: Calanlai Drafting 3116"x, 1'-D" March 25, 2016 978-902-0131 Sco/a opp/'es far 11 x 17 drawing £-malb o1an0-draft/ngx— 32'-10'/n" 'W, 32'-101A" 2'-8" 2'-8" 2'-6" 4,-6" 9'-2+n" 4'-6" 4'-6" 9'-2+4" J 7-+0"v 3'-s z'-m'x C_o' z•-m"x a'-a" 2•-10'w a•_6" z'-10^x a•-6' r-to"x Y-5" w w q Both r M Bedrm 1 ° M Bedrm 1 `° Bath -3. p" O w w iV O q 0 O 3'_g'• 5'-3V." 3'-2+�•• 0 3'_9" 7'-6" 4'-2„ 2'-9+.i 2- 2'_6" 2'_9ih., 4,_2.' 7'_6'. '-9" 3'-2W' 5'-3L4" 3'-6" 0 1 c N � � •+ � N Computer Computer Qs Bath Bath q Qs m ©o 'Q 0 0 Q� Q; o n s'—e"x 4'-5' 2'-10"x 4'-6" 7-10 x a'-S S B"x a'-s" w w Oal O U U I M 6'-1'/a" 5'-10" 2'-9Y<° 2'-3" 2'-3"[2'-gV4" 5'-10" 6'-1Y+" Bedrm 2 Bedrm 2 5'_04„ 11'-17J." U U N V-8^x 4'-0" I 1 6+A" 2'-8" 2'-6" 3,_44" 9'-0" 3'-6" 15'-10V+" 316" 15'-104° 32,_0" Colonic/ Duplex 4f 16-15 ® Drafting First Floor Plan 3/16"> 1'-0" Draw/ng date: Alan Ccrro# March 26, 2016 978-902-0131 Scala opp/'es for 11 x 17 drawing E-mol% a1an6cdmffing.com 0 Ridge Board 2 x B Collar Tie®4'-0"o.a. Slope Cut,(S)-12d No!/s 11 Roaf f ming-2 x 10 (ase Fmmin/pT�P/ons!or apoc/ng) y_p^ Nall 8d 6"a,.zprlmeter /n de/d Aft/c Fmminq -2./O Fnlsh Moor (see FmmM Plona lar apoc/ng) Sub//oar J/4`7&C Shaothlnp Cyd n,B/xk/n -_ Noll 8d-6"a.<.pedmeI r &Lateral BreNng 4 ------- S - - I1"a.c.In iia/d D i ! Fax/o i Header ///i ______� I I J/a4"plywood ntlnuaua aappalt / m slab Shinger 2nd F/n"'-"P-2 x l0 (see Froming Plana lar spaUng) Stair Top De to/l J/4"r&C Sheathlnp r 1 Noll 6d-6"o.c.perimeter 12`o.e.In fled ! Exterior W }_-====vaav 2s x' 92§/8'8'ot, d, Solid RM B-o- N/l B1/2 Shacth�ng &Latero/ m°v°°° d c _. ter 12' 1,l }amv vvavv- D` 39 1st Fl.F -2,10 S ~ tae==aaOi° - - (see Fromlrrp Plana for apeclnp) "w }°°° Finish//oar J/4`r&C Sheathing iavm=aaav= Nall 8d-6 o.c.perimeter _ Sublloar 1.a.c.In Meld �aa_vv xaa_ Stall 0000666106006605 NUNN 57/1str/nger !J-2 x 6(P.T.) 2 2x6 1'-6'• Solid frro Block/ng ___ ('1 ) x B &Latero/ Approx •o }e..=m a v v ••? Flnlah Crode r 2,!0 4(-Heodruo 6" m Clr. 6'-6"minlmum �. Baaemenr Beam ` °^ to stab below }°°'°°°°°° Canc.Fdn.&Ft'g. Stair Base Detail Lolly Column&Ftg, P= 66C==== emvvva I pq Ceneroie Siab I 13'_9° B'-0" 11•_9„ (c rwr4no-cww o•nn,•,v mw�m....r Duplex 16-1 D—igdata.- Colonial Drafting v4"=!'-o" March 26r 2015 978-902-0131 Main Building Section Sw/e appl/es l Ilx17 drowing E- al/. al-doorort/ng.com