HomeMy WebLinkAboutBuilding Permit # 8/25/2016 c- txORTH
BUILDING PERMIT
TOWN OF NORTH ANDOVERo _
APPLICATION FOR PLAN EXAMINATION
Permit N® Date Received � ���TEp aea A5
S+°OCHUSYc
Date Issued:
IMP TANT- Applicant must complete all items on thispage ._
LOCATION ~�
Print YL-L °
° ( l .v a
PROPERTY OWNER hs
Print 100 Year S cture yes no
MAP PARCEL a ZONING DISTRICT: Historic District yesLno
Machine Shop Village yes
TYPE OF IMPROVEMENT PROPOSED USE
_. Residential Non- Residential
❑ New Building ❑ One family
Addition F1 Two or more family El Industrial
❑ teration No. of units: ❑ Commercial
Repair, replacement T ❑ Assessory Bldg ❑ Others:
❑ Demolition 0 Other __..
Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer — ---
__.. DESCRIPTION OF WORK TO BE PERFORMED:
' - ,
o C)
_._. Identification- Please Type or Print Clearly
OWNER: Name: L c v -� Phone: o --\VNA '
r /
r
Address:
Contractor Name: Phone:
Email
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License; ___ Exp. Date:
A CHITECT/ENGINEER ` Phone;
Address: V . � t Reg. No.
,r
FEE SCHEDULE;BULDING PERMIT.$'12.!10 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED O!V$925.00 PER S.F
Total Project Cost: $ "� I �' � FEE: $
Check No.: _Receipt No.:
T}�7CTt: Pa_soa� �t vtt�i unre �t�I�cI cr)�atractors Flo not have access to the guaaanty.�`u���1
Sirtur � tL4er� ___ _. gtatire Of�ontr
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Town of = T 6 ndover
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No.
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oLAKV h ver, Mass, �5 XIL
_ L6CNIC NI WICK yh
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7 V+ U
BOARD OF HEALTH
Food/Kitchen
PERMIT D Septic System
THIS CERTIFIES THAT ..... ZOOM, .... ... ....... ..... ..
(:i 4BUILDING INSPECTOR
Foundation
has permission to erect .......................... buildings on . ..... .., ........ . . .s..................................
• �Y /�► Rough
to be occupied as faccepting
'1`/' . • f4,, ir,••„ jr......... Chimney
provided that the perso this pe mit 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 IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONST O ST Rough
do Service
Final
BUILDING INSPEC
GAS INSPECTOR
Occupancy Permit Regu red to Occupy BuRough
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.
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nor
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Dan's Deck Design
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FO LINDA TION LOCA TION PLAN
a-
WILLIAM BARRETT
CLIENT:
THIS CERTIFICATION IS MADE AND LIMITED
TO THE ABOVE CLIENT,
I CERTIFY THAT THE PRIMARY STRUCTURE SHOWN CONFORMS TO
THE HORIZONTAL SETBACK REQUIREMENTS OF THE LOCAL
APPLICABLE ZONING BY-LAWS IN EFFECT WHEN CONSTRUCTED.
(THIS CERTIFICATION DOES NOT CONSIDER ANY OTHER
RESTRICTIONS SUCH AS COVENANTS,WETLANDS,EASEMENTS,
ORDERS OF CONDITIONS,ETC.)
THIS DRAWING SHALL NOT BE USED BY THE CLIENT FOR ANY
PURPOSE OTHER THAN THAT OUTLINED ABOVE,EXCEPT WITH THE
WRITTEN PERMISSION OF CHRISTIANSEN & SERGI INC.
FURTHERMORE THIS DRAWING IS THE COPYRIGHTED PROPERTY
OF CHRISTIANSEN & SERGI INC. AND ANY UNAUTHORIZED USE
IS PROHIBITED.CHRISTIANSEN & SERGI TAKES NO RESPONSIBILITY
FOR THE UNAUTHORIZED USE OF THIS DRAWING OR ANY INFOR-
MATION CONTAINED HEREON.
BASED ON SCALED DATA ONLY THE PRIMARY STRUCTURE SHOWN
IS NOT LOCATED IN A FLOOD HAZARD ZONE AS SHOWN ON FEMA
FLOOD INSURANCE RATE MAP.
COMMUNITY NO..250098 0010 B DA TE:6/15/83
REFERENCE PLAN:N.E.R.D.8012
SCALE. 1"=40' DATE.12131193
MICHAEL
E Cil
y 197
STE E0
C !RI S TIANSEN SERGI PRO
LAND SURVEYORSEERS
160 SUMMER ST. HAVERHILL,MA. 01830 TEL, 508--373--0310
Q 1993 8Y CHRISTIANSEN & SERGI INC.
North Andover MIMAP June 14, 2016
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t Horizontal Datum:MA Staloplane Coordinate System,Datum NAD83,
SR Meters Data Sources:The data for this map vias produced by Merrimack
t4ORTh Valley Planning Commission(MVPC)using data provided by the Town of
Roads Ot ts`�u r pti3O North Andover.Add2tional data provided by the Executive Office of
tir Easements „�, �t p a Environmental Affairs/MassGIS.The Infonnat on depicted on this map is
Portals for planning purposes only.It may lint be adequate for legal boundary
Q ..--. "' A definition or regulatory Interpretation.THE TOWN OF NORTH ANDOVER
MAKES NO WARRANTIES,EXPRE=SSED OR IMPLIED,CONCERNING
4t. THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY
Y, Z x .yt OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT
4LASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
THIS INFORMATION
Ac HUS�S�y
1"W 78 ftc
IF
ver MIMAP
June 14, 2016
4 CHRISTIAN WAY
1a4.D-0002
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104.D-0091
261 BRIDGES LN
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co 197 VEST WAY
Vest Way 138`
104.D-0095
104,D-oo88
1a4.D-0106
104.D-0105
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225 BRIDGES LN 104.D-0104
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200 VEST WAY
[�MVPC Bo zoning Ovw ay Zoning
�T Municipal Boundary 0 Adult Entertainment Distric Buslne s 1 District
Mathis Shop Village Ove IBusine,s 2 District Busine.5 9 District Rail Horizontal Dalurn:MA Stateplarle Coordinate System,Datum NAU83,
-• t.Ene DJ Watershed Protection pill '1!d
Interswas Ilistodc Mill Area M Busine.s 4 District OR Y Malars Data Sources:The data for this map Was produced by Merrimack
-I („t Medical Marijuana Genera Business District * N f"1 ,q Valley Planning Commission(MVPC)using data provided by the Town of
- SR r3 Downtown Overlay District 147 Planne Carnmercial Dev `It�40 r y.��r(y North Andover,Additional data provided by the Executive Office of
Roads
( Historic District Corrido Development Dist „els 6 a d Encu mental Affers/MassGIS.The Information depicted on this map is
Osgood Smart Grmvih(40 Corrido Development Dist 0 for planning purposes only. It may not be adequate for legal boundary
e»,Easements Hydrographic Features 03 Corrido Development Dist 11. b definllion or regulatory interpretation.1 H TOWN of NORTH ANDOVER
indusiri tl 1 Dlstdo MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING
❑Parcels Streams Induslri 12 District M * THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY
Wetlands - Industri 13 District y,n0 e~ * OF THESE DATA,THE TOWN OF NORTH ANDOVER DOES NOT
Exempt Lands IR Industrl I S Dtsincl 940 ......�..a�e'� '�' ASSUME ANY LIABILITY ASSOCIATED WfFH THE USE OR MISUSE OF
Reside ce 1 District 'tl 4AT.0..v ,ry THIS INFORMATION
Resider cc 2 District
Reside as 3 District �$&ACNIl
de cc4 District
V=78 ft de cc
b District
de.co G District
.n=ge tesidentlal District
1
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LOT 25
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The Commonwealth ofMassachusetts
Department oflndustrialAceldents
M
1 Congress Street,Suite 100
r Boston,MA 02114-2017
www mass.gov1dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/I'lumtbers.
TO BE FILED WITH TBE PER1VJdT`l']NG AUTHORITY- ,
Applicant Information � VleasePrin.t Leiribly
N•aMe, (Business/Oxganizataonitndividual)_(2�_t�p •i/ t VL-( YV�K' C, ✓-
Addross: C�,L . -_ u-"o d ►�.p
City/state/Zip: fyy\,—A aV J2.,/ kyk- -_ 'hone#: —C�`l 2 c� d
Are you an employer?Checktlie apliropriafiehnx: Type of project()required):
I.❑I am a employer Wth employees(full and/or part-tirao).* 7r p New coristtuctiou
2.F-]I am a solo proprietor or partnership and have no employees working forme in $• Rermdelirig
any capacity.[No workers'comp,insurance required.]
9. DemtoRtion
3.F]I am a homeowner doing Wl work myself.[No workars'comp..insuranoe,required.]f
10 Building addition.
4.E,:)(.'1 am a homeowner and will be hiring contractors to conduct all work on my property. Zwill
ensure that aff contractors either have workers'compensation insurance or are solo 11.[ Electr7ical repairs or additions
pr6p'rietors withno employees. 12'
: Numbing repairs or additions
5,F]I am,a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. of r Roof epaixs
These sub-contractors Have emplcyeos and have workers'comp.insruance'l
6,E]We are a corporatign end ifs oft?eers have exercised their right o£'exemption per MGI.c.
14.F1 Other
152,§1(4),and we hive no.,employoes.[No workerscomp.insurancerequired.]
*Any applicant that checks b6x41 muse alsoM out the section below showingtheirworkers'compensation policy information.
T Homeowners-i10 snlimitgdEr afCdavit indicatingthey are doing all work and thenhire outside contractors must sa'bmit anew affidavit indicating such.
I'Contractors that check this box vaust•sttaclied an additional sheet showing the name of the sub-contractors and state whether orpotthose entities have
employees.'Ifthe sub-c,6A actors Have employees,they must pmvidetheir workers'comp.policy number.
X airz an employer tIz at is providing-wor'ker's'compensation insurance for my employees'Below is the policy and job site
information.
fnsurauce Company Name:
policy#or S elf-ins.Lic.#: Expixa#on Data:
rob Site Address: Czty/State/Zip:
AAttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL o. 152, §25A is a eximival violation punishable by a fine up to$1,500.00
and/or one-year impr'isoment,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 verifioation.
I do hereb certify under•thepains a Miesofperjury that the information provided a ove is true and correct.
-71 Si afore: L Date
Phone#:
Official use only. Do not Ifrite ite in this area,to be completed by city or town official,
•
City or Town: Permi"icense#
Issuing Authority(circle one): i
1.Board.of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Verson: phone#:
owd TOWN OF NORTH ANDOVER
OFFICE 0
'A B, UILDING DEPARTMENT
1600 Osgood Street,Building 20, Suite 2035
North Andover, Massachusetts 01845
Gerald A. Brown Telephone(978)688-9545
Inspector of Buildings Fax (978)688-9542
JJOMEOWNER LICENSE EXEMPTION
BUIDING PERMIT APPLICATION
Please PL11A
DA.TE':__7q
JOB LOCATIO N:
Number StreetAss Map/Lot
C
caw
HOMEOWNER
Name Horne Phone Work Phone
PRESENT MAILTNG-ADDRESS L
Ll
\AA-4—
City Town State Zip Code
The current exemption for"homeowners"was extended to include owner o"upie d dwelfings 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 sRPPEKisoK.
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 I I O.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 Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
HOMEOWNERS SIGNATURE__._
APPROVAL OF BUILDING OFFICIAL
Revised 8.2015
Form Homeowners Lxemption
BOARD OF APPEAUS 688-9541 CONSERVATfON 688-9530 UIFAUff-I 689-9540 P1,ANNW6 688-9535