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HomeMy WebLinkAboutBuilding Permit # 11/4/2016 OF aORTf-1 pH BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ' sa a� Permit No#' OI Date Received �'k �,y"•q�o Y tc9 SSACN�SE Date Issued: I17PQRTt1NT:Applicant must complete all items on this gage not - - . P„„not '500�'earStrucEure yes MAP �- P_P,RGEL� ZOfVING DISTRICT�Hisonc District `�}es <: I�Iachme In 'VA yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building N One family KAddition E.Two or more family E Industrial Alteration No.of units: -�Commercial ❑Repair,replacement C Assessory Bldg E Others: N Demolition- ::I-. ❑Other U Septic U Well ❑Floodplain D Wetlands 0.Watershed,District Nater Sewer DESCRIPTION OF WORK To BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: ' e, V' t Phone: th '3Ts3 Address:-'S-' Contractor Name: Phone: Email Address:% Superuisors Const�ucfion License: Exp Date: Home irriprovement License: Exp.,,%Dater ARCH ITECTIENGINEER Phone: Address: Reg.No. FEE SCHEDULE:BULDING PERMIT:,$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. `1 Total Project COSt:$ gv bL'Qe FEE:$ � Check No.: Receipt No.: 3f - NOTE: Persons contracting with unregistered contractors do not have access to the guarantj*fund Signature of Agent/Owner l Signature of contractor` Plans Submitted EJ Plans Waived 0 Certified Plot Plan W Stamped Plans EJ -fNRAGEDISPO&Z W(TF71§-EV�r, [Public sewer T-mmg/Massage/Body Att ❑ Swimming Pools Well Tobacco Sales Private tank etc. Food Packaging/Sales rivate(septic m"'k,etc. P—Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM PLANNING&DEVELOPMENT Reviewed On..1Signat, re_ f COMM ENTS—LQ41N CONSERVATION Reviewed on— Signature COMMENTS HEALTH Reviewed onSianature COMMENTS Zoning Board of'Appeals:Variance,Petition No: -Zoning Decision/recei Ptsubmitted yes_ Planning Board Decision: Comments_____ Conservation Decision:--7,——.—Comments Water&Sewer Connection/SkMIU—Ii-&—Q-.t—l�__--------q Driveway Perm—it DPW Town Engineer:Signature:___ FIRE D I EP' Dumpster on siteL6cated al"124 Mac Street Located�3840��o�cd street Temp I yes 6a Fire.De'Taft mentsignziture/date COMMENTS Town of F NORTH Andover o - No. 4r- 2.0 44— h ver, Mass, 40,#4P BOARD OF HEALTH Food/Kitchen ILD PERMIT TO Septic System THIS CERTIFIES THAT .....VI.N.C..0........ ............ BUILDING INSPECTOR has permission to erect..........................buildings on....Y.i....... ...... s Foundation TO At" Rough to be occupied as... #.ri Chimney provided that the person accepting permit shall in every respect conform to the terms...o' Vii... .. provided .......... ......... on file in this office,and to the'provisions of the Codes and By-Laws relating to the Inspection,Alteration and Final 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 CONSTRUCTION STARTS Rough Service .................... Final INSPECTOR GAS INSPECTOR Occupancy Permit RegWred 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. RORIN qN TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street,Building 20,Suite 2035 North Andover,Massachusetts 01845 Donald Belanger Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION r1ems-plarLt DATE:_ JOB LOCATION: Number Street Address Map/Lot HOMEOWNER Name Home Phone Work Phone PRESENT MAILING ADDRESS 'i I <-�-,j _ -Yl A ................ 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 supervisor. 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 fitior structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner,(780 CMR Section 110.85.1.2) 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 Honieom­Exemption BOARD OF APPEALS 688-9541 CONSERVA FION 688-9530 HEA1,11i 688-9540 PLANNING 688-9535 The Commonwealth of Massachusetts Department of IndastrW Accidents m 1 Congress Street,,Suite 100 Boston,MA 02114-2017 www massgov/dia worke&Compensation tasurance Affidavit:Builder8/Contractors!Electricians/1?lwnUers. TOBEFILED WyMTECEpFRM'MGAIITROI.t TY. ...VleasePrint Le'bt y. A 'licantlnformation Name(Basin 'aa5'ieall'ndividual):__ i✓_cQ. Addr ess_H l :,1.tvySn � 'f C-Yv A Phone 4: �9-715 City/State/Zip Are yon an employer?Check tii.e appropriate box: Type of project(required): 1-�1 am a employer �Playees(fulland/or part-time)." 'l. ❑N6*'d6MtrUdti0n 2.Q l am a solo proprietor or pscmarship and have no employees Workimg for mein A.❑Remodeling any capacity.[No workers'comp.insurance required.] 9, ❑Demolition 3,X'famahmneoo✓ner doing all Work mysclf[NO workcrs'camp.insurance required-]t 10r Building addition 4.Z 1 am s bomeowner-,Iw ll be biring contractors to conductall work onmy property-I will 11 Q Electrical repairs or additions emrseflist all contractors eitherhaveworkcrs'compensation uuuraace or arc sole IZ ]Plumbing repairs or additions proprietors withno emp16Yces. S.Qlamageneralcontmtorm4lhavehiredthemb-contractorslidedmtha ttachodsheet 13.,Ej Pirl6frepairs These sub-cont[actrns Irawe employees`odhaveworkcrs'comp.iasumnce3 '14.©Other-- 6.F1 ther _- 6,0 We am acorpomtionand its,ofEces have exercised their right of Lxcmption per MGL 0- 152,§1(4),audlve have no empldyees.[No workers'comp.inSrmannm required] "Ant aPPpcant that checks bbl:#1 tuost also fill out the seconbelaw showurgdezworkae compensation policy information.re doing all outside contractors must Mbialt anew affidavitiodicating tCormactors thatcheAthis hoi must attached an additional shmtshowing the namelire ofthe sabcoarracton and state whhe9rer arpp tthose,cntitie such employees.Ifthe sub-oozdiactors haysemployces,they most provide them workers'comp.policy number. .. - lam an employer Heat is prOvidingworkers'canzpensat ora iazsuraneefor my employees. Betow is the policy and,job site information Insurance Company Name:— Policy#or Self ins.Lie.#: _..�....——..—ExpirationDate_�, _ fob Site Address: ——� �" City/State/Zip Attach a copy of the workers'compensation policy declaration page(showing the Policy number and eapizatioxxdate). Failure ate)- Failure to secure coverage as required under MOL c.1.52„§25A is a criminal violation punishable by a fine up to$1,500-00 and/or one-yeas 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 Investigationg;of the DIA for assurance coverage verification- X doher�LlTelp !ties ofperymy that the informationprovided above is me andcorrectSienaturDate• . Official use Only.Do notwrite ill this area,to be completed by city or town Official. City orTown' --'— Pernait/I icense#__�.__ issuing Authority(circle one): p p ector 1.Board of Ifealth 2.Building Department 3.Ci /Town Cleric 4.Electrical ins ector 5.plumbing Insp 6.Other Phone# ContactPerson:__�.--.-- �_� CERTIFIED PLOT PLAN PREPARED FOR. VINCENT & KATHLEEN SIWCKI AT 41 SUMMER STREET NORTH ANDOVER, MA. NORTH ESSEX REGISTRY OF DEEDS: BK. 9111 PG. 78 ASSESSOR'S MAP. 65, LOT 62 ZONING. R2 SCALE.•1'--40' DATE.• SEPTEMBER 26, 2016 NOTE. EXIS77NG BUILDING DIMENSIONS TAKEN TO CORNERBOARD- ti 4. LOT A 44,242 SF Z 10 PROPOSED AD 77om 40-1, 19.5 73.3, 7.21 o S\ Ila,OF SSS A NO.35773 �5 LLPW PREPARED BY- JOHN ABAGIS & ASSOCIATES, PROFESSIONAL IXW SURVEYORS 9 BARMETT STREET NO. 252, ANDOVER, MA. (978)-688-4899 JOB NO. 6291 MATCH WALL AND FLOOR HEICHT5 TO EXI5TING RIDGEVENf 314'PLYWOODGd1�T TRIPL@ 1-5/4,X 14'LVL t?3 FAOH PAIR OF R4FfER5 RIDGEBEN1 COM P05MON ROOF 5HiG125 156FELTORBETTER VV 5HFATHING Rd hl'ERVfMS LAND WATEKNEMbRANE � d 6'X 6'P05T I R-491M15.IN OM.M MM ATED50FFrr R-21 IN5.MEJCf.WALL5 - -'-SIDING TOhWTLtiHOtSE OPENING DEMP.NINED TRIPLE i-3t4'X 11-7/6' '�-TWFKOREt,R1At. j BY5f2EEOFGA6F.P. f�LVLWADER 1/2'5HPATHING +--- P05TTOSILL 3 2'X6'JOt5T5®16-OZ. 3/f'ADJANTECH FLOORING - Z '.. 9-7l2'TJIJOI51S -... o-s DOUBLE2'Xb'P.T.rILL 6161O.C. '.. 1/2'DW ANCHOR BOLT 5FACED�g&C.C.b 12' R-30 M.IN FLOOR I ~Eth'?AM'CQRNER f-- 101 THICK POUREDOONCREfE WAtL5®3000 P51 3'THICK POURED CONCRETE 20'%10'POUREDGONCREIE GRt15HFD 5TGNE FLOOR a 3AW PSI �._ - FQOfiNtg�34LW PSI AROtND FOOTING - ' PERIMETER ORAMTODAYUGHT REAR 5ECTION ALL DIMEN5ION5 AND ELEVATION5 NT5 TO BE FIELD VERIFIED 2'X 10"RAFTERS 9-112"TJI J0I5T5 10"O.G, O.G. ------------------------------- TRIPLE 1-3/4'X 14"LVL- All VLA' MATGHFLOORHE[GM WMH EXL`TRla ROOM DOUbL.E 2"X G"5IL' \I LAYOVER ROOF E i FLOOR FRAME ------------------ r ROOF FRAME