HomeMy WebLinkAboutBuilding Permit #1033-2016 - 1 OAK AVENUE 4/1/2016 BUILDING PERMIT NORTH w•
o��.LEO
TOWN OF NORTH ANDOVER ?/y� _ •a Lp
APPLICATION FOR PLAN EXAMINATION
* H T
COQ/�'1 ^4
Permit No#: J Date Received ( 3 °wArEo
;M�L
�SSACHl1`��'(
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION '� G
Print
PROPERTY OWNER ,641011 / rzo w �9714,144 e-
Print 100 Year Structure yes .
MAP ZONING DISTRICT: Historic District < no
`Machine Shop Village yes
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building �0ne family
,4K-Addition ❑Two or more.family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition _ ❑ Other _
El Septic 0Wl ElFloodplain ❑Wetlands ElWatershed District
❑Water/Sewer
DESCRI WORK TO BE PERFORMED:
a e
Id e tification- Please Type or Print Clearly
OWNER: Name: / Phone:
Address: y v /✓- .� o>✓c I�.4S�.
Contractor Name011—yl�oz,�SaV zcw>,- Phone: q7e
Email:
Address
Supervisor's Construction License: Exp. Date:
Home Improvement License: . Exp. Date:
ARCHITECT/ENGINEER Phone:
f"
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 Cost: $ �� FEE: $ �`T
Check No.: Receipt No.: ��72--
NOTE: Persons contracting with unre i ered ntractors do not have access to the guaranty fund
Signature of Agent/Owner nature of contractor
Plans Submitted Plans Waived ❑ Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DI OS
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
PLANNING & DEVELOPMENT Reviewed On 1 Signature_
COMMENTS
CONSERVATION Reviewed on Si nature
COMM -NTS
HEALTH Reviewed on Signature
C �
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
DPW Town Engineer: Signature:
,.- 3 , . - . _ —
FlAh'DEPARTMENT To, Dumpster on,sine yes T T
Located Osgood Street
Located:at1,24 - --
Main Street
Fire Departfnent signature/date
CQMMENTS�__ _
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA— (For department use)
❑ Notified for pickup Call Email
Date Time Contact Name 3
Doc.Building Pennit Revised 2014
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
❑ Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
❑ Floor Plan Or Proposed Interior Work
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
❑ Building Permit Application
❑ Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
❑ Floor/Cross Section/Elevation Plan Of Proposed Work,With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
❑ 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)
❑ Building Permit Application
o Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Copy of Contract
❑ Mass check Energy Compliance Report
❑ 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 Clerics 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:Building Permit Revised 2014
r .i
Location ZZ h
No. L''1 ' 1 U Date Y
r
• - TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $�2
Foundation Permit Fee $
Other Permit Fee $ *91
TOTAL $__
Check# �7c -
i C
Building Inspector
Enter construction cost for fee cal - North Andover Fee Calculation
Construction Cost
$ 279000.00 m
$ - $ 324.00
Plumbing Fee $ 40.50
Gas Fee 100 comm. $ 100.00
Electrical Fee $ 40.50
Total fees collected $ 505.00
1 Oak Avenue
1033-2016 on 4/1/16
21x20 deck
a i
e
f i
CXusT.,
{
UI
�f
O E.XI5T"BGs►L—� NEW DEt(L=.
p I — —— i
a �
r '
EXiS i.,FENCE
I;
u
C
A i
f
C: S
t
IS
IFLAN
_ N61 E
LOT ,A_�v oAK v vE •f 61ZT9 ANDOVS R, MA.
Th.&follow" Drawng!S'bmum� �xis�>ng.rlovse �o did R,no✓and
/✓$rr = f!'�� TA TRACY L. F RAZ IER 2S.Skewn on Hoar 'I
'i �_ Sla.v'aAtovls.
�: f soma. o��Ia P�af•Pan In�o°n'�8�io» �0�'��m2a f.��m i"torfga�t
i
.S'rtspcte,4 o+7 Plan - �FotKA�«R.
u
4
Ib�,si'ira�_ _. 23x4-�_"± " _. _._. . .. - - _IS'..7''�� _�' •
Etat!;T., A:G.,LlWIT-,t PIED71
t - -------- I j
1_7
G d.
�t ___ i .,, .,.\ iBs p Rm.
I I -
- t1T4
— - ---- \ ;
-- ``
>r1YVNCc POM .. �
f
_
I n" (l PaNtiL_: OTAXi-
tAUNP.sLy-_'
N.1=-W_WP4OLC 'Z5TEP5
Rx
'Kill PM
`o -EXIST,BUSH
-
EacrST,���c7;,MSIrEP, I I I
1 A5 to._WA.LK.'wAY_. L:NC- NEW CANoto•
I
3LO.
FLOOK
-E A 37., !S-ID Cil V9i \
ub7F-:1 - \-, GV,t,4,T,vEt4I PIPJ
�07E- ' REaTY: Z NSW CANtrpy
Sam NOM SA \
.� ! , � I (. "} I ,I I � � Saa; Mei E....�.._.
MT
as
Ll I
r^xtsz.,BuScr —-- 01-C 7 1 1 Vki;E ,P.A'L'NG-
t -11 1 t
rti►4< _ -cam- i - _ _ � �
LJ
I
- _
� ___.-..:-..__-__---__•-_._ _.—
Mg—
NEW unYou vlszitNa t 41
N aTc:P° 1 I
_ L7
_A55vtv-o offoofw(is_
S_7A_L- ELS-VA r I09 EASE`
�.. .Ex1Siart4 PoW%A J-NE4",q Mts7"ER.4 PODS, Ar.Lo35. OARAVRNUL, �KISTIt4e. (ome,,?LA-IF M uo ZLoWC,,f;DUNS?Aj4o0 T�JCLUVIMG P.XG5)W6 S7ePS.ana
— ---_
`�< :12EMavE Fatt87 acortNG and PRoV1p6 �F-W Roof1NQ MAka iZF-PAI R$' A5 mEr-psv., PRov)od NEN V✓ooO DmGK? Sj EpS�RA�LtN� AtSo RcMOVE EXiS`fINCs ST0�16 p!QN�RS and(2 PL4
NE'w'._tApoP'faYiJ DkACKCT-5vff 5 '�, P,X15itNG WooD Fewer-- �n�oFEGROOMD-3es ?L4N,Ow`�'t
Q
�Cyo�']R"f4�J `�151fiEAC�= (/, �X4 lA4C .Ca RAW_.L' Qt4LC. G.N R6�t�GE-RGPIAC�W�N�Y✓C6l�BRS.-Dt! L+Or5iD E1G✓.
4. a.nJ POO-ViA'G.Nsw POOP—t, 4ARPWARt and Ao7Us77.tiG
ttPfl o2 Tt2tra AS f�:CcE.,),7ti.t7_. '
J. PROVIDC CVWGTUGLo FrtvQft( Wsft GX16TING CoNG,,t3uor-K CHIMNEY.
. � l • 1
�j
1
f '
i
i
y Nom= �\
m
OVA *3
f._......_-..__. _ .
o
CXIST. - -
Ll
i
--
I I
I
fc814 .._ _-- 1•�-- -y M
D cK�'3' PS 9 i -(� -- --flfiGK"'�tzA h'190 I
on !
s
' F�6Zd NT LE_VATIou LP-0,-4 SCUT (SEAR EL.'EVAT1oN Lcok%4 NoR rli
Y4 _
_ 1wn,
,1 �a(iSrilJ�O Sl•,vtidG 1�.s-t4a�sg� u �/NFw�,N-Av>:a � PA 141 010 GrEt,s.nsPINED.
PROVitvf> NEw WA1(. GoNS.J RUG1lNG
'/WD,SiMi.4M5 -•ALSO SLEE[JOTS. �:T
-— A9P SEE NO�:'JJ-A MANZ
ON DRAWING4f
—
r
OORTH
Town of
C ', - :: ti 0
No. * -
32-bl�
?, h ver, Mass I
o� > >
A- CQCHICHt..C. �1'
7,95RgTE0
U BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
THIS CERTIFIES THAT 1AR ... ........ ?� ..,, ... ,,,,�,�.,1, „ E�, BUILDING INSPECTOR
Foundation
has permission to erect .......................... buildings on ........ .......
..)k...... ... .Vice4 c.........
Rough
to be occupied as . .�.. �....� . ....v.. .. ........................................... 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
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit.
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION STARTS Rough
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.
of NORTFf 1 TOWN OF NORTH ANDOVER
OFFICE OF
-- A BUILDING DEPARTMENT
e ; + 1600 Osgood Street, Building 20, Suite 2035
+O^AT.O North Andover,Massachusetts 01845
1SSAC"tujs
Gerald A.Brown Telephone(978)688-9545
Inspector of Buildings Fax (978)688-9542
HOMEOWNER LICENSE EXEMPTION
BUIDING PERMIT APPLICATION
Please print
DATE: 3 i� 1.4�
JOB LOCATION:
Number Street Address Map/Lot
,04,!/✓ gI Ci L
HOMEOWNER ,¢CV <2 Cy
Na e Hom hone Work Phone
PRESENT MAILING ADDRESS / Q,�� �¢✓C
►-en_ -/, W/'
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, rop vided
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 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 he/ e will c ures and
requirements.
HOMEOWNERS SIGNAT
APPROVAL OF BUILDING OFFICIAL
Revised 8.2015
Form Homeowners Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
The Commonwealth of Hassachusetts
- Department of IndustrialAecidents
M 1 Congress Street,Suite 100
_
Boston,MA 02114-2017
Vqt www mass.gov/dia
-Workers,Compensation Insurance Affidavit:Builder/Contractors/E,lectricians/Plwmbexs.
TO BE FILED WITH THE PERMITTING AUTHORITY. Please Paint
A ''Tdcantxnfoxmation
Name(Business/Organization/Iadividual): /2 G
44 z 10/1
Address: f24 A-�
41/- �� ✓/2 Phone
City/State/Zip: .3•;:s'
box: Type of project(required);
Are you an employer.Check the appropriate
em to ees Rill and/or part time). 7. ❑New`construcilon
1.❑I am a employer with P y
2.E]I an a sole proprietor or partnership and have no employees Working for me in 8. ❑Remo deliiig
any capacity.[No workers'comp.insurance required.] 9. Demolition
3,E]I am a homeowner doing all.work myself[No workers'comp.insurance required.]' 10❑Building addition
a homeowner and will be hiring contractors to conduct all work on my property. I will
en ure that allcontractors either have workers'compensation insurance or are sole
11.❑Electrical repairs or additions
}. IR 14, 12.r 'Plunnb.Mg repairs'or additions
proprietors with no•'e Np`yees.
5.❑I am a general contractor and T have hired the sub-contractors listed onthe attached sheet 13;Fj goof repairs
These sub-contractors have employees and have workers'comp.insurance. 14.0 Other
6.Q We are a corporation and its.officers have exercised their right of exemption per MGL c. �Do�
152,§1(4),and'we Have iib employees:[No workers'comp.insurance required.]
*Any applicant that checks boa#1 must also fill.out the section below showing their workers'compensation policy information.
i Homeowners who submit t'is„affidavit indicating they are doing all work andthen hire outside contractors must submit a new affidavit indicating such
tContractors that checkthis 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.
lam an employer that is providingworkers'compensation insurance for my employees. ]3elow is the poricy and job site
information.
Insurance Company Name:
Expiration Date:
Policy#or Self ins.Lie.#:
NIAdGlob Site Address:
�✓•-�iyi/ r>2 ty/State/Zip: /l ��✓�dy/•,, /n'g
Attach a copy of a�yoxkexs' compensation policy declar 'on page(showing the policy number and expixatxoxa.dale).
Failure to secure coverage as required under MGL o.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 WORD ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
ormation provided above is true and correct.
X do hereby certify under the pains and pen f
Date:
Si ature: _
Phone
official use only. Do not write in this area,to be completed by city or town offaciaL
City or To-wn: Permit/License#
Issuing Authority(circle one): i
1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Phone#•
Contact Person:
Information and. Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their eiApf6yees:
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is'defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver'onttustee of an individual,partnership,association or other legal entity,employing employees.-However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment b6 deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applfcaiit-whd�has root produced-acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been.presented to the contracting authority."
Applicants
Please fill out theworkers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub:contractor(s)name(s),address(es)and phone number(s)along with their certificates)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does Have
employees,a policy is required. Be advised thatthis affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a-Wkkers'
compensatiorl'policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which willbe used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy infbrmation(i£necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each
year.Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to burn leaves etc)said person is NOT required to complete this affidavit.
The Department's address,telephone and fax number_
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston,MA 02114-2017
Tel. #617-727-4900 ext.7406 or 1•-877-AMSSAFE
Fax#617-727-7749
Revised 02-23-15 www.mass.gov/dia
.s� DA •
CONSERVATION DEPARTMENT
Community Development Division
NEGATIVE DETERMINATION 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 within 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 March 10, 2016
Prepared by Scott M. Cerrato,P.LS.
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).
0
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://www.townofnorthandover.com/Pages/NAndoverMA—Conservation/index
N/F
TRUSTEES OF RESERVATIONS
ANDOVER STREET
MAP 59 PARCEL 26
I .1.......... ...._7..... ,...'%....,.f
BORDERING VEGETATED ; Woau FIE C' I
WETLANDS WFB8 ' _ LOT AREA
� 32.1 I c
kWF88 i 5,248 S.F.
LU
cV
C PROPOSED ;'
zl DECK
S I
WFBS tL'I
50' � '
,L c-0)
� I
oI l l21
: 15.s'
rF9N/F
: ..: ..0
WFB4 9 15.7' .. . HON JIN CH
ANG &
BEVERL Y STRA SSNER
N/F }o �:Un o 3 OAK A VENUE
TRUSTEES OF RESERVATIONS zo I o
ANDOVER STREET ;f; MAP 59 PARCEL 53
MAP 59 PARCEL 26 I o ; 13.1'
4,
'"F83 , ? EXISTING .
DWELLING`
18.9
•3
\WF82
52.00'
WFB1
0114K AVENUE
(PRI VA TE — 40' WIDE)
BORDERING VEGETATED
WETLANDS
WFAa-�--- o WFA2
WFA3
ZONING SETBACKS: R3
PLAN FRONT YARD 30'
SIDE YARD 20'
GRAPHIC SCALE REAR YARD 30'
10 0 10 20 40
RECORD OWNER:
1„ - 20' TRACY L. FRAZ I ER
BOOK 14017 PAGE 239
OF
MgSs9c
SCOTT yGs
M. a
CERRATO N
No.50049
FESs�e�Pv SCOTT M. CERRATO
lqN� SURV��� Professional Land Surveyor
24 Pleasant View Drive . Exeter,NH 03833 . 781-775-3724
I 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 ARiT LOCATED AS SHOWN. 1 OAK AVENUE
-:3 _/a /c NORTH ANDOVER, MASSACHUSETTS
DATE IGNATURE MAP 59 PARCEL 27
MARCH 10, 2016