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HomeMy WebLinkAboutBuilding Permit #450-14 - 1020 SALEM STREET 11/20/2013 TOWN OF NORTH ANDOVER � APPLICATION FOR PLAN EXAMINATION Permit N0.• i�t Vrn-N Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION -- .�r a --: Print. PROPERTY OWNER P=rint v 100 Year Old structure yes, no MAP NO:104 PARCEL:85 ZONING DISTRICT Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT. PROPOSED USE Residential Non- Residential ❑ New Building 'g One family %Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other .0 Septic: El Well -- ❑Floodplain q Wetlands: ❑ Watershed District 0 Water/Sewer { DESCRIPTION OF WORK TO BE PERFORMED: l� y 34s dritc Identification Please Type or Print Clearly) OWNER: Name: i ouy W� Phone: 617- 17 u— 4`7 T-5 Address: b> 20 S ^ 1CONTRACTOR Name'. . _ Phone:-., Address: o Supervisor's-Construction License: am' . r--Exp: Date: _ Home Improvement License; _ - Exp Date: ARCHITECT/ENGINEER 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. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracts g 1W't unregi eyed contractors do not have access t t uaranty fund Si nature of A ent�Owri �' .!U], it of contractor _ 9.w _ _g.�_ _ - Plans Submitted Plans Waived 0 Certified Plot Plan ❑ Stamped Pla s ❑ Building Department The fol,,owing is--a fist of the required forms to be filled out for the appropriate permit to.be obtained. Roofivg, Siding, Interior Rehabilitation Permits a Building Permit Application ❑ Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o 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 o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract ❑ Floor/Crossection/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 ConstructionSin le and Two Family) � 9 Y) ❑ Building Permit Application ❑ Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Llccnscs o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations If Applicable) o Copy of Contract o Mass check Energy Compliance Report o 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 Clerks office must stamp the decision from the Board of Appeals that the apw-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.?ted with the building application Doc: Doc.Buiiding permit Revised 2012 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ .-TYPE_OP..SEWERAGEDISP-OSAL Public Sewer ❑ Tanning/Massage/BodyArt ❑. . Swinuning 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 DATE REJECTED DATE.APPROVED PLANNING& DEVELOPMENT [] COMMENTS A�_ PM Jez,-j i� -CONSERVATION Reviewed on �; v� - Sinature 1 � COMMENTS r HEALTH Reviewed on Si nature �l J 9 3 COMMS TS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/s_ianature& Date Driveway Permit DPW Tow;; Engineer: Signature: FIRE DEP,4RTM:rNT - Temp Dumpster on site yes Located 3noOs ood Street Located-bt 124 Mair Street.-- Fire Departme►�t signature/date r. COMMENTS Nrt { Dimension I 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 re quires a Electrical Inspector yes q pproval of No DANGER Z®N ' LIT ERATURE: Yes No MGL-Chapter 166 Section 21A-F and G min.$100-$1000.fine i N®TES and DATA — (For department use i at I L v . ® Notified foricku Da p p - to � t I f I Doe.Building Permit Revised 2010 Location 1��� ISC 1-,0_ vv) 54vz� No. Date it • - TOWN OF NORTH ANDOVER • Certificate of Occupancy $ -xv " Building/Frame Permit Fee $ Foundation Permit Fee $ .: Other Permit Fee $ TOTAL $ Check#t 27123 Building Inspector r , NORTH - w: 1 - A. -c ve' 'o 0 �. - ver, Mass )�o&m6a 2z T O AKE 1 A L , COC CKEW.CK � �V S U BOARD OF HEALTH Food/Kitchen PER IT T LD Septic System THIS CERTIFIES THAT 4frc! .............................................................. BUILDING INSPECTOR has permission to erect .......................... buildings on ., �....... 5 Foundation Rough to be occupied as ...�.Q..l.12 A:1..... �.!.:.' j.gT�resppec ...I...� :�1.9... .. ........... Chimney provided that the person accepting this permit shall in everynform 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 CONSTRUCTI ST TS Rough Service ............. ................................................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. SEE REVERSE SIDE Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 4%500.00 m $ - $ 594.00 Plumbing Fee $ 74.25 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 74.25 Total fees collected $ 842.50 1020 Salem Street 450-14 on 11/20/2013 18x24 Addition with Garage Below 16x38 Deck L & L STRUCTUPUAL ENCTRgEE II\T ERV-T E , TMC. South Portlm idp ME 04106 Telephone- 2077 767-4830 October 25,2013 Harry Hepburn BRIBURN Architecture for Life 28 Maple Street Suite 202 Portland,Maine 04101 Subject: Warren Residence—Addition 1020 Salem Street,North Andover,MA Dear Harry, As per your request we prepared and submitted the structural documents/drawings(S 101 &S 102)for the garage and family room addition to the Warren Residence located on 1420 Salem Street in North Andover,MA. Our analysis and design of the structure was performed utilizing the Massachusetts State Building Code(8th Edition)based on the 2009 International Building Code(IBC)and compliance with the 2012 International Residential Building Code(IRC) adopted by the Town of North Andover,MA. The analysis also considered the Building Code Requirements for Wood Construction(NDS-latest edition)published by the National Forest Products Association. We understand that there is a query regarding the structural"shear walls"and/or the Main Wind Force-Resisting System(MWFRS)for the building. The exterior walls of the building including the approximately T-0"wide stud wall on one side of the overhead garage door are adequate to resist the code stipulated lateral(wind and/or seismic)loads imposed on the building acting as"shear walls"as indicated on the design drawings(see drawing S 102 for typical exterior wall construction including blocking and nailing patterns indicated). Hence,no additional reinforcement; holdowns;wall sheathing;or structural ties are required and the design drawings are acceptable as submitted. If you have any questions,or require any additional technical assistance,please do not hesitate to call. Sincerely, L&L Structural Engineering Services,Inc. Joseph H.Leasure,P.E. Principal cc.:File OSEPH H. �LEASU TRUCi `� NO.4840 L vz rFSFG/STEPE� S ►� CONAL ENG 1♦�►1 REScheck Software Version 4.4.4 Compliance Certificate Project Title: Warren Residence Energy Code: 2012 IECC Location: North Andover,Massachusetts Construction Type: Single Family Project Type: Addition Glazing Area Percentage: 51% Heating Degree Days: 6322 Climate Zone: 5 Construction Site: Owner/Agent: Designer/Contractor: 1020 Salem Street Anthony&Stephanie Warren Harry Hepburn North Andover,MA 01845 1020 Salem Street BRIBURN North Andover,MA 01845 28 Maple Street anthony.warren@northstar-pres.com Suite 202 Portland,ME 04101 207-774-8482 hhepburn@bribum.com Compliance:15.2%Better Than Code Maximum UA:112 Your UA:95 The%Better or Worse Than Code index reflects how close to compliance the house is based on code trade-off rules. It DOES NOT provide an estimate of energy use or cost relative to a minimum-code home. • Floor 1:All-Wood Joist/Truss:Over Unconditioned Space 459 38.0 0.0 12 Ceiling 1:Flat Ceiling or Scissor Truss 399 54.0 0.0 10 Ceiling 2:Flat Ceiling or Scissor Truss 60 47.0 0.0 2 Wall 1:Wood Frame,16"D.C. 98 21.0 0.0 1 Window 1:Wood Frame:Double Pane with Low-E 76 0.250 19 Wall 2:Wood Frame,16"o.c. 57 21.0 0.0 2 Window 2:Wood Frame:Double Pane with Low-E 25 0.250 6 Wall 3:Wood Frame, 16"o.c. 117 21.0 0.0 4 Window 3:Wood Frame:Double Pane with Low-E 51 0.250 13 Wall 4:Wood Frame, 16"o.c. 98 21.0 0.0 2 Door 1:Glass 70 0.250 18 Wall 5:Wood Frame,16"o.c. 33 21.0 0.0 2 Window 4:Wood Frame:Double Pane with Low-E 6 0.250 2 Wall 6:Wood Frame,16"o.c. 40 21.0 0.0 2 Compliance Statement: The proposed building design described here is consistent with the building plans,specifications,and other calculations submitted with the permit application.The proposed building has been designed to meet the 2012 IECC requirements in REScheck Version 4.4.4 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist. Name-Title Signature Date Project Title: Warren Residence Report date: 10/22/13 Data filename:S:\BRIBURN Projects\1308_Warren Residence\04 Design(Process)\4.3 Codes and Regulations\Warren REScheck.rck Page 1 of 5 REScheck Software Version 4.4.4 Inspection Checklist Energy Code: 2012 IECC Location: North Andover,Massachusetts Construction Type: Single Family Project Type: Addition Glazing Area Percentage: 51% Heating Degree Days: 6322 Climate Zone: 5 Ceilings: ❑ Ceiling 1:Flat Ceiling or Scissor Truss,R-54.0 cavity insulation Comments: Where air permeable insulation exists in vented attics,a baffle(of solid material)is installed adjacent to soffit and eave vents.Baffles maintain an opening equal or greater than the size of the vent.The baffle extends over the top of the attic insulation. ❑ Ceiling 2:Flat Ceiling or Scissor Truss,R-47.0 cavity insulation Comments: Where air permeable insulation exists in vented attics,a baffle(of solid material)is installed adjacent to soffit and eave vents.Baffles maintain an opening equal or greater than the size of the vent.The baffle extends over the top of the attic insulation. Above-Grade Walls: ❑ Wall 1:Wood Frame,16"o.c.,R-21.0 cavity insulation Comments: ❑ Wall 2:Wood Frame, 16"o.c.,R-21.0 cavity insulation Comments: ❑ Wall 3:Wood Frame,16"o.c.,R-21.0 cavity insulation Comments: ❑ Wall 4:Wood Frame, 16"o.c.,R-21.0 cavity insulation Comments: ❑ Wall 5:Wood Frame, 16"o.c.,R-21.0 cavity insulation Comments: ❑ Wall 6:Wood Frame,16"o.c.,R-21.0 cavity insulation Comments: Windows: ❑ Window 1:Wood Frame:Double Pane with Low-E,U-factor:0.250 For windows without labeled U-factors,describe features: #Panes Frame Type Thermal Break? Yes No Comments: ❑ Window 2:Wood Frame:Double Pane with Low-E,U-factor:0.250 For windows without labeled U-factors,describe features: #Panes Frame Type Thermal Break? Yes No Comments: ❑ Window 3:Wood Frame:Double Pane with Low-E,U-factor:0.250 For windows without labeled U-factors,describe features: #Panes Frame Type Thermal Break? Yes No Comments: ❑ Window 4:Wood Frame:Double Pane with Low-E,U-factor:0.250 For windows without labeled U-factors,describe features: Project Title: Warren Residence Report date: 10/22/13 Data filename:SABRIBURN Projects\1308_Warren Residence\04 Design(Process)\4.3 Codes and Regulations\Warren REScheck.rck Page 2 of 5 #Panes Frame Type Thermal Break? Yes No Comments: Doors: ❑ Door 1:Glass,U-factor:0.250 Comments: Floors: ❑ Floor 1:All-Wood Joist/Truss:Over Unconditioned Space,R-38.0 cavity insulation Comments: Floor insulation is installed in permanent contact with the underside of the subfloor decking. Air Leakage: ❑ Building envelope air tightness complies by a post rough-in blower door test result of less than 3 ACH at 50 pascals. ❑ Automatic or gravity dampers are installed on all outdoor air intakes and exhausts. ❑ Wood-burning fireplaces shall have tight-fitting flue dampers and outdoor combustion air. Air Barrier,Sealing,and Insulation Installation Criteria: ❑ A continuous air barrier is installed in the building envelope including rim joists and exposed edges of insulation.Breaks or joints in the air barrier are sealed.Air permeable insulation is not used as a sealing material. ❑ Junction of foundation and wall sill plates,wall top plate and top of wall,sill plate and rim-band,and rim band and subfloor are sealed. Corners,headers,and rim joists making up the thermal envelope are insulated. ❑ Insulation in floors(including above garage and cantilevered floors)is installed to maintain permanent contact with underside of subfloor decking.Exterior insulation for framed walls is in substantial contact and continuous alignment with the air barrier.Crawl space wall insulation installed in lieu of floor insulation is permanently attached to crawlspace walls.Inspection of log walls is in accordance with the provisions of ICC-400. ❑ Spaces between fenestration jambs and framing and skylights and framing are sealed.Batts in narrow cavities are cut to fit;or narrow cavities are filled with insulation that readily fills the available cavity space. ❑ Exposed earth in unvented crawl spaces is covered with Class I vapor retarder with overlapping joints taped. ❑ Air sealing is installed between the garage and conditioned spaces. ❑ Exterior walls adjacent to showers and tubs are insulated and have air barrier separating the wall from the shower and tubs. ❑ Access openings,drop down stairs or knee wall doors to unconditioned attic spaces are insulated and sealed. ❑ Recessed light fixtures installed in the building thermal envelope are IC rated,airtight labeled at air leakage rate<=2.0 cfm,and sealed to the drywall with gasket or caulk. ❑ Duct shafts,utility penetrations,and flue shafts opening to exterior or unconditioned space are air sealed. ❑ Plumbing and Wiring:Insulation is placed between the exterior of the wall assembly and pipes.Batt insulation is cut and fitted around wiring and plumbing,or for insulation that on installation readily conforms to available space such insulation shall fill all space between wall and piping/wiring. ❑ Air barrier extends behind electrical or communication boxes or,air sealed type boxes are installed. ❑ HVAC register boots that penetrate building thermal envelope are sealed to subfloor or drywall. ❑ Fireplace walls have air barrier and closure doors are gasketed. Sunrooms: ❑ Sunrooms that are NOT thermally isolated from the building envelope meet the requirements applicable to the building envelope. Materials Identification and Installation: ❑ Materials and equipment are installed in accordance with the manufacturer's installation instructions. ❑ Materials and equipment are identified so that compliance can be determined. ❑ Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment have been provided. ❑ Insulation R-values and glazing U-factors are clearly marked on the building plans or specifications. Duct Insulation: ❑ Supply ducts in attics are insulated to a minimum of R-8.All other ducts in unconditioned spaces or outside the building envelope are insulated to at least R-6. Duct Construction and Testing: ❑ Building framing cavities are not used as ducts or plenums. ❑ All joints and seams of air ducts,air handlers,and filter boxes are substantially airtight by means of tapes,mastics,liquid sealants, gasketing or other approved closure systems.Tapes,mastics,and fasteners are rated UL 181A or UL 181 B and are labeled according to the duct construction.Metal duct connections with equipment and/or fittings are mechanically fastened.Crimp joints for round metal ducts have a contact lap of at least 1 1/2 inches and are fastened with a minimum of three equally spaced sheet-metal screws. Project Title: Warren Residence Report date: 10/22/13 Data filename:S:\BRIBURN Projects\1308_Warren Residence\04 Design(Process)\4.3 Codes and Regulations\Warren REScheck.rck Page 3 of 5 Exceptions: Joint and seams covered with air-impermeable spray foam. Where a partially inaccessible duct connection exists,mechanical fasteners can be equally spaced on the exposed portion of the joint so as to prevent a hinge effect. Continuously welded and locking-type longitudinal joints and seams on ducts operating at less than 2 in.w.g.(500 Pa). n All ducts and air handlers are located within conditioned space. Temperature Controls: Lj Where the primary heating system is a forced air-furnace,at least one programmable thermostat is installed to control the primary heating system and has set-points initialized at 70 degree F for the heating cycle and 78 degree F for the cooling cycle. Lj Heat pumps having supplementary electric-resistance heat have controls that prevent supplemental heat operation when the compressor can meet the heating load. Heating and Cooling Equipment Sizing: Ll Equipment is sized in accordance with ACCA Manual S based on building loads calculated in accordance with ACCA Manual J or other approved heating and cooling calculation methodologies. ❑ For systems serving multiple dwelling units documentation has been submitted demonstrating compliance with 2012 IECC Commercial Building Mechanical and/or Service Water Heating(Sections C403 and C404). Circulating Service Hot Water Systems: ❑ Systems include an automatic or accessible manual switch to tum off the circulating pump when the system is not in use. F1 Pipes are insulated to R-3 when any one of the following apply: (a)piping serves more than one dwelling unit, (b)piping between water heater and kitchen or water heater and distribution manifold, (c)piping outside conditioned space,buried,or located under a floor slab, (d)supply and return piping in recirculation systems other than demand recirculation systems, (e)piping is>3/4 inch nominal diameter, (f) piping runs>30 feet having 3/8 inch max diameter, (9)piping runs>20 feet having 1/2 inch max diameter, (h)piping runs>10 feet having 3/4 inch max diameter, (i) piping runs>5 feet having max diameter within the run>3/4 inch. Heating and Cooling Piping Insulation: ❑ HVAC piping conveying fluids above 105 degrees F or chilled fluids below 55 degrees F are insulated to R-3. Ll HVAC piping insulation exposed to outdoor elements is protected from damage and shielded from solar radiation. Ventilation: Ventilation fans satisfy the following efficacy criteria: (1)Range hoods and in-line fan:2.8 cfm/watt. (2)Bath-/utility room with rated cfm>=10>and<90: 1.4 cfm/watt. (3)Bath-/utility room with rated minimum cfm>=90:2.8 cfm/watt. Swimming Pools and In-ground Spas: ❑ Heaters have an readily accessible on-off switch. F-1 Heaters operating on natural gas or LPG have an electronic pilot light. ❑ Schedule-capable automatic on-off timer switches are installed on heaters and pumps. Exceptions: Where public health standards require continuous pump operation. Where pumps operate within solar-and/or waste-heat-recovery systems. F1 Heated pools and spas have a vapor retardant cover. Exceptions: Covers are not required when 70%of the heating energy is from site-recovered energy or solar energy source. Lighting Requirements: Ll Within permanently installed fixtures,75 percent contain only lamps that can be categorized as one of the following.Or,a minimum of 75 percent of all lamps within permanent fixtures can be categorized as one of the following: a ( )Compact fluorescent Project Title:Warren Residence Report date: 10/22/13 Data filename:S:\BRIBURN Projects\1308_Warren Residence\04 Design(Process)\4.3 Codes and Regulations\Warren REScheck.rck Page 4 of 5 (b)T-8 or smaller diameter linear fluorescent (c)40 lumens per watt for lamp wattage<=15 (d)50 lumens per watt for lamp wattage>15 and<=40 (e)60 lumens per watt for lamp wattage>40 Exceptions: Low voltage lighting systems. Lj Fuel gas lighting systems have electronic pilot lights. Other Requirements: Li Snow-and ice-melting systems with energy supplied from the service to a building shall include automatic controls capable of shutting off the system when a)the pavement temperature is above 50 degrees F,b)no precipitation is falling,and c)the outdoor temperature is above 40 degrees F(a manual shutoff control is also permitted to satisfy requirement V). Certificate: rl A permanent certificate is provided on or in the electrical distribution panel listing the predominant insulation R-values;window U-factors;type and efficiency of space-conditioning and water heating equipment;and results from any required duct system and building envelope air leakage testing.The certificate#does not cover or obstruct the visibility of the circuit directory label,service disconnect label or other required labels. NOTES TO FIELD:(Building Department Use Only) Project Title: Warren Residence Report date: 10/22/13 Data filename:S:\BRIBURN Projects\1308_Warren Residence\04 Design(Process)\4.3 Codes and Regulations\Warren REScheck.rck Page 5 of 5 2012 IECC Energy Efficiency Certificate Ceiling/Roof 54.00 Wall 21.00 Floor/Foundation 38.00 Ductwork(unconditioned spaces): �1 Window 0.25 Door 0.25 NA IL �� .• , Heating System: Cooling System: Water Heater: Building Air Leakage Test Results Name of Air Leakage Tester Duct Tightness Test Results Name of Duct Tester Name. Date: Comments: I North Andover MIMAP October 22, 2013 . x-Rsa ,arL4� 1 -��~J � °" �` .y.. c ° �M::g,�r*t��•F. �°'� ,� '��"'- 444 'J-' FINz, < < 67 1 y e . y n ;-fir` a,� mak= 's` �? s�<� � ,¢• �.. Interstates Interstate —Major Roads Honzontal Datum:MA Stateplane Coordinate System,Datum NAD83, Roads Meters Data Sources:The data for this map was produced by Merrimack 1:s Easements Of AOR?H qValley Planning Commission(MVPC)using data provided by the Town of "'SID .�. North Andover.Additional data provided by the Executive Office of ©MVPC Boundary ,Z. 9t `°+°�O Environmental Affaim/MassGIS.The information depicted on this map is ❑Parcels for planning purposes only.It may not be adequate for legal boundary N 9definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER lowMAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING • * THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY ^ # OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT * nog ,,,� ♦ ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION �SSACHus 1"=174ft ^�° The Commonwealth of Massachusetts Department of IndustriglAccidents Office ofInvestigations 0 600 Washington.Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/FIectricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/tndividual): Address: (b24 6mw b T- - City/State/Zip: AP-tW DVS A- Phone#•_ � � `7 2 2- Are you an employer?Check the appropriate box: Typo of project(required): 1.Q I am a employer with 4. Q I am a general contractor and I 6. Q New construction employees(fulland/or part-time).* have liiredthe sub-contractors 2111 am a sole proprietor orpartner- listed on the attached sheet.� �• E]Remodeling ship and'have no employees These sub-contractors have 8. Q Demolition working for me in any capacity. workers'comp.insurance. g. QBuilding addition [No workers'comp.insurance 5. El We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.X I am a homeowner.doing allwork right of exemption per MGL 11.[]Plumbing repairs or additions myself. [No workers'comp. c.152,§1(4),and we have no 12.Q Roof repairs insurance oyeesrequired.] empl .[No workers' 13.❑Other comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they dre doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that checkthis box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees: Below is the,policy and job site information. Insurance Company Name:. Policy#or S elf-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL o.152 can lead to the imposition of criminal penalties of a fine 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby eel' and r ie pains an penalties of perjury that the information provided above is true and correct. Signature: Date: 2 Phone#: C7 77 V !?A S Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - . Ph nn Pf• Information and Instructions . Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. 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 em to er or the receiver or friss p y tee of an individual,partner ship association or other le&al entity,employing employees. However the owner of a dwelling house having riot more tfa°nthCee apartments'air d ilio resideser ' th em,or the occupant of the dwelling house of another who employs persons p p y p s to do maintenance,,co�siruction oxxepair work on such dwetling house or on the grounds or building appurtenant thereto shall not because of such employirien't"tisaMdhl d to be"--hnaployex" .,•, �_-. MGL chapter 152,§25C(6)'also'states that"every state or local li"nsingagency 0011 P61" the issitai ce or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced.acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any ofits 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 beenpresented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phonenumber(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are notregaired to carry workers'compensation insurance. If an LL C or LLP does have employees,a policy is required. Be advised that this affidavit maybe 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 workers' compensation 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 will be used as a reference number. In addition,an applicant that must submitmultiple permit/license applications"Many given year,need only.submit one affidavit indicating current Policy information(if 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 ox commercial venture (i.e.a dog license or permit to burn leaves etc)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any ghestions, please do not hesitate to give us a call. . The Department's address,telephone and fax number: _ The Gox oartweaXt�o�'Massa..chizs� 'f° ' � : �- Depafteut 001dustxlal Accidents OfRoe of Iitvestigatzoas 600.waswngtoa Strut Boston MA,021 X 1 Tel,#617-727-4900 oxt 406 ax 1-877 MASSAFF Revised 5-26-05 Fax#617-727-7749 TO"OF i-tOR OFFICE OF BUILDING DEPARTMENT NT o t Osgood Street B °• ceding 20,-Suite 2-36 �qs Acuus��`� North Andover,Massachnsett8 01845 Gerald A.Brown Inspector of Buildings Telephone(978)688-9545 HONMORNER-LICENSE XENLPTION Fax (978)688-9542 E BU DING PERMIT.APPLICATION Pleaseyrint • , ' DATE: ld �22-1(3 JOB LOCATION: (O2p -6— (G Number Street Address Map/Lot HOMEOWNER Name. g 6 2 i -- 6 ome Yhone Work Phone PRESENT MAILINCT ADDRESS S E2 ip Code The current exemption for"homeowners" to allow such homeo�r - was extended to?��clude owner-occupied dlvellings to two units or Iess and seas to engage all hire Who does not possess a license,provided that the owner acts as supervisor). State DO, ding (Code Section 10S.3.5.1) DEFINITION OFROMEOWNER Persons)who Qwus a parcel of land on which he/she resides or intends to reside,on which(here is,oris intended to con ss idered a homeowner,one or two family structures. A person Who constructs more that one home in a two-yearpeniod shall not be o The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations c The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department minimum inspecfiion procedures and the e/she will comply with,said procedures and requirements, HOMEOWMMS SIGNATURE . APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9547r T 's • CO]�SERZATION 688-9530 HEALTH 688-9540 PLANNING 689-9535 North Andover MIMAP October 22, 2013 #43 065.0-0077 ..;::..1k6rr..::::::atltr ":.::'kl •: :.. 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ROW- #42 OW 2 #1044 065.0-0221 ,�` ••• _ , �� t. #19106 A-0061 #30, `�•�j, -•._:_:;_,•. 106.A-0060 #27 065.0-0220I . • • I 106.A-0062 065.0-0210 .. #102,; 106 A;0048 #4T ,�. ._. 106.A-0059 065:0:0219 1•. #1062 t, = 065:0=0211 `=`''��"•����-- - -- 065.0-02185:0.0212•:.'•.:. 106.A-0058 #.59i •::: #62- ••-.._. #10.6..3,: • - :•• .'_`: #,'1060 Rail Line =N Wetlands Zoning Interstates Exempt Lands C:Busine s 1 District Interstate C Busine s 2 District Horizontal Datum:MA Slateplane Coordinate System,Datum NAD83, —Major Roads G Busine s 3 District Meters Data Sources:The data for this map was produced by Merrimack 0 Busine s 4 District NORTH Valley Planning Commission(MVPC)using data provided by the Town of Roads ®Gener Business DistrictOf `�a 4,�, North Andover.Additional data provided by the Executive Office of Ci Easements 0 Plan— t Commercial Dov = b '��6 DO Environmental Affairs/MassGIS.The information depicted on this map is CS Corrido Development Dist -� L for planning purposes only.It may not be adequate for legal boundary Q MVPC Boundary D Corrido Development Dist Odefinition or regulatory interpretation.THE TOWN OF NORTH ANDOVER 0 Municipal Boundary O Comido Development Dist #' — 9 MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING Zoning Overlay Industri it 1 District i - ,F THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY S7 Induslri 12 District 0 Adult Entertainment f 2 ^ .� OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT Q Downtown Overlay District O Induslri 13 District >f o r i ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF O Industri I S District • ' ©Historic District ^ ��f•"Ay THIS INFORMATION Water Protection Reside ce 2 District 11,' q Reside ce 2 District SSAGMUS�'� ❑Parcels 97 P—idei ce 3 District 10 Hydrographic Features YYY de ce4 DisMct --Streams 1"=174 ft .. .de ce5 DisMd de ce 8 District �a a esidential District Anthony Warren 1020 Salem Street North Andover,MA 01845 11/14/13 Susan Sawyer Public Health Director Town of North Andover 1600 Osgood Street Suite 2035 North Andover,MA 01845 RE: Application for Building Permit and wastewater system expansion at 1020 Salem Street(Map 104D,Lot 32) Dear Susan, We kindly request that the Health Department accept this letter of agreement in regards to the septic system expansion at 1020 Salem St. As you aware,we have submitted the septic system expansion plans for the above mentioned property, designed by Ben Osgood for approval by the Town of North Andover Health Department.Upon receipt of the approval letter,we kindly request that your department expedite approval for issuance of the building permit. The following are the reasons for our request: • Due to the late date in the year we would likely not be able to start construction on the septic system without going past the town's cutoff for completion of the system. • We are however able to start on the addition and would like to get the foundation in this fall before frost enters the ground so as to avoid spring site work and to be able to start framing directly their after. • We are committed to starting the septic system in the spring and completing it as soon as feasible and before the addition is finished. The main purpose of adding the addition to our house is to provide a sun room for our family and not an added bedroom,as such the impact while technically adds a bedroom will not adversely affect the existing compliant system during construction. In order to keep to a strict schedule and complete construction expeditiously,we would like to move forward with construction as soon as possible. Currently,we are receiving bids on the septic system upgrade including excavation work for the addition and will be securing a contractor soon,but have not done so to date. Worst case we will complete the installation of the septic system no later than July 2014 and no later than the addition. Respectfully Anthony Warren