HomeMy WebLinkAboutBuilding Permit #Exception - 105 CARLTON LANE 5/1/2018 (8) � Of NORTFt q
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATI �N "
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Permit NO: Date Received 2
Date Issued: !/ RSS�CNUS���
I
INTPORTANT: Applicant must complete all items on this page
LOCATION 1 n<�- ccx_A`� 1`111 y ,
Mt
PROPERTY OWNER_- ��� C 1'L ' L�'' l 6,r-Q_.
'Q Print = '� �,
MAP NO: PARCEL: ZONING DISTRICTlw - Historic Districf~ --'yes no
v j �,.
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building VOne family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑Other
❑Septic ❑Well ❑Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer
zew-vwak 6� � (VS46,�ton J
Identification Please Type or Print Clearly)
OWNER: Name: CNAAq � ro Phone: 111 t _3 31- _70S_
Address: ( 02 4Lin
CONTRACTOR Name: Phone: 5
Address-
Supervisor's Construction License: 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: $ �#- r)o6 FEE: $ 3 6,00
Check No.: Receipt No.: 21 -LZ
NOTE: Persons contractin i unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner Signature of contractor
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit N0: Date Received
Date Issued:
IMPORTANT:Applicant must complete all items on this age
- _ - ,
LOCATION
Print
PROPERTY OWNER _.� -
Print r 1OO Year-0ld Structure yes no
MAP RID: _ _._ PARCEL:. ZONING DISTRICT: Historic District yes no
- Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑New Building ❑ One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
_ -- ,., .
°❑Septic ❑Well ❑ Floodplain 0 Wetlands ❑ Watershed District=
❑Water/Sewer
R DESCRIPTION OF WORK TO BE PERFORMED:
M
r
t
Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address:
CONTRACTOR Name:..._ Phone:
Address: _- - --
f Supervisor's Construction License: A_._ _._ Exp. Date:
Home Improvement License: Exp. Date:
F ARCHITECT/ENGINEER Phone:
t
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
I
Total Project Cost: $ FEE: $ �M
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
I
=Signafure of Agert/Ovvner.., Signature of contractor
Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
Building Department
The foihwing is a]i'st of the requited forms to be filled out for the appropriate permit to.be obtained.
Roofivg, Siding, Interior Rehabilitation Permits
aBuilding Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L Licenses
❑ Copy of Contract
a 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/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 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
o 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 casco if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the apn•,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.tted with the building application
Doc: Doc.Building permit Revised 2012
Plans Submitted ❑ Plans-Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE_OF;SEWERAGE DISPOSAL-,-
Public
ISPOSAL .Public Sewer ❑ Tanning/MassageBody Art ❑. . Swimming Pools ❑
Well ❑ Tobacco-Sales El -Foo_dPackaging/Sales ❑
Private:(septic tank,etc. ❑ -permanent Durapster on-Site ❑
THE-FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
- DATE REJECTED DATEAPPR-OVED
PLANNING & DEVELOPMENT* ❑ ❑
COMMENTS
CONSERVATION Reviewed on Si natureKl`
COMMENTS :A' --- , 1� � �`
HEALTH Reviewed on Si nature
/z—
COMMENTS (� ��,, t D 4'o co )
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: :Comments
Water& Sewer Con neCtionisignature&Date Driveway Permit
DPW'Tow,! Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMcaVT mp Dump ter on site yes no
Located7bt X124 Mair Street
`Fire-Departme►it =signatiareldate
.f .. a
COMMENTS ; :.
- Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total-land-area,sq. ft.:
ELECTRICAL: Movement of Meter location, rust or service drop requires approval of
Electrical Inspector Yes No
DANGERZONE LITERATURE: Yes No
MGL-.Chapter--166 Section.21 A.=F and G min.$100-$1000fine
NOTES and DATA,—(For department use
64I
® Notified for pickup - Date
Doe.Building Permit Revised 2010
,. ALocation /
No. Date Z/2
. • TOWN OF NORTH ANDOVER
. Certificate of Occupancy
. ,
Building/Frame Permit Fee $
Foundation Permit Fee $
`' Other Permit Fee $
.:
TOTAL
r
Check# �'�
27322 Building lKispector
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r -1 NORT/� +•
c w: 1, . . ve. .
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No. e _
C' h ver, Mass, 2e,
COCMIc"a WI[K V
�.95 RATEO /.PR�.�S
LI BOARD OF HEALTH
Food/Kitchen
PE IT T LD Septic System
V0419THIS CERTIFIES THAT ...M. P.41. ....i... � a� ........... .............. BUILDING INSPECTOR
has permission to erect ...................... buildings on . cft& �i� Foundation
.... ................................................
Rough
to be occupied as .............lkl-,�w.......Ae-�_k................................................................ 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
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION S ARTS Rough
''`` ��� ....................... Service
.............. ..... .%Z_4_2::tel.. :�-:r....... 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.
SEE REVERSE SIDE
I
1
G5.5YI •
1k• f+T-f'R' /_}s•m rI i4.S.Al• NOTES:
loo I; vRn.nNrzs , Ir
I _
.-34' ASSESSORSMAP 210 LOT 106.c
� ( RECORD OWNER:MICFIADAIiNUM
C/0 PETER CORDARO
ti°rtia'ccF drJcF.a�cl \VETLANDSFLAGS DY ru,�•,J, 1i ,\,
1 Anw wrfA�/ck.d I [ANA(NDSAW LAND )nl $�, - �-P/ LOTADDRESS:105 CARLTONLANE
1 FI Ifrr fn6rvc �I 5 MANAGP41F3N'C I / LA/`f•{�'Rotl: rucvd5 y1� NORTIIANDOVER.MA
`,Z7 I •1.'GSI�ld4la ^, ..
k/
I. duchnrrle 'rT'I� + 1/ �r�'+J I ,/o" DEED RIIFnIIENCfi BOOK 11602 PAGR 12
I e ,� I✓I !- ,`r7 I ♦ �` . F/ ,DOb OP WOODB
� 1.--• -_ _...(,
_� PLAN AEPERENCE:1'LAN A`ROB)
Qn�(er 1715YI,A
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I r PaoPosRD FR.L.a ^.��__._I_.�.._T. •� �' /'� col•a t sK 1 � .. - .
REGRADING RETAWSLOPa 7A7NB:R2
WITx VP_GET—ON.-11-
r.,l�- -•� '
,tLd NOT TO EXCEED 3:I I (� , i \ VERTICAL N TUM: THE Tomir
it OF'TONLANE
AS BUILT ON FILE AT TAE�1'OWN OF YOILTH
I � .—� / '� I 1 I APACHING PR07C1T ACTIDE .ANUOVEIt
PROPOSED Sa T4TION--- / LEED AS FER �'
YIAybalc Corm/ OC—i--7 BAIUW3[C /./ / l ASBUILT 3 SURFACE.
ft1,7T:R, DISPOSAL S[Y1�T PLAN
N7'S NORTxANDUVER DO NOT—�r-, / Q/ l III 57/ED / n � BY KAMINSKI,GGEELBdAS
DIS'CURB MARKERS /'!1T n/�_�" / tI _ &ASSO—IjTES
'Amdk.fF.i by !✓f/9n./s. �I,r;��' (ov i• o� 6?I / ���r P ��� \
1.,.."d °'f"''f.- rd•t.'�3 %mt ,�� ti� i I /•_1_-• 20•.N- �1 I' .. _ .. . .
APPROXIMATE \ �.
I LOCATIONOF POOL.
% mI' I/ /w.,,• / /, POOL �" I SURROUND,&FENC
'CC TOBEINST'ALLDD '
PRIVACYPLANTII/t➢S R
%CARPGNI/ 1 // {jy� I'ROPOPOST�F - I-
\�� l t"„�i.__�j♦i 62''F� 1� -..-^II LANEISGAP
' o DO NOTDI$TURI]MARKERS
N7?'CLANUS FLAGS / x -I ,�,! APPROXIMATE L50UGAL.
'O
I' =ICTANKAS PFRAS '
• PROPOSED PRUCI TREES \ , 1>' r .y, I_ Py' —BUILT SUB SURFACE
Ivr \ DISPOSAL SYnVJ FLAN BY -
EX1S1'INCiCONTOURLINE 11y1 \j' / 'PROPO _I KAD ASSOCIATESAS+t
PROPOSED CONTOURLINE I ua j /j 2q x IR
PROPOSFI)FENCR
wvwa^n PROPOSEDSR.TATION BARRIER Iw,1-'LORI I ) I L-EMS1 DECK
)I- I I•' IDI2IlTll i\ r TO 105 15E
Nb. /
' v '
VVINTIP$ j. "-``��` _ ___ _____ EXISTING CONDITIONS
S PLAN IS BASED ON THE REFERENCED PLANS,DEFDS, r- -_._IT PLAN OF LAND W/PROPOSED
D THE RESULTS OF AFIELD SURVEY AS OF THIS DATE I /
CERT=,'M0N1S INTENDED AS TO PROPERTY TITLC .POOL LOCATION'
` ,i 1 - /
AS TO TITS.EXISTENCE OF UNWRITTEN OR UNRECORDED
MMENT$ `;, L--tl + ryo/ Located In .
�r NORTH ANDOVER,MA
') �S /
Prepared y
�/ IAIT 31 Amcri
A 43,704+I.ST. caD I an Sy urve Associates,Inc.
=
ma Kirk W.Benson,President,PLS
42 Cherry Street Gloucester;MA 01930 -
raw 978-281-7878
'Ilry n=150.00, i SCALE 111=201 OCTOBER.5;2013 'Re✓Iz
9 .0(, .;K 1.
K W.BENSON,PRESIDE-NT. PLS'I1003G -5/1-3 t •£ 'Preparred For .De: 4— �fn,
j;: \ GGROPP:.V,MNI EMILYCORDARO
roa¢Imouornm4 or Tri6PROiR56:ON,LSR.u.Ls tRwu'nvs oP :.\ --..—.._..------- -----"-"�--•--
a�naDUUTfiATN 00 f:41 �1N1.1RC w�+TnoviHOR1°Fl�irnl.L CARLTON LANE l-`�--4
nccRPr rxoru,�,•rzouccnoN eonuVV�IRtrom rxrs,9AR Is eoR
IINAL.OWlOSR5PVRF'CyR nNDIi NO'fT/)IPR WI.D fIR n1M`RFIiN1tF.1,)T'fIAM' / �"'
OWNERO0.ITIIRO PARTY. 1 0 10 40 R0
J-1541
. �oRry
�p t7teo rbc yd TOWN OF NORTH ANDOVER
a OFFICE OF
BULD]NG DEPARTMENT
�R •�� :"1600 Dsgood StreetBuil -36
7q ao'4t"�5 ding20,Suite 2
North AndoverlVMassachusetts 01845
Gerald A•Brown
Tnspeetor of Buildings Telephone(978)688-9545
• Fax (978)688-9542
IOMEOWNER LICENSE EXEMPTION
BbXD11�G P-RNUT APPLICATION
Please pr:ln
DATE:
JQB LOCATION:_)yy
ivuznbcr StreetAddress
JJ0.'k EO'S M ER tMap17 of
33�-/7,s-
e Home Phone
' Work Phone
PRESENT MAMING ADDRESS C)y
N � 4A
Zip Code
The current exemption for`$omeowners"
was extended to fiaclude owner-occupied divelIings to scvo units o
acts
allow su;h homPo:vers to engage an i;�dividual•forbire wno does notpossess a license,provided that she less and
acts as supervisor). tStateBui_iding (Code Section
DEFINITION OFHOMEOWNER
Person(s)who Rwns a parcel of land on which he/she resides or intends to reside,on which there is,oris intended to
oo s one or two family structures• A person Who constructs more sliat'one home in a twa yearperiod shall not be
considered a homeowner.
The undersigned"homeowner"assumesresponsibMtyfor compliances with the StateB
Applicable codes,by-Jaws,rules andregulations. uilding Code and other
t
The undersigned`laomeownez"certfies that he/she un erstands the Town of North Andover Building Deiiarfinent
rumunum inspection procedures and require encs an at he(she will comply with,said procedures and
requirements,
J30MBOWMMS SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Revised 7.2009
porm-iomeovmers Exemption
'BOARb OF APPEALS 688-9341CORSE r ,
AMN 688-9530 HEALTH 688-954()
PL.-.NNING 688-9535
The Commonwealth of Massachusetts
Department of IndustrialAccidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Cont°actors/ElectricianslPlumbers
Applicant Information Please Print Legibly
Name(Business/OrganizatiorAndividual): &Y`r` 0Ct 0
Address: J QHS C6 c`�p r\
City/State/Zip: 1N �P Phone#: l S
. � �� 7`'.33 -1?03—
Are you an employer?Check the appropriate box: Type of project(required):
LEI[] I am a employer with 4. ❑ I am a general contractor and I `
6. F1 New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and•have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers'comp.insurance. 9. ❑Building addition
[No workers'comp.insurance 5. ❑ We are a corporation and its
,/equired.] officers have exercised their 10.❑Electrical repairs or additions
3.h/1 I am a homeowner doing all work right of exemption per MGL 11.[]Plumbingrepairs or additions
myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs
insurance required.]i employees.[No workers'
comp.insurance required.] 13.1i Other
*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 a're doing all work and then hire outside contractors must submit a new affidavit indicating such.
t Zontractors that ehwk this 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 Self-ins.Lic.#: Expiration Date:
Job Site Address: City/state/Zip:
Attach a copy of the workers'compensation Tolley declaration page(showing the policy number and expiration date).
Failure to secure coverage as requiredunder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a
Eno 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 maybe forwarded to the Office of
Investigations o the D for insurance coverage verification.
I do herebyc t der hep ins a ties ofperjury jury that flee information provided above is true and correct
Si ature: Date: 3
Phone# o" 33S-11
Official use only. Do not write in this area,to he 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.EIectrical Inspector 5.Plumbing Inspector
6.Other - - -
Contact Person: Phone#:
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 ofhire,•
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 or trustee of an individual,partnership,associatlon or other legal entity,employing employees. However tha
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 be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local lie-ening 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
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 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 the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s),address(es)and phone number(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 not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this 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 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 Jive.
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 submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(ifnecessary)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 home owner or citizen is obtaining a license ox 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 Office of Investigations would like to thank you in advance for your.cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
`Z':he ComMoawoalthofMassaclausottq
Department of Zndustrlal,(accidents
Office of Investigations
600 Waft&-n&n street
Boston}MA 02111
Tel 0 617-727_4900 ext 406 or.1-877-NIMSAF,
Revised 5-26-05 FOX 0 617-727-7749
www-mass,pvfdia