HomeMy WebLinkAboutBuilding Permit #443-11 - 1092 GREAT POND ROAD 11/23/2010 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: 4�3 Date Received
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION 40 9 Z
Print
PROPERTY OWNER 57r���N r�
Print
MAP NO: e� ® PARCEL: 2 ZONING DISTRICT: Historic District yes
Machine Shop Village yes
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building One family
['Addition 6i ,��� El Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
Flood laui r; ®Wetlands` Watershed
e tie ®Well 3 p
... a y e ,. «"d4a.+x.• -a`.r.,s+n._ _ _ *�nadX"''S�"'4dew f1 :: .r. :::''.
D S RIPTION qF W(PK TO BE PERFORMED: 10i
,�/U �rr,c.,�✓A T%U.r/ /1IPe ops T b� �u,`L�~
I entification Please Type or Pri t Clearly)
OWNER: Name: S T���0) . a (=,Q�1�G Phone: L�3 ���33051
Address:
CONTRACTOR Name: Phone:
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT.$12.0Q,PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ l d add FEE: $ 430. 00
Check No.: /399 Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
—S—i-' nature of contractor
Sig= ---- ---
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ N
[TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Swimming Pdols
Tanning/MassageBody Art ❑ ,^
Well ❑ ❑
Tobacco Sales Food Packaging/Sales 11
Private(septic tank,etc. ❑ Permanent Dumpster on Site- ❑ _ 4
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF U FORM <
110
DATE REJECTED DATE AP R. VED
PLANNING & DEVELOPMENT ❑ ❑ �QZ%
COMMENTS
j CONSERVATION Reviewed on ( � C v Si nature
r if .. . � • -
C� MMENTS io X ;6
ALM
HEALTH ( Reviewed on _ Signature
COMMENTS
R
e
y
Zaning 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:
:1 ,�. -° Located 384 Osgood Street
FIRE DEPARTMENT `Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS
v
i
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 1
i
NOTES and DATA— For department use
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® Notified for pickup - Date
Doc:.Building Permit Revised 2008
i�
f
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
o Copy of Contract
o Floor Plan Or Proposed Interior Work
o Engineering Affidavits for Engineered products
NOTE: All dumpster p ter permits require sign off from Fire Department prior to Issuance of Bldg Permit
Addition Or Decks
o Building Permit Application
o Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
o 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
o 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)
o Copy of Contract
o Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
' VOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
hat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
lust be submitted with the building application
Doc: Doc.Building Permit Revised 2008mi
i
I � .
Location
No.
NORTh TOWN OF NORTH ANDOVER
3 -
O t
0 Certificate of Occupancy $
;.�b•�no•r►'`�j• fit" 1 .�
ssncwust< Building/Frame Permit Fee, $ 3/}
Foundation Permit Fee $
-G
Other Permit Fee $
TOTAL $
Check #
23736
Building Inspector
f.NpRT1�
3r Oett�•o;e 100
Town of North Andover
ti A
x Office of the Planning Department
*�"�q,••���' Community Development and Services Division
�Ss�c►+use�
Osgood Landing
1600 Osgood Street
Building#20,Suite 2-36
P(978)688-9535 North Andover,Massachusetts 01845
F(978)688-9542
Steven French
1092 Great Pond Road
North Andover, MA 01845
November 22,2010
Dear Mr. French,
After reviewing your Building Permit Application for the construction of a`lean-to' shed to be built as an
attachment to an existing barn at 1092 Great Pond Road, I have determined that the project does NOT
require a Watershed Special Permit from the Planning Board for the following reasons:
• The shed will be built within the Non-Disturbance Zone of the Watershed Protection Zone since
it will be located within 150 ft. of a wetland area. The construction will takelace approximately
P Pp Y
138 ft. from the wetland area, as estimated by the Conservation Agents,Heidi Gaffney and
Jennifer Hughes, who have performed site visits.
• The construction of the shed will have minimal impact since it will consist of a roof and one side.
Both ends of the shed will be open and there will be no foundation.
If you have any questions, please feel free to contact me.
Regards,
udith Tymon, AICP
cc: Jerry Brown, Inspector of Buildings
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
/0.'00 hA
c2 U — 2 : v
The Commonwealth of Massachusetts
Department De artof IndustrialAccidents
P
Office of Investigations
600 Washington Street
Boston,MA 02I11
UV www.mass.gov/dia
Workers, Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information
Please Print Legibly
Name(Business/Organization/Individual)'
Address:
City/State/Zip: Phone#:
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ 1 am a employer with 4. ❑ 1 am a general contractor and 1 6. ❑New construction.
employees(full and/or part-time).* have hired the sub-contractors
2.El 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. P�<i lding addition
[N workers'comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
quired] officers have exercised their
3. 1 am a homeowner doing all work right of exemption per MGL 11.E]Plumbing repairs or additions
c.152 1(4),and h ❑Roof we have no 12. re
myself. [No workers comp. p
insurance ]re uired. employees.[No workers' �/
q 13.�ther /k�xa�
comp.insurance required.]
OF
* e section below showing their workers compensation policy inform
ation.
Any applicant that checks box#1 must also fill out th s g P
idavit indicating
such.IHomeotners who submitthis affidavit indicatingthe are doingall work and then hire outside contractors must submit anew aff
Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
lain 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.Lie.#: Expiration Date:
Job Site Address: /d f2 � 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 c. 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 maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
Ido hereby cer under the pai andpenalties ofperjury that the information provided above is tr�correct.
Si afore• ,� �
Phone#:
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.EIectrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
ORTH
Tovm .of �, 5Andover
_ LAKE O dower; Mass., ) -VA
2:.3t e C�
I� COCMICHEWICK y1.
7�ADRATED
S BOARD OF HEALTH
PERMIT T Food/Kitchen
Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT
....... .................... ............ . ....................................................>................ Foundation
has permission to erect........................................ buildings on ... .......... `.....:........I C.s...... Rough
to be occupied as sl\V_4......10,cuk. .in......aV.......&.C.n ............................. Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final
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 CONSTRUCTIT ARTS Rough
.................. Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
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.
SEE REVERSE S 1 D E Smoke Det.
(978)688-9545
Town of
_
Fax(978)688-9542
NORTH ANDOVER
DIVISION OF
COMMUNITY DEVELOPMENT&SERVICES
BUILDING DEPARTMENT
Office Hours 8:30-10 a.m., t-2 p.m.
MICHAEL McGUIRE
Local Building Inspector
27 Charles Street•North Andover•Massachusetts•01845
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F N°RTM TOWN OF NORTH ANDOVER
OFFICE OF
4A00
BUILDING DEPARTMENT
*��o e* 1600 Osgood Street Building 20, Suite 2-36
�qsA,,,; North Andover,Massachusetts 01845
SACHUS
Gerald A.Brown Telephone(978)688-9545
Inspector of Buildings Fax (978)688-9542
HOMEOWNER LICENSE EXEMPTION
BUIDING PERMIT APPLICATION
Please print
DATE:
JOB LOCATION: /092
Number Street Address Map/Lot
IiOMEOWNER � f C f f
Name Home Phone
Work Phone
PRESENT MAILING ADDRESS GAe 1(2b
City Town Srwrw
Zip Code-
The
odeThe current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and
to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner
acts as supervisor). State Building (Code Section 108.3.5.1)
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or
intends to reside, on which there is,oris intended to
be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be
considered a homeowner.
The undersigned"homeowner"assumes responsibility for compliances with the 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 7.2009
Form Homeowners Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530
HEALTH 688-9540 PLANNING 688-9535
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(NACCPER) North Andover Country Club
Actual.: 9/3Qj94>:::
A/C#
Total Oct Nov Dec .tan Feb Maruse r May June
July Au Sept
430 D R Sales (140,741) (1,010) (11,180) (15,507) (8,217) (8,995) (7,068) (10,773
431 Bev Sales (54,126) (113 ) (12,385) (17,982) (19,105
(5,222) (7,064) (3,806) (3,315) (2,742) (3,592) (5,056) (6,445) 5,935) (15,153) ((5,360)
433 Func Food Sal (19,089) 0 (394) (2,306) (2,497 (2,089) ( ) ( , ) (5,723
434 Func Bev Sale: (8,553) p ) ( � ) (377) (3,509) (1,787) (1,436) 0 (2,297) (2,397
440 Min Bill (25,553 (73) (2,327) (771) (995) (269) (611) (569) (1,386) 0 1
(6,467) (1,713) (1,358) (2,140) (1,841)
(Z 549) (1,888) (1,380) (1,465 ( '248) (304)
441 Rental Income 0 0 0 0 0 p p ) (1,617) (Z 042) (1,507
442 Other Inc 0 0 0 0 0
X2494) p0 (1,693) (711) (412) (449) 53 (2,359) (514) (367) (10) 0 (130)
443 Func Enter (Z510) 52 0 0 0 0 0 0
450 Food Costs 87,603 578 12,547 11,084 6,512 4,799 5,162 9,597 6,798 6,953 8,620 8,322 6,6310
451 Bev Costs 21,082 4,444 2,719 212 1,831 1,488 164 2,510 2,248 1,705 1,734 2,027
452 Spoilage 606 0 0 0 0 0 606 0 0 0 0
453 Wine Costs 1,069 0 150 245 109 0 854 1,297 1
459 Func Costs 1,444 0 0 0 165 441 54 329 (178) (410) 160 (117)
501 P/R 37,495 3,650 2,920 3,420 3,650 3,015 2,920 4,795 2,500 2,500 3,125 2,500 2,500
502 P/R Casual 91,200 1,226 13,859 13,268 8,163 4,564 3,420 5,664 7,567 8,453 10,429 6,995 7,592
504 P/R Kitchen 40,975 0 0 3,917 4,331 2,350 1,620 2,502 2,337 5,503 8,606 5,836 3,973
509 P/R Taxes 19,438 512 1,761 2,163 1,969 1,477 974 1,586 1,519 1,809 2,436 1,685 1,547
515 China 0 0 0 0 0 0 0 0 0 0
516 Linens 2,482 0 410 591 291 366 388 436 p 0 0 0
517 Equip Rent 890 0 367 405 64 42 p 0 0 0 0
518 Decorations 598 p 0 0 0 0 12 p
0 277 286 0 0 35 0 0 0 0 0
520 Paper Supp 1,427 0 0 0 0 0 0 0 0 236 511 352 328
521 C L Func 8,166 0 590 0 340 0 0 1,036 2,147 2,939 40 570 504
522 Bar supp 49 0 0 0 49 0 0 0 0 0
535 Electricity 12,180 0 413 784 768 946 810 1 623 2,806 0 1,869 3,160
537 Emp Meals 1,469 0 264 0 0 0 0 0 248 228 45 410 274
541 Fuel 6,361 (610) 645 247 1,450 1,321 969 664 405 415 9 345 501
542 Insurance 3,868 1,300 0 0 1,300 0 0 430 0
543 Laundry 3,890 36 0 0 0 478 360
0 0 0 0 0 435 839 973 713 894
544 Licenses 1.654 150 1,130 0 124 0 0 0 0 250 0 0
550 Printing 3,439 0 199 3,214 12 0 p 0
555 Repairs 3,586 61 789 p 14 0 0 0 0 0
219 0 62 0 624 1,180 443 160 48
556 Maint 4,115 0 737 2,169 0 68 68 1,073 0
560 Supplies 10,082 1,528 1,528 1,119 402 776 757 468 821 769 1,263 350 3011
570 Telephone 2,386 160 529 176 209 160 273 129 232 201 4 166 147
572 Television 428 0 0 0 107 30 30 126 0
577 Cleaning Supp 2,181 180 p 45 30 60
0 295 295 0 34 345 237 33 634 128
578 Waste 5,662 212 212 648 510 510 510 510 510 510 510 510 510
580 Water 2,700 225 225 225 225 225 225 225 225 225 225 225 225
590 Alchohol Exc 0 0 0 0 0 0 0 0 0 0 0
599 Misc 2,709 1,157 415 (389) (432) 799 0 6
123,706 2,775 23,707 14,4U4 13,4W 6,241 6(09) 8,503 10,302 8,593 11,972 9,328 395 136 29 626 8,161 76
123,706
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