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HomeMy WebLinkAboutBuilding Permit #469-13 - 1132 SALEM STREET 12/2/2013 l TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Q ° Date Received Date Issued: k 02 a 13 IMPORTANT: Applicant must complete all items on this page LOCATION - Pr* t �-- nn eSla _ _ PROPERTY OWNER rint 100 Year Old Structure v yes (1i do MAP NO: iOCA PA R_ ZONING DISTRLCT: _ .z.HistoncDistract Y es Machine Shop Village _ yes 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 , 0 Wel ❑ Floodplain ❑Wetlands ❑ 'Watershed ©istrict• _ L'Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Glen )�.r c lPhone: �- 4 Address: ( 1 S 4 t, Sk a -CONTRACTOR-Name: .-"Phone.-- Address: -- ®___ .__ -.,_- •P.hone.-Address: Supervisor's Construction.License.. - �._.. Exp. Date: - ' Norrie. lrnprovement License: - _ Exp Date; �. - ARCH ITECT/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: $ o)'-? o d FEE: $ Check No.: `� 1 , 9 Receipt No.: �1 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund gnat eru of=Ae'nt%Owner R_ ��g-�a u of contractor:-_, f Plans Submitted LiIan Waived ❑ Certified Plot Plan ❑ Stamped Plans 11 i Building Department ~The fol;'swing is--a list of the required forms to be filled out for the appropriate permit to.be obtained. Roofirig, Siding, Interior Rehabilitation Permits o 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/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 ❑ 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 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-tted with the building application Doc: Doc.Bui!ding Permit Revised 2012 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYP1 _OP SEWERAGED3SPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑. . . Swimming Pools ❑ Well ❑_. Tobacco.Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc..- -❑ - _ Permanent Dumpster ori Site ❑ THE.FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM .DATE REJECTED: DATE.APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on 3 Si nature ` COMMENTS HEALTH Reviewed on Signature COMMENTS Zoni1. 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'I owo Engineer: Signature: Located 384 Osgood Street FIRE DEPART�fIr:I `f Temp Dumpster onsAP .yes no Locat4at-',124,Mairo Street Fire"Departure►�tsignatiare/date ' F �* . _. x. , _ .4. COMMENTS iI II .. 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-$1000fine NOTES and DATA— (For department use El Notified for pickup - Date Doc.Building Permit Revised 2010 Location No. L 4.� Date 2 2 3 . - TOWN OF NORTH ANDOVER 4 �w.wx �.• - . Certificate of Occupancy $', Building/Frame Permit Fee s'd j Foundation Permit Fee $ ` " t Other Permit Fee $ TOTAL $ Check# ' 27144 Building Inspector The Commonwealth of Massachusetts Department of IndustridlAccWnts Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information //'� 1 (� l Please Print Legibly Name(Business/Organization&dividual): V `e n nS t es ot 11 Address: 113 a YA 1 e M S-t city/state/zip-go ri-k A A AJ t ,el-4 fA Phone#: S 0 g - 3 6 c -- i O O O Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑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. E]Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. g ❑Building addition [No workers' comp.insurance 5. F1 We are a corporation and its ,�, quired•] officers have exercised their 10.El Electrical repairs or additions 3.2 XIam a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance ]ired.re q ut employees.[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. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check 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.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 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 t under thepains and penalties ofperjury that the information provided above is true and correct. Si atur : Date: la a 13 Phone#: + f Ai 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 - - - 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 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 j oint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal,entity,employing employees. However the owner of a dwelling house having not more than three,apaftmerits and}tzrho.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 cipployr lent be deemed Yo i e an employer." MGL chapter 152,.§25C(6)a,46 states that"every state or locafliteensing ageficyg�all 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. AIso 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 submit multiple permit/license applications in any 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. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum 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-telephotie-and fax number: The Commonwealth of Massachusetts Department of ladustrial Accidents Office ofInvestigAtitons 600 Washington Street Boston,MA 021 It Tel,#617-727-4900 ext 406 or 1-877,7MASSAFE Revised 5-26-05 Fax i#617-727-7749 www mass,govldia {O troraa1Q TIOVf1°( OFNORTH 13NDOVER Tfi OMCE OF BUMDING IDEPART MNT ' 7.600 Qsgood Street BuRdin 20 ' g 20,-Suite,2�.36 y9s A�us cis North Andovor,Massachusetts 01845 Gerald A.Brown Tel--Phone(978)688_9545 InspectorofBuildings Fax (978)688-9542 ' •� HOMEOWNER•LICENSE EXEIVIpTION ' 13MDING PERMIT APPLICATION 1']easenrint - DATE: 1� i21� 3 JOB LOCATION: Number StreetAddress (Q s 3 Map/Lot UO-MEOWNER tix A,syl4t �� �Gq- t aU o , - Name Ho Phone ' Work Rhone PRESENT MAILING ADDRESS 0 02 T.A le M Na old lr t City Tom ` The current exemption for"homeowlip Code ners"was extended to include owner-occupied dwellings to two units o� less and to allow su:h homeo:,.�ners to engage an in hire who does not acts as supervisor). State Building (Code Section 108.3.5.7) possess a license,provided that the owner DEFINITION OFHOMEOWNER. Persons)who gwns a parcel of land on which he/she resides or intends to reside,on which there ior is intended to s, be,a one or two family structures. A person who constructs more that-one,home in a two-yearperiod shall not be considered.a homeowner. The undersigned"homeowner"assumes responsibility for c Applicable codes,by-laws,rules and regulations. compliances with the State Building Code and other 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 p requirements, HOMEOWMERS SIGNATURE n APPROVAL OF BUILDING OFFICIAL, Revised 7.2009 , Form homeowners Exemption BOARD OF APPEALS 688-9541r : COITSERN ATION 688-9530HEALTH 688-9540 PLANNING 688-9535 NORTh Town of Andover 0 �O `^NE h , ver, Mass, Z coc MIc"aw". ^' AOR^Teo ► �(5 S U BOARD OF HEALTH Food/Kitchen PERMIT T . LD t6w Septic System ell THIS CERTIFIES THAT ........... 14.. ...�iiA.. ... �. ......... BUILDING INSPECTOR .......................... ...................... has permission to erect buildings on . .. . .. Z.. , ' Foundation Rough tobe occupied as ........12r.. ...t.J .......5.. .. . ..A..................................................................... 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 3cUNLESS CONSTRUCTIO STS Rough Service ................it>.. .............................................. 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 pORTH Town of2ndover O 0% No. T �O LAKE h . ver, Mass, Z COC KIC Kl WICK S V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System 10) THIS CERTIFIES THAT . ...� „� ... h.,.,. ,,,,,,,,, BUILDING INSPECTOR ............ ... .......... A . ................... has permission to erect buildings on . .. . .. Z,.. Foundation Rough tobe occupied as ........�...V... .......�.. .. . ..A►...................................................................... 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 3o_ UNLESS CONSTRUCTIO ST S 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. SEE REVERSE SIDE _....... .... . _..._. _. . . ... . ..... .... _ _.__ ... ...... ...._ _._ . ... _... . . zJ - � EDWARD d DIANE HANLEY BOOK 2360 PAGE 122 ASSESSORS MAP IOBA PARCEL 181 01212 SALEM STREET . SALEM ST N� JOHN K ELLEN PAGE BOOK 4883 PAGE 88 ASSESSORS MAP IOBA PARCEL 55 507 5o'35'E /1110 SALEM S„'26'22Es 9TE I 87.03 LOCUS MAP N.T.S. FOR REGISTRY USE ONLY - - \ - ALL slp�l 41 IRON PIPE _-_ }, •1 FOUND .� ASSESSORS MAP PARCEL 52 N/F AT£A AC 1.5 ACRES (FORGE k BOOK 10877 PAGE 315E` ' •!w. ASSESSORS NM 108A PARCEL 33 J/'/ '•1'-... 1150 SALE71 STREET ' APPROVED: NORTH ANDOVER ZONING BOARD OF APPEALS i, 12.A W_7LAND Il A { N� E ASSESSORS MAP 106A PARCEL 53------ � ran m ANDRE h KATHLEENABOU-FARAR r/ AREA = 0.80 ACRES �1 BOOK 4197 PAGE 278 , 107.1' PROPOSED LOT 02 ASSESSORSNAP 106A PARCEL 43 i ; AREA 58.3358 S.F. /1716 SALEM STREET k N 1.3 ACRES myy 8AEDGE 07 4O .Z E PROPOSED LOT AL1 .. Ai REA = 45,427.4 S.F. W`' 9 1.04 ACRES 1 r, 47.0' t ' ZONM TACE ZONE R-1ISTY REWIRED E70SRNG PROPOSED 'i GARAq REAR 442YFROT 10.6 3 3 2C r rOJ, 't PORCH 1731: LOTAREA 87,120 S.F. 454274SF./58,535.6 i S.F. i _......-._...._. FRONTAGE 17100' 179.19'/198F, .08' POOL"--..._t 4 t THIS PLANIS THE RESULT OF AN ON GROUND SURVEY i (TO BE REMOVED).. PERFORMED BY NEW ENGLAND ENGINEERING ON OCTOBER 10.2006. `APROPOSED .� FOUNDATION ' , t 2 STY i 48.8' { AL 32 DRILL 39.8' 352' 380 GPAPIUC SCAU HOLE � �. STONEWALL FOUND _ .... ... ' TOTAL FROM AGE�179.1C 'i L�12 10.8' TOTAL FRONTA'G'E ... ._ .199. .... 138.1 L�O.SB' N05'03'26'V (Of llta) NOl'26'24N 16"4' •' - _,...... ._ ._ F DRILLHOLE i FOUND .20' - p�SH OfRSS4 cxl 188.84' (1973 COUNTY LAYOUT) STRUMT REFflRICE! ( I CERTIFY THAT WAS PR L&n 111 . G 1. 1973 ESSEX COUNTY LAYOUT-SALEM STREET CONFORMANCE RULES AR ONS 2 NERD.PLAN p302 PARCEL,52 AND 53 INTO TWO NEW LATS CONTAINING AT LEAST . 3 OF THE REGI 3 N.ER.D.PLAN 06138 1 ACRE EACH. 4 4 RECORD OWNER:RICHARD AND JOANNE ADAMS RECORD DEED: BOG(7728 PAGE 221 FRUFL5519NAL LAND VE IF C�NO SJR i