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Home My WebLink AboutBuilding Permit #361 - 114 STONECLEAVE ROAD 11/5/2009 BUILDING PERMIToNo oTN qti TOWN OF NORTH ANDOVER 3? -f%.90 -�6'° APPLICATIC F%. ,PftMEXAMINATION L, Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Paint PROPERTY OWNER Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes pno TYPE OF IMPROVEMENT PROPOSED USE Reside Non- Residential uilding One family A�eratiorn more family Industrial No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other eptic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: ��_ !1 �dw,..� Phone° 'l6) k3 Address: k l SwMc cls. CONTRACTOR Name: Phone: Address__ Supervisor's Construction License: 05'.300V0\ Exp. Date: k-LI t 1 Home Improvement License: Lp Exp. Date: �tZ,� to 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: $ Z�Z-,�;Ii 1) FEE: $ D-710 Check No.: Receipt No.: NOTE: Persons cont with u registered contractors do not have access to the guaranty fund signature of Agent/Own .. Signature of contractor 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 II o Building Permit Application I ❑ 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 o 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 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL `, �Z j-L LIj .. t Public Sewer Tanning/MassageBody Art Swimming Pools Well Tobacco Sales Food PackagiAgAale's F 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 CONSERVATION Reviewed on "C 2 signature ,-' -C COMMENTS &PP "V PIZ HEALTH Reviewed on Signature l COMMENTSL,y 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: Located 384 Os god Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date 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, mast or service dron 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 4 F. t I L ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 LocatioAf -7 No. .361 Date NaR,M TOWN OF NORTH ANDOVER H?.• • OR A ♦ s Certificate of Occupancy $ ss14Us cBuilding/Frame Permit Fee $ cZA7 Foundation Permit Fee $ ` Other Permit Fee $ TOTAL $ Check # 1 ,7,24 f 226U ! Building InspectoY - � � f-o I I I i I I I I � I I i I I I � I I II i I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgovldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electriaans/Plumbers Applicant Information Please Print-Legibly Name(Businesstorpnizarion/individual): t —J Address: v,�- City/State/Zip: o`%,t�Phone#: Are you an employer?Cheek the appropriate box: Type of project(required); !. ,1 am a employer with �;L-- 4. ❑ 1 am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hued the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet t 7 Remodeling ship and have no employees 'These sub-contractors have S. ❑ Demolition working for utc in any capacity. workers' comp. insurance. . 9.'o Building addition (No workers'comp. insurance 5. ❑ Weare a corporation and.its I O❑ ElectricaI repairs or additions requhv&] officers have exercised their 3_❑ I stn a homeowner doing all work Tight of exemption per MGL ❑ Phimb'�repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.]t employ=. [No workers' 13.❑ Other comp.insurance required.] Any applkat that ebecb box#1 must also fin out the section below showing their workers'covilmsetion policy infbnMtion: Homeowners wbo submit this affidavit they are doing all wort and thea hire outside wntmcton must submit a new affidavit indicating snot �(ntraetols that check chis box mast attached em KU tirn►al sheet showing the name of the sub-contractors and their workers'comp.policy information. am an employet that is providing workers'eampensaden.insurance for my employees. Below is the polkcy and job site nformation. asurance Company Name: 'olicy#or self-ions.Lie. #: K9& t_v C.. U L)k�31 Expiration Date: ob Site Address: City/State/Lip: \Qzt T-, kttacb a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). 'ailwe to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of crilninal penalties of a me up to$1,500.00 and/or one-year imprisowment,as well as civil penalties in the form of a STOP WORK ORDER and a fine if up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of nvestigations of the DIA for insurance coverage verification. 'do here certify under the pains and penalties o Bury that the information provided above is tate and correct. ii atiue: L-0 Date; 'hone#: f use only. Do not write in this area,to be completed by city or town official, Town: Permit/Ucense# Aathority(circle one):d of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Iaspector r t Person: Phone#: GERTIFIG ATE OF LIABILITY INSURANCE DATE(FRODIA "�,D�,m,« NK 7109 M.P, Roberts Xns%j%vLu" TNlf FWATE 0193NED A8 A FfA77ER OF!f�lF"OR1AATfON 1060 Os eY ONLY AND CE?NF'ERS NO RIt�MiP UPON THE CER7tRCATE Osgood sorest ALTER THE�RA��A��C�o BYOTW pNo In ND R ao�c�h Andpvar, MA 018x$ riiu .. .. 11MEtlIiLRS Amp COVEpA6E NAM 0 3iE = IdORPttY RE t.x�tt3 INNNERA: pyg uE►I _._ 1.69 Z100mmm "mm ONIuRER s atian I co 1Q== AWOVBR, Nh 01845 1 0 JMeurft u CCRA Aw t82t N1 1�4�IA OR�mk�41IL 1�8611Ei��D'1Fd;1 iV FOR MAY 71f II4fl�'tgNCA AfiFDROED BSYT�PQ4�lCd�OE ®RF�NDOC WRH RE6P6C? TO %=c9MCATV Wy$EhNTM on PQ.�IE�AOI LA�ItfBAdQ1AlAfMAV NAYSglIt®L1C�78YPl�tDt��tM�SUBJECTMALLTHEMA&FbQvU1410Ng M4Yf3E 012 AMC WNDITK"or 1%" pmw w ---._- A ML 081A IilllMbuttl C1AM� AIR OCCUR C"0060A68 04 11/.22/08 11/22/p9W$ iIn- o S 0 _1 a�,A96ild►t��wrApn�reR �� e D a P Lac PAootAot8-W�'A7P AW s 000 1MR6Ud1ft1' AWAM ce OM lELUfT = 500.000 H ft4W"AUfW 7AM0277013608 1/23/09 1/23/10 Wft=lly $ t1lRI'i0AVT08 NOMWWl00AttfOb ��e.YRY � �.""—� � _�1+DAMataE a 500,000 gh"u"L"y AWAM oONLY-V DENT a BAAM AUfO Qf11,Y e�tuN��ertrr oc" „r caAMaww "00 &-= At20AEM7E DIDWTOW MCNDttlle C E 11M006931 7/1/09 7/1/10 8d0 ot►s�e Son nAA tscsxmowoRar noNst+�xy►nwarvaeaas+ataa eAlMW 8NDuFA Wlate, PRwvrAuww M: 978-688-7207 QR CAfICl�.LA p ;i!! NEA� W*V4PMA 9dPftNWWd. ft A1�DOVER 11E t�AM IWUR/R NW1600 OSGOW 8TSi f �NAM %LLNC7R"l AMOVER, to 01848 PA aaR440ae ACOtib TM ACCAD MR*and foga 00f*06p0dmaet Of ACORD ANwed. „ . � :, I, . — .,.. . _ . . . . "� _ .. ; � _ �.. � s y a � I _ ... .1 L� • • r i 4 r r � t .� ..ice : y I s _ � �. :. � _ _ .�..._ .. ..... _ .f � s' � .. � ,5 Y � t .. ' � � � � � � - � � 1 ' � _. r 1 _ ` ”. .. 4 •,via. -w ._. � _ J ---------------- RIS`HA D AND J0 'N' JVD A1S RECEIVE[ OCT 0 7 2009 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 114 Stonedeave Road North Mdover,Ma 01845 (978)685 6743 Jetadams@Comcast.net October 2,2009 Susan Sawyer Health Director 1600 Osgood Street Building 20,Suite 2-36 North Andover,MA 01845 Enclosed is a letter of confirmation that Richard and Joanne Adams,of 114 Stonedeave Road, will be updating our Septic System. We wish to go forward with the construction of the addition, of the 12 X 12 porch,which occupy a Hot Tub. If you need any further information,you can contact us by e-mail or 978 685 6743. Sincerely, Richard D Adams rC IC �l D. Joanne E Adams t1ORTFr O0 �t►sO �s�ti O OL O i A ° cx.i[wcv.c. 1• A �q0 �SSACHUS�� PUBLIC HEALTH DEPARTMENT (ommunity Development Division Date: September 10,2009 Address: 114 Stonecleave Road w Re: Application for12 x 12 addition Dear Mr. Adams: , Your application for an addition at the above address has been reviewed by the Health Department. Unfortunately,the application was denied on September 10, 2009 for the following reasons: 1. x Missing information 2. x Passing Title 5 inspection of septic system required 3. ❑ Location of structure not acceptable unknown at this time 4. x Undersized septic system unknown at this time To address the problem(s): If#1 is checked, please supply: a. Floor plan of existing and proposed addition—all rooms b. Certified scaled plot plan showing house,septic system in relation to the proposed addition If#2 is checked: a. If the homes size is approved, have the septic system inspected by.a certified Title 5 inspector to determine its location and whether it is operating properly: b. Tie-in to municipal sewer If#3 is checked: a. No permanent structures shall be placed on any part of the leaching area or over the septic tank If#4 is checked: Once submitted, the floor plan of the home will be reviewed along with any additional information. The assessor records indicate a 3 bedroom home until 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8416 Web www.townofnorthandover.com other information is submitted it can be assumed that this septic system was built for a maximum 7—room home. If the floor plan shows greater that 7 an upgrade may be required, therefore please do not conduct the Title V inspection until the size of the septic system is evaluated. For more information regarding the regulations regarding subsurface disposal systems,please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sincerely, Susan Sawyer, REHS/RS Health Director Cc: Building Department File 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 fax 918.688.8416 Web www.townofnorthandover.com