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Home My WebLink AboutBuilding Permit #157 - 134 MILK STREET 8/26/2009 TOWN OF NORTH ANDOVER APRUCATION FOR PLAN EXAMINATION Permit N0: � ZG �`� 0 Date Received 01 Date Issued: ' IMPORT icant must complete all items on this page y LOCATION -1 u t ttic1VIR Print PROPERTY OWNER —A—afcv\ Print MAP NO: fe PARCEL:. - ZONING DISTRICT: ' ,Historic District yesno 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` Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: heck Identification Please Type or Print Clearly) OWNER: Name: fca^ ccv�-},we Phone: q7r- 6SS-136? Address: ?� nillg�f jtk 4 p ( `� CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Dater Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ � FEE: $ Check No.: 4?6� Receipt No.: NOTE: Persons contracting with nregistered contractors do not have access to the guaranty fund gnature of AgentJOwner _ Signature of contractor Plans Submitted Plans Waived Certified Plot Plan Stamped Plans 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 ❑ 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 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: Doc.Building Permit Revised 2008 9 TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/MassageBody Art SwI *" Pools Well Tobacco Sales =Food Packa mg/Sales Private(septic tank,etc. Permanent Dumpster on Site F THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM k—T-IE rL S HTE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on V Signature V U 0 COMMENTS HEALTH Reviewed on Signature COMMENTS_ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Panning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood 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 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 NOTES and DATA— (For department use) f Gds �G/l o Nlwy- / ❑ Notified for pickup - Date Doc:.Building Permit Revised 2008 S� Locationy& rh, I f No. �'� Date „ORT" TOWN OF NORTH ANDOVER 3? • p P q + ; , Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ � s�cmust 9 , Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 22361 Building Inspector NORTH TOMM, of t . 4 over. . oW..:.�w. .- �. : No. 4-S-7 - _ - _ _ 4" _ = A K E dower, Mass., _ COC HIC HE WICK`y^ S RATED BOARD OF HEALTH PERMIT T Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..� ..�.�....,._. ... . . . ......................... ................................OL ...�i6 ............................. Foundation a ' n has permission to erect........................................ buildings on ......f l� .......N.. ... ......0................... Rough to be occupied as.......�. .�t..Lz.......... .........�'f. ,�,WAJ!....... .. 0................................ Chimney provided that the person accepting this per it shall in every respect &form to the terms of tT1e 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 3 6 , PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS TR TARTS Rough ............. .. ..... .... .... ........................................."`............... Service BUILDING INSPECTQR 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 SIDE Smoke Det. NORrk TOWN OF NORTH ANDOVER OFFICE OF ° A BUILDING DEPARTMENT 4 1600 Osgood Street Building 20, Suite 2-36 North Andover,Massachusetts 01845 �SSAC14 SSS Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please print DATE: 7 �, 0 C JOB LOCATION: 3 N Number Street Address Map/Lot HOMEOWNER NCO^ �=Gyts+r i� q76"655 -13 Go , G [7- Z 0-c(3oC� Name Home Phone Work Phone PRESENT MAILING ADDRESS Nom City Town State Zip Code The 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,or is 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 der tands he Town of North Andover Building Department minimum inspection procedures and requirements th he/ e 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 The Commonwealth ofMassachusetts �-. ► Department of Industriad Accidents f O 'Ce of Investigations . 600 ;flashineon Street U4 B c�� oston, MA 02111 + Workers' Compeasaiion InsuranceJMdavi s.�gov/din A ridavit~ Builders/Contractors0ectricians/Plambers A� 'cant Iafor�afian Please Print Leeibl Name(ausirt�ss/Organiaation/individ y +�t'/v� �. �s �. Adcjress: S Are you ao employer?Cheek.the appropriate box: I. I am a employer with 4. ❑ I arri a Type of Project(req7additiam general contractor and i . employees(fun and/or part-time).* have hired the suis-conlramm 6• ❑New constructi2•❑'I am.a.sole proprietororpaler_ listed on the attached sheet 3 7. (]Remodeiigg ship and have na employees'. These suls.contlactorb have working for me in any capacity, worker' comp.insurance. Demolition(No worlcars'comp. inswmnce 5. [] Wearea corporation and its 9• El Building additi[NGwor officers have cxcrcised their 10.0 Electrical. I am a homeowner do' �PssIf o war all rightof exemption par MCIL 110 plumbing repai �' gyp, C 152, §1(4),and-we have no insurance-required..].t .ernplOyees.[No workam' 12•Q Roof repairs COMP. insurance requinLI I3.1.t� t Ho aPPlr�t ti�et t#reelcs box'#I must also fill out the section below showing their;woticara'ii t IiomeOwn=who submit this aftr'dawi indicating they am doing an work MPMWio"policy infomtation IConftft s that check this box musrattw*Md an additiomsl shasaho end htie outside contractors must submit'a new affidavit ind' wing.tfte nems df the sub•contt�and&,• 10�7D6 m� !asF..st errtptoyer that�'PA?I�a we PP .^�'c^. errs tr F jf' `�fY site Insurance Company Name: Policy#or Self-ins.Lie.#: Y . Expiration Date: . Job Site A ldrams Attseh a copy of the workers''com nsatioa Failure to City/Sfsip; Pe policy declaration page(showing the policy number and expirafion da*4 . secure coverage as required under Section 25A of MGL t:. 152 cart cad to the imposition of a urinal fine up to 50.00a d y apr one-year' as well res civil perialiies in the form of a STOP WORK ORDER of a Of up to$250.00 a clay against the violator. Be advised drat RDER and a fine investigations of the DIA for insurance coverage verification.copy of this statement may be forwarded to the Office of Ido hereby citify n e and penattiEs nfPE'!rc'7'tyi� Si nrnzsiion the in f` P corte ' ded above is true and cores Date: �j Phone#: Ofj`scial we only. do not write is this ass¢,m bt c»mpt��!�' or town nflFriaL Cify or Town: Permit/License# Issuiteg Aathotify(circle one}: 1. Board of Iiealtit L So DepmrEment 3.City/Town Clerk 4. Electrical Inspector 5. Pinmhi 6 Otbe'r lus r pedn . Confect Persorz• Phone#: Information a lid In's' tructions- Musa huseM General Laws,chapter 152 requires all emp Ioyers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"..:every person in the service of another under any contract Aire, express or'implied,oral or written:" I' An en player is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the'fbmgcaing engaged in a joint enterprise,and includi"g the legal representatives of a deceased employer,or flit receiver artrustee•of m individual,pmt ership,association or other legal-artity,cmpioying etrtpfoyem'However the owner,of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maim mtmarrce,construction ori wdrk m such dwellinghou:.se or on the grounds or building appurtenant thereto shall not because of sorb employment be deemed to be an employer." MGL chapter 152,§25C(6)also states$rat"every state ow-local greasing agency shall withhold the ismaneeor renewal of a license or permit to operate a besmess or *a construct buildings inthe commonwealth for any appPicant who has not produced acceptable evidence zir compgauce with the.insurance coverage required." Additionally, MOL chapter 152, §25C(7)states`Neither t ho'cormnonwealth nor any of its political subdivisions shall enter tritearty eort>ract far the performance of public wane turtt'1 aeeeptaiile evidence of compliance wide the insraancx requirern=9s.of this chapter have been preserttzd to the contracting authority," .Applicants Please fill out the workers'compensation•affidavit completely,by checking the boxes that apply to yourotuation and,if necessary,supply sub-contracior(s)name(sj,address(es):2md phone number(s)along with their certificate(s)of insurance. Limilad'LinbUity Companies (LLC)or Limited Liability.Partnerships(LLP)with no employees otherthm the members orpattners,arc not required1to carry workers'cr rnpensafron insurance. Van LLC orUP does have employees,a policy is required. Be advised that this afrttd.-vit may be submitted to the Departaerd of Industrial Accidents for confirmation of insurance coverage.. Also Eae sure to sign and date the affidavit; The affidavit should be retxmred to the city or town that the application for the peztinif or Iicdase is being requested,not'the Department of Industrial Acoidenta Should you have arty questions regarding the law or if you arc regained to obtain a workers' oompaisation policy,please-call the Dcpartrnent at the•nutz rber.HgW below, Self itrsured omnpanies slreuid enter their self-ir18uMnez iice;a sc numbtr on 6:'appropriate Trac. City or Town Officials Please be sure that tno affidavit is compierte and printed lsglbiy. The Department has provided a space at the bottom of the.affidavit for you to fill out in fire event the.Office of invwogafions has to contact you regarding the applicant. Please be sure to fill in the permit/lictme,number which wriII be used as a reference number. In addition, an appikant that must submit multiple permit/licxnse applications in any given year,need only submit one affidavit indireting-currerrt policy'irrfonnation(if necessary)and ander"Job Site Adds-ess"the appiicant should write"all locations in (city or t"m)"A appy of-the affidavit that has be=officiak stun. ped or marked by dee city or fawn may be provided to the applicant as proof that a valid afftdevrt is on file for future r permits or licenses. A now affidavit must be Med out each year. Where a home owner or citizen is obtaining a licease ar Permit not related to any business or commercial vm tum (i.e. a dog license or permit to bum leaves et:.)said person is NOT,required to-compietz this affidavit The Of i=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: The Comnmorrealth of Massachusetts Departrnent of Industda.1 Accidents Office of Enusstdgsfions 600 Washington Street Boston, MA 02111 TeL 4 617-727-4900 ext 406 or 1-977-MASSAFE Fax 9 617-727-7744 Revised 5'26--t15 Www. -,:mq govidia N 100'-0' i g �s g 19,_2. 1 n aee , I ee\ i JO'-0'SET 80 i r I F I s 5 li a � i North Andover MIMAP 134 Milk Street August 6, 2009 Y. tia s� e "r xe e 1.410.0-o azZ . f �Y r •� v 060 0 O v - s � t G� 4 ry —00 —00 Interstates Interstate Major Roads Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, Roads Meters Data Sources:The data for this map was produced by Merrimack NpRTM Valley Planning Commission(MVPC)using data provided by the Town of r;EasementsNorth rovided by the Executive of MVPC Boundary �t 4t��o .♦9ti0 EnvhonAndover. ntal Affars/MassGIS PTh The depicted oonn this map Is LJ �� s p LJ ParcelsL 3' for planning purposes only.It may not be adequate for legal boundary F .••-• p definlfion or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING �l THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT �o� r r r �� ♦ ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF +o�;z,o'�•`tg THIS INFORMATION 1SSACMUS�t 1"=116 ft ~�° a North Andover MIMAP 134 Milk Street August 6, 2009 r� w� 060A-0013 �1 / 060.(1-0002 r- l S 060-4-0012 Ire, r r� --Rall Line Interstates Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, Interstate Meters Data Sources:The data for this map was produced by Merrimack —Ma)or Roads NORTH Valley Planning Commission(MVPC)using data provided by the Town of Roads Ot t qac ,�, North Andover.Additional data provided by the Executive Office of r;Easements ? spa re�b C0 Environmental AffalrstMassGIS.The Information depicted on this map is Trails 3` G for planning purposes only.It may not be adequate for legal boundary O •—• A definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER Streams ~ p MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING C)MVPC Boundary # +► THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY } y # OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT E]Municipal Boundary } o9q �� # ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF 11 Parcelsrr+ '�" g THIS INFORMATION Hydrographic Features �1SSACMUS�t Wetlands :: Exempt Lands 1"=24 ft "�` Residential Property Record Card PARCEL ID:210/060.A-0013-0000.0 MAP:060.A BLOCK:0013 LOT:0000.0 PARCEL ADDRESS:120 MILK STREET FY:2009 PARCEL INFORMATION Use-Code: 101 Sale Price: 1 Book: 02824 Road Type: T Inspect Date 04/10/2008 Tax Class: T Sale Date: 10_/12/88 Page: 0178 Rd Condition: P Meas Date: 04/10/2008 Owner: Tot Fin Area: 1290 Sale Type: P Cert/Doc: Traffic: M Entrance: C SERVERIUS,CLEMENTINE, LT Tot Land Area: 0.50 Sale Valid: A Water: Collect Id: RRC ROBERT E&WERNER SERVERIUS Grantor: SERVERIUS CLEMENTINE Sewer: Inspect Reas: C Address: _ 120 MILK STREET Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% / NORTH ANDOVER MA 01845 RESIDENCE INFORMATION LAND INFORMATION Style: RN Tot Rooms: 5 Main Fn Area: 1290 Attic: NBHD CODE: 7 NBHD CLASS: 7 ZONE: R3 Story Height: 1.00 Bedrooms: 2 Up Fn Area: Bsmt Area: 0 Seg Type Code Method Sq-Ft Acres Influ-Y/N Value Class Roof: F Full Baths: 1 Add Fn Area: FnBsmt Area: 1 P 101 S 21950 0.500 210,440 Ext Wall: AV Half Baths: Unfin Area: Bsmt Grade: VALUATION INFORMATION Mason Trim_ : Ext Bath Fix: 0 Tot Fin Area: 1290 Current Total: 314,300 Bldg: 103,900 Land: 210,400 MktLnd: 210,400 Foundat on: CN Bath Qual: T RCNLD: 103912 Kitch Qual T Eff Yr Built: 1962 Mkt Adj: Prior Total: 319,800 Bldg: 109,400 Land: 210,400 MktLnd: 210,400 Heat Type: ST Ext Kitch: Year Built: X1946-. Sound Value: Fuel Type: O Grade: A Cost Bldg: 103,900 Fireplace: 1 Bsmt Gar Cap: Condition: A Aft Str Val 1: Central AC: N Bsmt Gar SF: Pct Complete: Att Str Va12: Aft Gar SF: 264%oGood P/F/E/R: /100/100/73 Porch Type Porch Area Porch Grade Factor P 32 SKETCH PHOTO 324 27 2 $ i FM G 22 1290 Sq. 264 q.F 41 22 22 R a 4 q.R 120 MILK STREET °•` Parcel ID:210/060.A-0013-0000.0 as of 8/11/09 Page 1 of 1