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HomeMy WebLinkAboutBuilding Permit #342-11 - 135 RALEIGH TAVERN LANE 10/25/2010 i TOWN OF NORTH ANDOVER i APPLICATION FOR PLAN EXAMINATION -211 Permit NO: �/ Date Received 'b Date Issued: 6 IMPORTANT:Applicant must complete all items on this page LOCATION 6 eRALM x=,9-0 14VEP V 4 �i _ Print PROPERTY OWNER kRI V— :'QL 14 Print MAP NO: %gl� PARCEL:O//=Z ZONING DISTRICT: Historic District yes Machine Shop Village yes -, no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building Mone family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other {R�.�s � _. =� 5 (] Septic ®Well v I; ,®kFloodplain �Weflands ® �Watershed�DistrietLL k L i DESCRIPTION OF WORK TO BE PERFORMED: i 12t f 20 l� ItntifiLation Jlease Type or Print Clearly) OWNER: Name: V I. L)L I Phone: Z�Oqzf 'r Address: CONTRACTOR Name: Q 1 Phone: 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: $ 7000 FEE: � i Check No.: d_�S Receipt No.: <;3 NOTE: Persons contracting ith unregistered contractors do not have access to the guaranty fund �Signatureof�Aent/Owner nature ofcontractorg ,> ^Y ' g - g PAC Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ - Food Packaging/Sales _ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ 'j { } +. . THE FOLLOWING SECTIONS FOR OFFICE USE ONLY - INTERDEPARTMENTAL SIGN OFF - U FORM n a - js t Sdd�r%6N DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ COMMENTS - r i, CONSERVATION Reviewed on ID DI c'� Signature �S COMMENTS vJ j ao s „�,. �s o• s ©O' b v HEALTH Reviewed on 1V /v �r. Si natur / -'Z' _ COMMENTS 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 01 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 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.$10041000 fine NOTES and DATA— For department use F ® Notified for pickup - Date Doc:.Building Permit Revised 2008 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 2008mi Location No. � Date U �oRT� TOWN OF NORTH ANDOVER f 'Ih a t a Certificate of Occupancy $ • i � ; Nu I Building/Frame Permit Fee $ o 't"'� a,+cst Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # U� 23594 Building Inspector F ORTH 0 0 over No. =+ LAKE O over, Mass., I� ~COCKICKEWICK %ORATED PPa,`�� �l S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System ---� BUILDING INSPECTOR THIS CERTIFIES THAT..... ����...J.. )..�i.1.✓.................................. .................................................................. Foundation has permission to erect........................................ buildings on -13S. ...... ..............4. Rough tobe occupled.as........ 2.-P......... ...a,.......................................................................................................... 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 CONSTRUC STARTS Rough ................................... Service BUILD CTOR 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. a� Card#�n qtr Y.Ty�F 1� f � fipfiOh TaVFta Lh` w i LOCUS LOT 124 LOT 123 N74'50'00"E 168.00' LOT 112 0 M PROPOSED SHED AREA 44,184 SF +/— IZ- 71.1' 9 � _�I H rn 0 O 04 5 cg u7 N ( YJO ry / ~ 34)0 2A' o �1.6' ~ 5 o or LOT 111 ��" �g a �� 1p,,�. 50.2' 47.2, "" �� ,yy�o�� � �� , J ; LOT 113 N/ bi 0 N S74'50.00"W RALEIGH TAVERN LANE \ (50 FT R.O.W.) OF MASs9� - ey' JOHN 4- Mc�U�LKIN, JR CERTIFIED PLOT PLAN 9 No. 36120 w 0 �F Q Ss�oN�< <aNOSJ 135 RALEIGH TAVERN t�NE NORTH ANDOVER, MA. SCALE: 1 in. a 40 ft. DATE: AUG. 26, 2009 010 REFERENCES: REVD DATE: APRIL 14, 2 PREPARED FOR: 1. TITLE REFERENCE — BOOK 10308 PAGE 272 NERD Erik Julin 135 Raleigh Tavern Lane North Andover, Ma 01845 2. REFERENCE TOWN OF NORTH ANDOVER PREPARED BY: ASSESSORS MAP 107A PARCEL 112 JM Associates 325 Main Street North Reading, MA 01864 978-664-6668 www.jmassociateseng.com www.cer-tifiedplotplans.com JOB# 7---197 Scale: 1/8"=1'0" Notes: Proposed Deck extension entirely within 100'of wetlands and is expected to require approval of Conservation Commission Leach Field 15'x 50' Septic i T k 1 i ;i 1.x Proposed �•�\�,_ o ` Deck Extension \ L N Porch-� �ts, "•-•. ED (No Foundation) .0 n r cirN •� Exiting Deck ? r 9'7"x 27'6" -- 17',3".. 2T 6 112',V: R Existing Dwelling 4 t w 135 Raleigh Tavem Lane Liu ` � ..r{sK 3C `? fir17xxc y-N �< (>h {L" .�y^•. s'��.[f` " ?4'yy,ti5?'� 1 5'u#�,.�5`''N Ii SSL✓+�` " .J� }, �x. .(�.r ti�'� �t.: .y�r =,. '�. {� l- �� { F�t �v{•K�uC^",s!�%. {r '�k r '✓ :'f +5,,'.`��: F NORTH TOWN OF NORTH ANDOVER a"v OFFICE OF O O� * BUILDING DEPARTMENT * ^ * 1600 Osgood Street Building 20, Suite 2-36 *7y"°�,�D North Andover Massachusetts 01845 SSACHUSE� Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 . HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please print DATE: 20 (-,)C'T 2010 JOB LOCATION:_ S 1�ALE(GhI 11\Jwt4 Number Street Address Map/Lot HOMEOWNER Ewi J��)ht ` S� Z I cP�ZS80(73I Name Home Phone Work Phone PRESENT MAILING ADDRESS—13S SAL E1Q1{ I r t t Lnl Ci Town City S+,arw 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 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 CONSERV AT1ON 688-9530 HEALTH 688-9540 PLANNING 688-9535 The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Na1ne(Business/Organizatio (ndividua �14 a,.I PS L A Address: f�� JZ)9 LEI(5 H �A Vt�d City/State/Zip: NoRTO AN-baQUZ 64 0105Phone#: q9� ,,-58 0f 2/ 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. 1PNew 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. �• 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 10.n Electrical repairs or additions required.] officers have exercised their 3. '1 am a homeowner doing all work right of exemption per MGL 11.FJ Plumbing repairs or additions myself. [No workers'comp. c. 152,§ (4 1 ,and we have no ) 12.0 Roof repairs insurance �ired.re q uemployees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. f 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 isproviding workers compensation insurancefor my employees. Below as thepolley andJ ob 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 c der thepains andpenaldes ofperjury that the information pro vided ab o v e is true andcorrect. Si ature: Date: o� ��` 20 10 Phone#: ' 9? a-qz 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.PIumbing Inspector 6.Other Contact Person: Phone#: