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Home My WebLink AboutBuilding Permit #271 - 156 PALOMINO DRIVE 10/15/2008 BUILDING PERMIT OD t�E ' b OFt • q~O TOWN OF NORTH ANDOVER ? 4 y,. .a o� APPLICATION FOR PLAN EXAMINATION 41 Date Received 744DAATED��' Permit NO: gssac►+us�� Date Issued: 0 a C)'K' IMPORTANT Applicant must complete all items on this page ° �„ L � k�,'. Y,> ?� n i '� � t � »�`-N.- °' t urnq, .. Ej {� � ,��yk� ��,•-.xs. TLV Wit- 4 a, 3 MA��O � ��=4PcF2;i✓�L _��' � 1 i�� ST�R�C'�^�� . �3s��i�� st�cf ��.�" -�� s ��c "ya r' � �' - $ •^' '� 'T�mw.ft `'d "'- ` .,,� - "�e...-�'+�:1.+�P°' i .3d,"P�"Z3#'". m�cFhr'`� �c7��:' ° ��ay.,3t'{ �,�$�}"�"iM.' 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 >a""s' F` l eT e 77'— �-. DESC IPTI N OF WORK TO BE PRE ORM �:, ac[& CL �S'hen h xQ Ga✓j . Identification Please Te or Print Clearly) OWNER: Name: /Vl hTa.Vl Q Phone: 7� l 7S --1//9.. Address: IS( pado M i VAoyl`of, . - �� IN si; { �.' r'i -� �. ��,x r �a� � i,e€§'"� Via" i .m°�� s+ �r. a ,� •,.,�,.`' ; .A. ,'S.o9'S -Y "g t ,�" '1—�, r € }�-�n °+��, -r °� `' �'�"t r6 ,4a-�,+ ,;� ,� xA`,�ru.� ',�. ,��, ,T .�- •,��R ?j,r. x a��„a �,1b��s w# - t� k �� 7 aw s+ z r ;Y, ✓ r,` . f v.+7 '.°+� F a -e�. a a"5 s ¢ = 3y `" �. 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: $ -/l, da--7- FEE: $ �0 --- Check No.: 510- Receipt No.: XoZf NOTE: Persons contractin - w* unregistered contractors do not have access to the guaranty fund i Sagn`ature o , enareT ' . � gi � urea contraeot x , _ L, s 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 - - - -------L3 Workers 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) t, j ❑ 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 !t { Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 J i 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 THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on S Si nature l COMMENTS HEALTH Reviewed on Signature I 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 DPW Town Engineer: Signature: i # Located 384 Os ood Street ►► TIMET 7rr� teros#e a .. c ,..„. .�:ta- oet gt .e.,u:.�y*A,.s.aviv :.•qac qtr.,•«:`�'�� wt:„,+ k�,,;�,.,`�� ='� z�?..�++ar �-� Md��,a�:,., a � �..��t*r�`a <a . ��'��'2a".vs�"°`"'m�-� Dimension Number of Stories: Total square feet of floor area, based on Exterior dimen sions. 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 i P:J :No:tfifi:ied:for pickup - Date Doc.Building Permit Revised 2008 Location 16-41,o No. Date MOR,M TOWN OF NORTH ANDOVER ~ 9 4, Certificate of Occupancy $ — �'�b'••" 'tt' Building/Frame Permit Fee $ (J • ssx�se Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # " 21664 « Building Inspector ` NORT1y '9 T0VM of over No. Z W o ,& .o �` dower, Mass. COCMICMEWICI y�. ADRATED S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.....D. . ......... + .G►. f 1404W.......:................................:. ....�............................... Foundation buildings 11!.. has permission to erect................................... . . gs on .........�.�........��... .........:..... .. �.................. Rough. to be occupied as 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 3P • PERMIT EXPIRES IN .6 MONTHS UNLESS CONSTRU STARTS ELECTRICAL INSPECTOR 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 SIDE Smoke Det. gORTM TOWN OF NORTH ANDOVER +��'"•� *'�"� OFFICE OF a BUILDING DEPARTMENT * + 1600 Osgood Street Building 20, Suite 2-36 * t North Andover,Massachusetts 01845 sswcHus'� Gerald A.Brown Telephone(978)688-9545 Inspector of-Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please pztt DATE: Q JOB LOCATION: Number Street Address MapJlot HOMEOWNER p — 7 — Name Rome Phone Work Phone PRESENT MAILING ADDRESS /LI i 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 strictures. 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. i 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 Rc%ind 10.2005 Faro Homeowners EAoaWhon TIOARD OF \PPE:\1.S 688')541 CO.\SFRV.\'I'ION 688-9530 I-iE.U.:11i 688-9540 PL.L\,`1\C3 688-9535 - r� \ The Commonwealth of Massachusetts 1 Department of Industrial Accidents Office of Investigations °1p'` 600 Washington Street r Boston, MA 02111 www. mass.gov/dig Workers's Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): /() ��N Y) Y) Address: L0,10VVVY16 �1^V--( i City/State/Zip: �V j'1 qh ne#: 17� -I U 7l Ip 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 I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.F77. Remodeling I am a sole proprietor or partner- listed on the attached sheet. # ❑ g 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 area corporation and its equired.] officers have exercised their 10:❑ Electrical repairs or additions 3. 1 am a homeowner doing all work right of exemption per MGL 1 l.❑ Plumbing repairs or additions myself. [No.workers' comp. C. 1.52, §1(4), and we have no 12.7 Roof repairs insurance required.] t employees. [No workers' comp. insurance re uired. q 13. Other ] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they arc doinig all work and then hire outside contractors nmsi submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am ann employer that is providing workers'compensation insura mp ace for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-.ins. Lic.#: 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u er the pain and penalties ofperjury that the information provided ab ve is true and correct Signature: Date: A�> Phone#: Official use only. Do not write inn 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 joint 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 apartments and who 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 employment be deemed to be an empioyer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall 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-contractor(s)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. Also 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 burn 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,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents. Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-7274900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax# 617-727-7749 www.mass.gov/dia Town of North Andover F "pftTH q p tt�ao ,ea tip Office of the Conservation Department 0 _ - Community Development and Services Division p�AAT6o 400 Osgood Street �SSACHus�s North Andover,Massachusetts 01845 Pamela A.Merrill Telephone(978)688-9530 Conservation Associate Fax(978)688-9542 July 27,2005 Dro Kanayan 156 Palomino Drive North Andover,MA 01845 RE: 156 Palomino Drive,North Andover Dear Mr.Kanayan, At your request,the North Andover Conservation Department inspected the above-referenced property to determine if there were wetlands within 100-feet of house lot. It is my understanding you intend to clear some trees in order to extend the lawn area. This letter has been prepared to inform you that there are no wetlands within the project area.This was determined by examining the Forest View Estates proposed and as-built plans,as well as conducting an on-site inspection. have Should you questions or comments regarding the contents of this letter,please do not any Yqu hesitate to contact the undersigned at your earliest convenience. Respectfully, NORTH ANDOVER CONSERVATION DEPARTMENT Pamela A. Merrill Conservation Associate BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 I-IEALTIJ 688-9540 PLANNING 688-9535 9' PI•I MARCH I ONDA&ASSOCIATES 781 438 9654 r 1 I _ PALOMINO DRIVE z _Z3 If L�r L�29.1$' L-49.38' 102-30.00 '19" R-250.0119" -250 04-10'5201„ -D �� N� j np, -27,47 31.5' / Rs260.00' I ? I '}} • i1 TOP FOUNDATION ! ELEVATION=151.79 � j{ 16.2' ' � I I 74.2' i +r LOT 19 l' NOFh4 14118 S.E 3Oti 0.33 Ac. a 0. 9 �- iAssS, S433g S"E I f 89-3p' .I, O uS qG , A 2511��• _ t oo� ;I JJ.3 v WE HFRF8Y CERTIFY THAT WE HAVE EXAMINED THE PREMISES AND THAT THE BUILDING I5 LUCr(cG I'HIS PLAN IS INTENDED FOR ZONING AS SHOWN,- THE STRUCTURE SHOWN CONFORMS i' } p�ftpn�t ; ONLY. IT WA9 PPEPARE0 TO THE ZONING LAWS RELATIVE TO REQUtREL7 SETBACKS nL�a,� ,.n,r, c7FI',1RIli 1 t MUNICIPALITY WHEN C0N.`;IHUt;ltU- ALSq C?d.'C,r.C�ri�[l WITH THE STRUCTURES SHOWN LOCATED 1b IHt F.t.M.A./rl•U.U. rwvu +iy�unr,.o� rt%•TC .5. "', 0098 B 93 , THE'SY AN INSTRUMENT SURVEY. THIS PLAN COMMUNITY PANEL N0. 'STRTRUU 0015 C GATED 6 2 19CTURE IS NO I- LOCATED SHOULD NOT BE USED FOR PROPER' IN AN ESTABLISHED 100 YR.FLOOD HAZARD ZONE, UNE DETERMINATION, CERTIFIED FOUNDATION PLAN �'. T VIEW ESTATES M ARCHI ON DA & ASSOC. � L . F . 9, FOMES I\�OR TH ANDOVER, MA ENGINEERING AND PLANNING CONSULTANTS PREPARED FOR62 MONTVALE AVE. SUITE I i l _. HOMES OF NEW ENGLAND; LLC STONEHAM, MA. 02180 (781) 438-6121 '57 TURNPIKE ROAD SUITE 200SCALE: t"=30' DATE: '%1-1 /04- i 11-I60ROUGH, MASSACHUSETTS 01772 ,�..,,,