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HomeMy WebLinkAboutBuilding Permit #100-2017 - 17 EMPIRE DRIVE 8/1/2016 NORTI BUILDING PERMIT TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION _ �,� /iJ ,. Permit No#: Date Received �gq�Rw1T¢U "C`� gSSACHUS�� Date Issued: IMPORTANT: Applicant must complete.all items on this page LOCATION. PROPERTY OWNER r' Print 100 Year Structure yes no MAP� PARCEL: ;L ZONING DISTRICT: Historic District yes eo Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Resiclential Non- Residential ❑ New Building k6ne family Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement - ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic •❑Well n Floodplain ' p Wetlands ❑ Watershed District ❑Water/Sewer - - - DESCRI TIO PF RO B PEtYR E j I I enti c tion- lease a or r' t Clearly I 7f J KX-�;�7V OWNER: Name: Phon . Address: Contractor Name: Phone: Email- Address: Supervisor's Construction License: Exp. Date: Home Improvement License/ Exp. Date: , ARCHITECT/ENGINEER Phone: t gQ2— Address: Reg. No. FEE SCHEDULE.BOLDING PERM 12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost-. $—, FEE: $ Check No.: 6 Receipt No.: © 0 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signa PrP of Aaent/Ovvner Sianat.ure of nontra tnr Location t 1;21 o�Z,f 11 No. 10fli Date tJl � t • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ / Foundation Permit Fee $ Other Permit Fee $ TOTAL $ f Check#J�r� f 30633 Building Inspector �f F 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 Dmnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On �l Z� Signature_ � COMMENTS r Lum L CONSERVATION Reviewed on //( Si urep x Q// • f COMMENTS HE=ALTH Reviewed ori Signature COMMENTS : Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Plarning 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 12.4 Main Street Fire Department signatureldate COMMENTS �1 I 1 I Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: I ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector lies No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department apse) I i i �I i ® Notified for pickupCall Email Date Time Contact Name Doc.Building Permit Revised 2014 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 4; Workers Comp Affidavit 4. 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 OTE: 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/Cross Section/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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application s 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 2012 I ECC Energy code Engineering Affidavits for Engineered products OTE: 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:Building Permit Revised 2014 TOWN OF NORTH ANDOVEROFFICE OF } BUILDING DEPARTMENT 1600 Osgood Street,Building 20, Suite 2035 *1 North Andover,Massachusetts 01845 Gerald A. Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTKON BUDINC PERMIT APPLICATION Please print DATE: (J 7/e 70 JOB LOCATION: 'Amber Street Address Map/Lot HOMEOWNER15 & k - -Or I/r)9_30-�7 Name Home Ph e Work e PRESENT XMILING ADDRESS � City Town State Zip Code The current exemption for"homeowners"was extended to include owner occupied dwellings of one or two family dwellings and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. 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 dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner.(780 CMR Section 110.R5.1.2) The undersigned"homeowner"assumes responsibility for compliance with 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 4 \�. APPROVAL OF BUILDING OFFICIAL Revised 8.2015 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 1 tRTH : :. .c . : ve' 4* 0 ' _ ,� oh Z. ver, Mass, ad ®® z0v 6 COC14Ic Hl WICK O 'tl,9S 4ATED U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ....... ,... 4# 10......... .�.........., BUILDING INSPECTOR has permission to erect ........................... buildings on W. .. ...... Foundation�...�.�.�......................... • .. Rough tobe occupied as ................. ........... .......... ��.... .. R....................................... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTT10 Rough Service .. . . . . ........ ..... .......... Final BUILDIN NSPECTOR 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. Plans Submitted ❑ Plans Waived ❑' Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/MassagelBody Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Permanent Dwnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On ��Lc! Signature_ COMMENTS CONSERVATION Reviewed on b Signature COMMENTSjj"k L HEALTH Reviewed ori Signature COMMENTS i Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Sic�natcare�Date Drivewav Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIDE DEPARTMONT - Temp Dumpster onsite yes no Located at 12.4 Main Street Fire Deloartment signatureldate COMMENTS • Delivery and professional 3rd party assembly Victoria $899.99 included within 25 miles of Costco where purchased 8'W x 41 C� • Roofing felt and 25-year shingles (— j (5 colors to choose from) 32"wide doors on both ends with full-length e� 4 continuous hinges • Heavy-duty wood construction • Partitioned interior • Primed and ready-to-paint engineered wood siding Fz-`-6"—'; • Complete wood floor with protective, aluminum Included with Purchase threshold–Oriented Strand Board (OSB)floor decking with treated 2x4 joists and 44 treated runners • Pegboard partition • Three 24"W x 12"D shelves i • 15-year manufacturers material warranty • Locking T-handle - • Decorative door hinges ►° • 1-year assembly labor • wall vents y i warranty backed by • Roofing felt I YardLine—guaranteed cd�YEAR P• a urst $1199. If you have questions, call YardLine: j 81 Gener 800-844-9273 • • N. double doors with full-length continuous hinges 6'tall side walls included with Purchase • 2'deep storage loft • Two 8'W x 8"D shelves • Gable vent _ y • Locking T-handle n� • Decorative door hinges • Wall vents "f • Roofing felt u °=o � � The Commonwealth of Massachusetts Department of Industrial Accidents • ': = d 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia sV• Porkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO Bl;FILED WITH THE PERMITTING AUTHORITY. Applicant Information � Please Print Le 'bl Name(Business/Oiganization/Individual): Address: i Ci /State/Zip: Q IonV ' V fi 01�^"� 5 � Are you an employer?Check t&appropriate box: Type of project(required): 1.❑I am.a.employer with s employees(full and/or part-time).* 7. Q New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. [:1 Remodelilig y capacity.[No workers'comp.insurance required.] g, ❑Demolition 13-,,, ,1�jn a homeowner doing all work myself[No workers'comp..insurance required.]t 10E]Building addition a homeowner and will be hiring contractors to conduct all work on my property. I will ' 1.ensure with no employees.that all contractors either have workers'compensation insurance or are sole 11.[�Electrical repairs or.additions p 12:[(Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs , These sub-contractors have employees and have workers'comp.msurance.t 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.5210ther� 152,§1(4).and we have no,employees.[No workers'comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. T Homeowners who sdbi ittbis 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•gitached an additional sheet showing the name of the sub-contractors and state whether or not.those entities have employees.'If the sub-contractors fiave employees,tliey must provide their workers'comp.policy number.• lam an employer that ispiovzdirzgworkerrs'compensation insurancefor my employees.'Beloiv is thepolicy acid job site- information. Insurance Company Name: Policy#or S elf-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 MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as weR as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby ce f nd the pains an - 7enfles fpejy�he information provided above is true and correct Si afore: (1,1, Date: Phone#: Official use only. Do not write in this and a,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#: I 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 ofhire, 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 employer." 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=he'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 anLLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Ihdustrial Accidents foi•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 oz 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 areference 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. Anew 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.# 617•-727-4900 ext.7406 or 1-877-MA.SSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia LOT 29 18.3 • L=135 � 916.2' I _ �\ 26.9' LOT28 : FND. = r cp - :1 �Og 93.4' 2 ��. L INOFP4q T s O 7 s MICHAEL 90y O G J. SERGI m v No.33191 ARO�ss�`'Pv �'bsuRv�°4 FOUNDATIONLOCATION THIS DRAWING SHALL NOTBEUSEDBYTHECLIENTFORANY PURPOSEOTHER THANTHATOUTUNED ABOVE•EXCEPTWTTH THE WR/TTENPERMISSIONOFClfUSTIANSEN ASERGIINC CLIENT• ORCHARD VILLAGE, LLC FVRTHERMORETHISDRAWOVGISTHE COPVRJGHTM PROPERTY OFCHR/STMSENASERGIINC.AND ANY UNAUTHORIZED USE IS THIS CERT7F/CATION/SMADEANDUM/TEDTOTHEABOVECUENT PROHIBITED.CHRISTIANSEN&SERGI TAKES NORESPOWIBIUTY LOCATION: 17EMPIREDR. NORTHANDOVER,MA. I�MAnON�,�ED�ON SORAWINGORANY DA 7E. 8/15/12 SCALE..1=30' BASED ON SCALED DATA ONL Y THE PRIMARYSTRUCTURE SHOWN IS NOTLOCATFD HV AFLOOD HAL4RD ZDNEAS SHOWN ONFEMA FLOOD INSURANCERATEMAP_COMMUMTYNO-250M OWSC DATE5211993ZONEX PROFESSIONAL ENGINEERS&LAND SURVEYORS } CHRISTIANSEN & SEROI INC. 160 SUMMER STREET, HAVERHILL,MASSACHUSETTS 01830 WWW.CSI-ENGR-COM TEL.978-373-0310 FAX.978-372-3960 i DWG.NO.:06029.001.047 tA� +:f ,E Town of North Andover Youth & Recreation Services 2016 Summer Band Concert Series Sunday evenings (July 101—August 281) 6:00 PM on the North Andover Town Common Summer Band Concert Series July 10th— Mystic River Band ft. Ed Antonelli is a cover rock band that performs a great selection of classic and contemporary music spanning five decades of hits! July 17t''— The Smoothies is a duo that performs a range of jazz standards to classic R&B and pop with songs by popular artists including Frank Sinatra, Bobby Darrin,Tony Bennett and Barry White. ob July 2e —Better Her Than Me plays a little something for everyone as they perform a wonderful mix of cover tunes from the 1960's to present! July 31" — Jumpin' Juba performs an engaging and upbeat mix of roots-y rock& roll, blues and Americana! August 7" — Quentin Callewaert Trio, a band fronted by a 15- year old guitar whiz, plays a combination of classical,traditional, contemporary and popular material that is capturing the hearts of their Youth and Recreation Council audiences! Tom Cieslewski, Chairman August 14th Peter Breen — Overdrive HOMS is an eight-piece band that plays John Lennhoff reen dance music from the past three decades, all the number one brass-rock hits, Hollie Williams and a large selection of swing and songs from the Stax and Motown eras! Sandy Savoie Andrew Firmin August 21" — Stillhouse Down is a Boston-based Bluegrass band Maureen Ferris featuring a wide repertoire of Bluegrass and crossover favorites. Kevin Driscoll Terry Holland August 28th - Oberlaendler Hofbrau Band performs German music that is sure to get everyone up dancing! NA YRS Executive Director Richard Gorman The Summer Concert Series are made possible through charitable donations from local individuals and companies.