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Home My WebLink AboutBuilding Permit #429-2017 - 17 LACY STREET 10/24/2016 +pN� $cAr►w'FD Ot ,%.so q BUILDING PERMIT 3� ,�tTM`°,•;6.6 '00 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION « Permit NO: 4ag _ �G1.7 Date Received / 0- Date V Date Issued: D a - �9SSgCNUS IMPORTANT:A licant must complete all items on this )age G� r� PROPERTY :NO: N ,-„t Print 01Print L�_PARCEL:A-5 _ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building 0 One family Addition 0 Two or more family 0 Industrial Alteration No. of units: 11 Commercial L! Repair, replacement i_i Assessory Bldg 0 Others: Demolition 0 Other `7 Septic n Well 0 Floodplain 71 Wetlands 9 Water/Sewer 0 Watershed District In S40 Yr Identification Please Type or Print Clearly) OWNER: Name: 0J_W_ Phone: Address: G �r;fx f CONTRACTOR Name. ' _ ._Phone: Address: Wp k � r Supervisor's Construction License: ✓✓✓ Exp. pate: Home Improvement License: i , { /, 1 Exp. Date: '7 `T 1 l 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: 0 v FEE: $_�(' ! 00 Check No.: Receipt No.: '3_/ p 7 9 NOTE: Persons contracting with unregistered contractors do not have access to the g ranty Signature of A ent/Owner 9 _Signat:ure of_contractor h V k 6 . Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swinuning 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 I PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature r 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: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster.on site yes _ no Located-at 124 MainStreet Fire Department signature/date COMMENTS limension 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) i ❑ Notified for pickup Call Email ate 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. i Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o Floor Plan Or Proposed Interior Work o 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 o Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) a Copy of Contract a Mass check Energy Compliance Report o Engineering Affidavits for Engineered products VOTE: 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 Doe:Building Permit Revised 2014 Location L Y" No. �T�f'f� o�t� Date /d ' ^ �?alb • ' TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ t Other Permit Fee $ TOTAL $ Check# Building Inspector r 1 NORTh q _ . w: .. . : . a . .. .c ve" . O jh_ A-0 o. ver, Mass, / OIL • 00%, 016 A- COCNIC"1WtCK yA. BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ......... �.Q ...�.. Y. .4...... .. �w�h 4..... opC�!lirr BUILDING INSPECTOR ....................... C .. � !...... .. . .... Foundation has permission to erect .......................... buildings on ....... . .......... .......57`l..«. occupied as Rough to be occu p ................ ...... I4. d. .41.......... ... L ....... n....44 .. Chimney I 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT104 STA S Rough Service ........... ....... ..�.. . .... ............................... Final BUILDING INSPECTOR 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. Invoice Colonial Fireplace Date Invoice# 2261 Main Street 10/19/2016 2181 Tewksbury, MA 01876 978-447-5192 customerservice@colonialfp.com Bill To Ship To Don Lane Don Lane 1.7 Lacy St 17 Lacy St Rep Terms North Andover,MA North Andover,MA 01845 01845 Quantity Item Code Description Price Each Amount 1 Labor Installation Labor-Installation of a Regency GC60 Pellet 1,520.30 1,520.30 Stove. MA State Sales Tax 6.25% 0.00 Total $1,520.30 Payments/Credits -$760.15 Balance Due $760.15 TVD -Floo rS LCI n e a boy--e- 17Z ac rill 1-7 s ri 0 s Doa��►Y C � ILS D GC60 Hampton Freestanding Cast Iron Pellet Stove 23" (584mm) 28.7" (729mrr to; CLEARANCES TO COMBUSTIBLES 29.4" (748mm) I Back Wall �a4 3" c (76mm) Qp 3., 3 ••• ••• (76mm) 31.7" 71 (80 mm) N 9.' (229mm) - 28.4" (722mm) 28" These dimensions are minimum clearances but it is recommended (713mm) that you ensure sufficient room for servicing, routine cleaning and maintenance. Side wall to unit 9 inches (22.9 cm) Back wall to unit 3 inches (76 cm) Corner to unit 3 inches (76 cm) Ceiling height 60 inches (152 cm) Alcove Maximum Depth 36 inches(91 cm) Alcove Minimum Width 48 inches(122 cm) Alcove Minimum Height 60 inches(152 cm) The unit must be installed with a minimum of 6"(152 mm)of floor protection in front of and to the sides of the door opening. 18.5" (470mm) D GF60 Wood Pellet Stove MOBILE HOME INSTALLATION EXHAUST AND FRESH AIR INTAKE LOCATION • Secure the heater to the floor using the four(4)holes in the pedestal. • Ensure the unit is electrically grounded to the chassis of your home (permanently). • Do not install in a room people sleep in. '•' ••- • Outside fresh air is mandatory. Secure outside air connections directly to fresh air intake pipe and secure with three (3)screws 6 Q evenly spaced. • All specified components must be used. Do not use any components other than what's specified. 11.3 Optional Hearth Pad Flooring i Steel Frame 4.9" I 6.5" 77' 1/4"Lag Bolts Securely Fastened Ground Wire Directly to Metal Chassis This unit uses a 4"exhaust vent. EXHAUST: Base of unit to center of flue , „ 15 h (392 mm) Center of unit to center of flue 63/8" (162 mm) FRESH AIR INTAKE. Base of unit to center of intake 12" (305 mm) Center of unit to center of intake 47/8" (126 mm) omww GF60 Wood Pellet Stove THROUGH WALL WITH VERTICAL RISE AND HORIZONTAL TERMINATION INSTALLATION: ° Elbow with Screen or Termination Cap 4"90 Wall framing Wall Strap Clean out Tee 4, Horizontal frame MAX for thimble Vertical section of 4"vent pipe Wall Strap ab Wall Thimble THROUGH CONCRETE WALL WITH VERTICAL RISE INSTALLATIONS: Horizontal frame for thimble 4"900 Elbow Wall Thimble 4"45° Elbow with screen or Termination Cap Wall Framing Vertical section of 4"pipe Clean Out Tee Concrete Wall The Commonwealth of Massachusetts DepairimentoflndustrialAecidents ' : s 1 Congress Street,Suite 100 d Boston,MA 02114-2017 www mass gov/dia Workers'Compensation Insuraned Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THC RERMITIiNG AUTHORITY. A �llcantInformation ]?lease Print Le 'bI Name(Business/Orgy iization/Individuai): Q Erdaa Address: +t`� I 1�1 a i Y1 1 City/State/Zip: AEU*sbMAAOIM Phone#: ! 14 Axe you an employer? Type th a appropriate box: Type of project(Tecltdred); 1.❑I am a employer withemployees(full and/or parttime).* 7. F]Nevi'donstraci1on 2.❑I am a sole proprietor or partnership and have no employees working.for me in $, ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.Q I am a homeowner doing all workmysey[No workers'comp.insurance required.]t 9. ❑Demolition 4.Q I am a homeowner and will be hiring contractors to conduct all work on my property. I will XO F]Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical rep#s or additiops proprietors with no employees. 12.E P1TWVng repairs or additions 5. I am a general confrgctor and T have hiredthe sub-contractors listed on the attached sheet. ❑ t 13.[�Roof repairs These sub-contractors have employees and have workers'comp.insurance. 6.F]We are a corporation and its,offices have exercised their right of'exemption per MGL c. 14. Other 152,§1(4),andtve have no employees.[No workers'comp.insurance required.] *.Any applicant that checks bbk41 must also fill out the section below showing their workers I compensation policy information:' T Homeowners who submit•"affidavit indicating they are doing all work pndthen hire outside contractors must submit a new affidavit indicating such. #Contractors that check ibis tioic must attached'an additional sheet showing the name of the sub-contractors and state whether or pot those entities have employees. Ifthe sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers compensation insur•ancefor my employees. Below is thepolicy and job site information. Insurance Company Name: An Policy#or Self-ins.Lic.#:. 4 J� 1 e ExpirationDOe= 141 •1 lob Site Address: City/State/Zip: Attach a copy of the workers'compep tion 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 find 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 ofup to $250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify and thepains qndpenaltles ofperjury that the information provided above is trued orr(ecct. Si afore• Date• r t` Phone#: y r Of use only. Do not-write in this area,to he completed by city or town official~ City or Town: Permit/License# Issuing Authority(circle one): 1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person, Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is d'e$ued 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 commonvvealth 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 IndustrialAccidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensatiori 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 burnt 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-MASSAFE Fax#617-727-7749 Revised 02-23-I5 wWW.mass.gov/dia Massachusetts Department of Public Safety ` aorroro�r�aexll✓r tC�lrwaclrt�ella.i Board of Building Regulations and Standards Office of Consumer Affairs&Business Regulation License: CS-105920 ME IMPROVEMENT CONTRACTOR Construction Supervisor egistration: 181414 Type: xpiration: ,4/1[2017 Corporation SCOTT M HAYES COLONIAL FIREPLACE 6 CANTERBURY AVE ' HAVERHILL MA 01830 ( ; ! ' SCOTT HAYES 474 MAIN ST � ,.. WILMINGTON,MA 01887 Undersecretary i Expiration: Commissioner 08119/2018 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) r[0-3NNotiffi—edfor pickup - Date Doc.Building Permit Revised 2012 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 TOTE: 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) o Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products )TE: 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 K.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 o Engineering Affidavits for Engineered products ►TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit I all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of ppeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof r recording must be submitted with the building application Dec:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Plans Submitted ❑ Plans Waived ❑ Certified Piot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tannin Swimming Pools ❑ Tanning/Massage/Body Art ❑ g 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 ❑ ❑ COMENTS CONSERVATION ❑ ❑ COMMENTS HEALTH ElDATE REJECTED DATE APPROVED ❑ 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 Drivewav Permit Located at 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS I