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Home My WebLink AboutBuilding Permit #465 - 170 LACY STREET 12/8/2011__L TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received �1- Date Issued:��% IMPORTANT• Applicant must complete all items on this naLye LOCATION 4ZJQ eg CY S7' Print PROPERTY OWNER �/� A�� / �,Q jw t/ / Unit # Print MAP NO.10s� PARCEL: ZONING DISTRICT: Historic District Machine Shop Village 100 year-old structure TYPE OF IMPROVEMENT ❑ New Building 0 Addition 0 Alteration 9-RTpair, replacement ❑ Demolition ❑ Septic ❑ Well ❑ Water/Sewer OWNER: Name: PROPOSED USE Residential ie family ❑ Two or more family No. of units: ❑ Assessory Bldg 0 Other ❑ Floodplain ❑ Wetlands DESCRIPTION OF WORK TO BE PERFORMED: Please Type or Print Clearly) Non- Residential ❑ Industrial ❑ Commercial ❑ Others: ❑ Watershed District Address:_ 17 a L �- S�`' �Gr �,� /,�.� �� 91 T - �►�5- CONTRACTOR Name: Phone: 92 E Pa- %(o1 Address: 'as ,_1 Supervisor's Construction License: S_,23 d '] Exp. Date: Home Improvement License: yE 7 Exp. Date ARCHITECT/ENGINEER Phone: Address Reg. No. FEE SCHEDULE. BOLDING PERMIT: $92.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: �y Receipt No.: 0 q0- 2 -NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor 7 - If--// 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 COMMENTS . II HEALTH a COMMENTS Reviewed Reviewed on - 1 ( Sign R�9 - Jn) P 1 l j Signa N Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Commen Conservation Decision: Comments Water & Sewer Connection/Signature & Date Drivewav 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 ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi 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 o Building Permit Application ❑ 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 ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition or Decks La Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o 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 Li Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract Li 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. r Date Check # Q `I 3 24872 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ G -J Building Inspector CONSERVATION DEPARTMENT Community Development Division December 8, 2011 Robert Rainville 170 Lacy Street North Andover, MA 01845 170 Lacy Street, North Andover Repair of existing deck footings and removal of one dead tree. Conservation Conditions of Approval, NACC #89 Pursuant to section 4.4.2 Q) of the North Andover Wetlands Protection Regulations, Robert Rainville (owner) filed for a small project for work proposed at 170 Lacy Street, North Andover. The proposed work includes the installation of concrete footings to repair the existing footings which are rotting. The footings are associated with the sunroom and deck and are located approximately 22 -feet from the edge of Bordering Vegetated Wetland (BVW) as shown on the herein referenced plan. The removal of one dead tree, without the use of heavy equipment, is also permitted. Erosion controls have already been installed and shall remain throughout the duration of the project. During the December 7, 2011 public meeting, the North Andover Conservation Commission (NACC) voted unanimously to approve this project as proposed. The following conditions are hereby mandated: RECORD DOCUMENTS: Small Project Filing Including: Narrative, Sketch on Plan titled "Plot Plan 170 Lacy Street No. Andover, Mass." original plan dated December 20, 1978 (sketch drawn November 29, 2011), Application Checklist and photographs. Prepared by: Robert Rainville Received: November 29, 2011 CONDITIONS: 1. Excess material shall be properly disposed of offsite. 2. Accepted engineering and construction standards and procedures shall be followed in the completion of the project 1600 Osgood Street, Building 20, Suite 2-36, North Andover, Massachusetts 01845 Phone 978.688.9530 Fax 978.688.9542 Web www. http://www.townofnorthandover.com/conservel.htm rf 14 3. No heavy machinery shall be allowed in the No -Disturb Zone. 4. Upon completion of the approved project and site stabilization, please contact the Conservation Department for a final inspection. 5. This Permit shall expire six (6) months from the date of issue. Should you have any question or comments regarding the contents of this letter, please do not hesitate to contact the undersigned at 978.688.9530 at your earliest convenience. Thanking you in advance for your anticipated cooperation with this matter. Respectfully, NORTH ANDOVER CONSERVATION DEPARTMENT J�n fer A. ghes servation Administrator 1600 Osgood Street, Building 20, Suite 2-36, North Andover, Massachusetts 01845 Phone 978.688.9530 Fax 978.688.9542 Web www. http://www.townofnorthandover.com/conservel.htm The Commonwealth of Massachusetts Department of Industrial Accidents 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 Name (Business/Organizatio ndivid Address: %7oGy City/State/Zip: �/, �, ��,t Phone 19 3 r Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3 I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. ❑ Roof rep irs 13.9 OtherI *Any applicant that checks box #I must also fill out the section below showing their workers' compensation policy information. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must 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 an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Job Site Expiration Date: 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. Ido hereby ce y under the``ins andpenalties ofperjury that the information provided above is true and correct. 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. Plumbing Inspector 6. Other Contact Person: Phone #: Gerald A. Brown Inspector of Buildings Please print TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT '1600 Osgood Street Building 20, Suite 2-36 North Andover, Massachusetts 01845 Telephone (978) 688-9545 Fax (978) 688-9549. HOMEOWNER -LICENSE EXEMPTION BUIDING PERMIT APPLICATION DATE:_ % Z.. / JOB LOCATION: C y S Number Street Address HOMEOWNER Name Home Phone PRESENT MAILING ADDRESS / 7o L& -r y J-7- Cil T Cil Town i Map/Lot Work Phone Zip Code The current exemption for"homeowners- was extended to include owner -occupied dweIIings to two units or less and to allow such homeovTjers 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 awns 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 fancily 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. / J HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONTSERVATION 685-9530 HEALTH 688-9540 PLANNING 688-9535 r rA � 1 ui elmz C G a I . a , O �o C H c . v C3 Z -ate O a � ev E: U U a w. o cc N E a :mCF L y.. x rJ C � � Z• a m 0 o O V { cocm ti m = c E /Q �mCL,mas a N D.- ca cm H m d cc - N O N O E CD v cn or m t O •o,oc Cf = a ;o. JON p,ct O O m • cc-" O w aRi cn O w O G w' U w ' p G u: w O G w' chi ii O w u. = i CO cn cn � 1 ui elmz a �40 L z 0 U 0-1 2 w • AO 00 I U 0. LU 0 CO) LLI U) W W 19 ujW N C G c O �o C H c v C3 Z -ate a � ev E: o cc N E a :mCF L y.. rJ C N ES m 0 o O V { cocm ti m = c E /Q �mCL,mas a N D.- ca cm H m O cc N O N O E CD v aCD� m t O •o,oc Cf = a ;o. 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