Loading...
HomeMy WebLinkAboutBuilding Permit #Exception - 19 JOHNSON STREET 5/1/2018 NORTH BUILDING PERMIT o*�<,�o bq% TOWN OF NORTH ANDOVER Off. APPLICATION FOR PLAN EXAMINATION '" z h Permit No#: Date Received �.9 Q�R�7ED I•Pa�.(5 Ssgc5use Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 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 ❑ Septic Elwell ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: . Exp. Date: ARCHITECT/ENGINEER Phone: A 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: $ FEE: $ ro Check No.: Receipt No.: NOTE: Person" contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner :� �" Signature of contractor �� ~ 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on ' ( � Si nature e COMMENTS )C__ _ , / HEALTH Reviewed on Siqnature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes ou Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit r DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street f 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 Call 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. w Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit i ❑ 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 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) ❑ 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 he that t 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 Location No.Al w Date 4 . - TOWN OF NORTH ANDOVER v Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ ,� TOTAL $ Check# :- u / .� Building Inspector F_ 7 NORT11 . 0 ..�. - No. 47 I - �]`( z h ver, Mass, T OLANE COC NIC Nl WICN V ADRAtED s U BOARD OF HEALTH Food/Kitchen PE IT T LD Septic System C� J.* AAA BUILDING INSPECTOR THIS CERTIFIES THAT ... .Q . .............. has permission to erect .......................... buildings on Jot .5�01�. Foundation .. Rough to be occupied as .. ! ..... .. ,....rst. ..�....... .. K .. � .... .... .. Chimney provided that the person acceptingthis permit shall in every rtspect c nform to the terms of the appli tion 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 CONSTRUCTIO T TS Rough Service .................. .. ...................................................... Fina 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. North Andover MIMAP November 17, 2014 X059:0-0019 JO.HNSOWST Bl\ o \ � 104OHN ON;S-r14dOHN ON.S7 0960-002 1 JOHNSON ST \,\I I \ \\ \ \ Q \ 096.0-0023'111 AOHNSONST 3 JOHNSOMST �� \ � \ �JOHy80�3T 096.0-0025 \ HIlstoric ASI-ket: 0960 .0-020 ��\\ \ _ •1s,,,Oxy st; ©9 U-002 \`1\9JOHN�S,O. ,ST\\\1 >':\ �9b:0"0028 �\\ � � 1.8,aJOi;3NSON,•57 '059. -0023 .` 096:0-0029 059.0;0095 \'k 1X, ° \ ig90.0-0030 096:0-0032 Rail Line N Wetlands Zoning Interstates 0 Exempt Lands C 3Busine s 1 Disrict O Busine s 2 District Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, SR m Busine s 3 Disldct Meters Data Sources:The data for this map was produced by Mernmack ■Busine s 4 District gORT11 Valley Planning Commission(MVPC)using data provided by the Town of Roads ■Gene Business Distnct OE 7 q� North Andover.Additional data provided by the Executive Office of D Planne Commercial Dev .'U `r Easements ? `� r���00 Environmental AHairs/MassGIS.The information depicted on this map is C7 Corrido Development Dist 3. L for planning purposes only.It may not be adequate for legal boundary Q MVPC Boundary O Corrido Development Dist O to definition or regulatory 0 Municipal Boundary O Corrido Development Dist F p 9 ry interpretation.THE TOWN LI NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING Ind usln I 1 District Zoning Overlay # >♦ THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY [7 Induslri 12 District 8 Adult Entertainment • i ^ * OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT 13 Induslri 13 District Q Downtown Overlay Disldct ®Industd I S District * °1 .+ a. * ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF Historic rotecti b a r+f.•"q THIS INFORMATION ®Water ProtectionReside ce 1 Distract "to r• t t- Reside ce2District SSACMUS� ED Parcels a Reside ce 3 District 0 Hydrographic Features de ce 4 District —Streams V=65 ft ^ °de ce 5 District FFF de ce 6 District —a esidential District CONSERVATION DEPARTMENT Community Development Division November 6,2014 i Cochickewick Masonic Lodge 19 Johnson Street North Andover, MA 01845 19 Johnson Street, North Andover Installation of a Fire Escape Conservation Conditions of Approval,NACC #135 Pursuant to section 4.4.2 Q) of the North Andover Wetlands Protection Regulations, the Cochickewick Masonic Lodge, applicant/property owner, filed for a small project for work proposed at 19 Johnson Street,North Andover.The proposed work includes installation of a Fire Escape/Second Egress from the second floor (installing 4 footings), the work is proposed outside of the 50-Foot No-Built Zone as depicted on the herein reference plan. During the November 5, 2014 public meeting,the NACC voted unanimously to approve this project. All work shall conform to the following: RECORD DOCUMENTS: Small Project Filing Including: Application Checklist Received October 28,2014; MIMAP Aerial Map with wetland line and fire escape sketch Construction Plan titled: Cochickewick Masonic Lodge; prepared by:JD LaGrasse &Associates,Inc.; dated: March 7,2014 The following conditions are hereby mandated: CONDITIONS: 1. Prior to the start of construction the applicant shall ensure that the site contractor has reviewed the small project permit and is aware of the wetland resource area and the limits of the proposed work. 1600 Osgood Street,Suite 2035,North Andover,Massachusetts 01845 Phone 978.688.9530 Fax 978.688.9542 Web www.http://www.townofnorthandover.com/conservel.htm k ISI 2. Excess construction material shall be properly disposed of offsite and accepted construction standards and procedures shall be followed in the completion of the project. 3. Upon completion of the approved project and site stabilization,please contact the Conservation Department for a final inspection. 4. This permit shall expire six months from the date of issuance. 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.Thanking you for your anticipated cooperation with this matter. Respectfully, NORTH ANDOVER CONSERVATION DEPARTMENT J refer Hug es onseivatio Administrator III 1600 Osgood Street,Suite 2035,North Andover,Massachusetts 01845 Phone 978.688.9530 Fax 978.688.9542 Web www.http://www.townofnorthandover.com/conservel.htm i i / � I i I I I I z3� np r0) D I Z� NZrn 13M M M0 ma = (Prn ma - I r c� z I mUZ� I m � �m NN I D I m I I iS 1 I I - I I I I _ I I I I I I I I I U3 I I 4 Z n I ' (1 I ' I � N Z 0 I —i I rnz I ' I I , I , I , I , I , �Z'-011 I I I I ' I ' I I I I , I , _ I I 0 I I _I N C1 D r JOHNSON STREET � r 11_ � az •'� efPe COCH/CKEW/CKLODGE COCHICKEWICK JD LaGrwse 0 e: D SITE PLAN MASONIC &�, Inc. w O n Architects-Engineers-Interiors-Land Planning °' --j o LODGE One Elm Square,Andover,MA 01810 T.A 19 JOHNSON ST N.ANDOVER, MA Ww 978-470-3675 ts.com 9E8a1�°oLAo°O.CaM SDN_ ONS AMU M x M -R ? D D D ® •M 6J (� b m � 40 '® ZO E� z F r r 3 E p - m � O i 2'-10' wNi A i i N_ "� �N O O 4 bop ZXl O rb tDD O O zz 0 N D � 0 = Z .. erg° COCH/CKEWICKLODGE COCHICKEWICK JD LaGrasse e: z > 0 SECTION MASONIC & Inc. W OLODGE Architects-Engineers-Interiors-Land Planning M c One Elm Square,Andover,MA 01810 19 JOHNSON ST N.ANDOVER MA T.978-470-3675 F.978-470-3670 www.logmwearchitects.com — E—mail:JDWOAOLCOM JA. N ' m -n l E N iW U1 4 v m �, M _EXISTING 1-16 Z EXISTING PITCH E PITCH N 0 D A 5'-0" 4'-7" r D Z z � 0 XT o :!6 n :!6 4° ST 6m v z 4° STEP m 00 I30 z rn O U r O v Z D r– m 0 D — N •'� 's fF COCH/CKEW/CKLODGECOCHICKEWICK LaGrwse Cn n XISTING SECOND MASONIC & N W O n Architects-Engineers-Interiors-Land Planning rn v oFLOORLODGE One Elm Square,Andover,MA 01810 PLAN 79 JOHNSON ST N.ANDOVER, MA T.978-470-3675 F.978-470-3670 www.logromearchitects.com — E—mail:JDWOAOLCOM i �O"7J1O"""Pe Zl�� License or registration valid for individut use only Office of Consumer Affairs&Bdsiness Regulation g Q HOME IMPROVEMENT CONTRACTOR i before.the expiration date. If found return to: Registration: 161510 Type: Office of Consumer Affairs and Business Regulatio Expiration: -10/23/12014 Individual 10 Park Plaza-Suite 5170 -- Boston,MA 02116 SHA N R DUFRESNE- , 1 i SHAWN DUFRESNE: _.,. �--- 5 EQUESTRIAN � MERRIMAC, MA 01860 Undersecretary Not valid without signature 11 Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor j License: CS-065128 - SHAWN R DUFRFANE-,, 5 EQUESTRIAN WAY; Merrimac MA Of860 j°• �+ t Expiration Commissioner 04/01/2016 D o & [+ PROPOSAL Homes and Demolition PROPOSAL UB J ,ED TQ' WORK TO BE PERFORMED AT: NAME NAME ADDRESS_/�/' ADDRES ,/,rvrr PHONE N0. li i - % PHONE NO. We hereby propose to furnish the materials and perform the labor necessary for the completion of J��e4/ QX -Azlcl &JCk' le lee All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specification submitte or above vgr and completed in a subst ntial workmanlike manner for the sum of &'V57 otlars($ j•� ) with payments to be made as follows. ,0q 74- Respectfully submitted .'&/e Per Any alteration or deviation from above specifications NOTE -This proposal may be withdrawn by us involving extra costs will be executed only upon written if not accepted within_,� days. order, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents,or delays beyond our control. ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Signature Date Signature The Commonwealth of Massachusetts Print Form , Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 ' Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone#: 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 employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction INI am a sole proprietor or partner- listed on the attached sheet. 7. K Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.$ 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.F-1 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself.m se ' right of exemption per MGL y �o workerscomp. 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *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 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 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.#: 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 under the Cains d enalties o erjury that the information provided above is true and correct. Signature:1::2 Date:' r "� Phone 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#: .4coRv® CERTIFICATE QF LIABILITY INSURANCE DATE(MMfDDlYYYY) 10/28/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Sandi Munroe M P ROBERTS INS AGCY SNC °No Ext: (978).683-8073 NC,No:(978)683-3147 1060 Osgood Street n oRlEss:danielle@mprobertsinsurance.corft North Andover, MA 01845 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A:AMERICAN EUROPEAN INSURED D & H HOMES INSURER B: SEAN DUFRESNE INSURER C: PO BOX 522 INSURER D: NORTH ANDOVER, MA 01845 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR YWD POLICY NUMBER MM1DD MM/DD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 000 CLAIMS-MADE CI OCCUR PREMISES Ea occurrence $ SKP2001014 06/30/14 06/30/15 MED EXP(Any one person) $ 5,000 1,000,000 A PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2.000.000 POLICY C1 PRO- JECT CI LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED Ea accident $ ANYAUTO BODILY INJURY(Per person) $ ALL OVVNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAG HIRED AUTOS AUTOS Per accident $ UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS LIAB E.. CLAIMS-MADE AGGREGATE $ DED I I RETENTION S $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN I STATUTE I ER ANY PROPRIETOR/PARTNERIEXECUrIVE $ OFFICERIMEMBER EXCLUDED? I I Mandato Iry rNH) L— NIA E.L.EACH ACCIDENT E.L.DISEASE-EA EMPLOYEE$ f yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF NORTH ANDOVER THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 OSGOOD STREET ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER, MA 01845 AUTHORIZED REPRESENTA71 &ro ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD25(2014/01) The ACORD name and logo are registered marks of ACORD