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HomeMy WebLinkAboutBuilding Permit #508-2017 - 192 WINTER STREET 11/16/2016xw�y BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: 5- T — ;LO C7 data Icci iari• It — I � — �_01 toy Date Received 10 /11" 9a1 � TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ❑ One family Name: I i G M ac 11� 0 Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial 0 Repair, replacement Assessory Bldg ,5 t ❑ Others: 0 Demolition ❑ Other Septic O Well z ❑ Floodplain ❑ Wetlands atershed Dlstrlct .. D Water/Sewer::. .... ,... _....... x, ..ww.«. ✓tea.. 'v4iV, i S }moi a10 DESCRIPTION OF WORK T BE PERFORMED: C'00_51, e l 5t x a o mood I 'SupeIsor„�,Constructlon . NnmA.lmnrri`v`i�mant I irPn�a. ,•. _. ,. . . '.• .�:."��..'..�,_��_,....� ARCHITECT/ENGINEE Phone: Address: Reg. No. FEE SCHEDULE:CM—GPERMIT. $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COSTBASED ON $925.00 PER S.F. I otal Project C$ or -0 FEE: $ Check No.: I` Receipt No,_l NOTE: Persons contracting with unregistered contractors do not have. access to the guaranty fund Signature of.Agent/Owner Signature of contractor Identification - Please Type or Print CIPS OWNER: Name: I i G M ac 11� � Sa, C Y\ -Or --' ° ' ° Phone: X 78 X37 79. Address: 1.�/inft� /9-;441 �� . /Vol•-Inalav� ✓�A . 018'zF.s - r Contractor Name.,.. Pone:,. r .y.,..R. � � r � f�'}F'.j,�„i. d.% t •► � .- «.y. •d i}. YaM».Y.*��'�� ♦ 4 Fa. -.w... t.V �.! �iY j.. Address I 'SupeIsor„�,Constructlon . NnmA.lmnrri`v`i�mant I irPn�a. ,•. _. ,. . . '.• .�:."��..'..�,_��_,....� ARCHITECT/ENGINEE Phone: Address: Reg. No. FEE SCHEDULE:CM—GPERMIT. $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COSTBASED ON $925.00 PER S.F. I otal Project C$ or -0 FEE: $ Check No.: I` Receipt No,_l NOTE: Persons contracting with unregistered contractors do not have. access to the guaranty fund Signature of.Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ OSAL TYPF-' F SEWERAGE DISPx 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��OHIIZD16 Signature_ 0 CONSERVATION COMMENTS HEALTH COMMENTS Reviewed on Reviewed Sianature nature Zon;ag Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes i Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located Jd4 Usgood Street FIRE DEPARTMENT' - Temp Dumpster on site yes no Located at 124. Main Street r Fire Department signatureldate COMMENT -)imension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: d'T 0 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.sloo-sl000 fine Doc.Building Permit Revised 2014 P-- Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. r 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 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/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 o Photo of H.I.C. And C.S.L. Licenses o 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 40TE: 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 / r Location 9 W eA No. 5762 — ,) Qr',? Check #I Q ( d- 31180 Date //// da©) (0 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $""� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ / I V `�' 11�- U Building Inspector - r J LLI S LL O O m v yLnm O O LL O_ w N 0 F- U CL IA z Q z co O 1 7 O LL 7 O d' ? E t= U LL p u W 0.oW. (A z z m 2 J d O K _ m O LL O u Vf z u vLU W J W z O K ai N (n _ � C LL w p U a ? H 1 . 7' O K _ LL z W °c a CL W 55 LL 7 m O Z UJ ,� (n N Y O E N ZT C O m n� - � c E ,F 110-o o ;F, c E cLi d d 3 C� O O oVQ L • � ..Q h � � c � a VAG N ¢ P 1 N O** Q C N J i °' ' mm a d �° L W co moo= > A•� �a QO W Z tm OO O O C = 0 O � • w .y 3 .� x0 1'� � CL•� CDr m �i a) / Q CO) i is •a •O = as CL (D N w N O VCf) m d W o •a ig O O LLI I-- LA Li .N Na C O •0- = Z O W f - c C ���� a0 —Z CL o C.) > O W CL U) z IM Y/ Z G Z ~ . W a. Z w0 H V W LLI -j IL Z N r_1 S.: O d pORTy TOWN OF NORTH ANDOVER OFFICE OF p BUILDING DEPARTMENT i 4 1600 Osgood Street, Building 20, Suite 2035 North Andover, Massachusetts 01845 Donald Belanger Inspector of Buildings HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please print DATE: ,1/ go 1 b JOB LOCATION: jqA Number Street Address Telephone (978) 688-9545 Fax (978) 688-9542 /a4' C 7 HOMEOWNER AMA7bP.G/ Rl w4lC !r' (9788 6s9-.S7&5,e 6B//r78) 937,79,T-9 Name Home Phone Work Phone PRESENT MAILING ADDRESS /902 Z✓/nftl' S� Aldovv< elft O /t i`r 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 I IO.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 APPROVAL OF BUILDING OFFICIAL Revised 8.2015 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 The Commonwealth of Massachusetts _ Department of lndustrialAccidents M 1 Congress Sheet, Suite 100 tl021X4 20X7 - Boston, MA o� www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/CG a�0 s iciaxzs/ lnxnbers. I'O BE FJLEA WCT3a IM PERAff1 1N ,o, �o prin4 l APP11caul waurwa�.,,. /��s�t.G/J l Name (Business/Orgaaiizaiion/Individual): �G .,G • Address: 1942 wl#q�ee- �avo— AA.pghonc#: $377959 City/State/Zip: �0�� � .......: ...�:,:..:. , _ , ro riatebox: Type of xoject (required): Axe yon an employer. G7ieck ih a app P e to ees ction full andlor part -time) -.k 7. New "do`nstra 1.[] I am a employer with mP 3 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remo deliiig any capacity. [No workers' comp. insurance required.] 9. ElDemolition 3. ❑ I am a homeowner doing all work myself [No workers' comp. insurance required-] t 10 0 Building addition 4. n I am ahomeowner and will be hiring contractors to conduct all work on my property. I will 1LE] Electrical repairs or additions ensure that all contractors either have workers' compensation insurance or are sole 1210Plumbing repairs or additions proprietors with no employees. 13•. [] Roof repairs 5. L]I am a general contractor and I have hired the sub -contractors listed on the attached sheet. C� These sub -contractors have employees and have workers' comp. insurance. 14.-_ ther 6. Q we are a corporation and its, officers have exercised their right of exemption per MGL c. 152, § 1(4), and vre have no emplogees. [No workers' comp. insurance required ] *Any applicant that checks box #1austsdicating they arffl out the e doing on all work and then hire outside w showing theirwOrk-ers' contractors must submiinformation. new affidavit indicating such �Homeownerswho submit -this ._, .. rvift ?Contractors that check this box Windt attached an g the re sheet showing the name of the sub-conizactors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. W is tliepolicy andjob site lam an employer that is providing -Workers' compensation insurancefor my employees. Belo information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expirationl)Oc, lob Site Address: iration date). City/State/Zip: • Attach a copy of the workers' compensation policy declaration page (showing the policy number and exp Failure to secure coverage as requir ell as enalties?in the form ofis a ra STOP WORK ORDER nal violation Iand a fine of p to $250.00 a and/or one-year imprisonment, as w P day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA, for insurance coverage verification. X do Izereby certify undertliepains andpenalties ofperjury that the information provided above is true and correct. Date: Signature: Official use only. Do not -write in this area, to he completed by city or town official. permit/License ## City or'Town- Issuing Authority (circle one): 1. Board of Health 2. BuildingDepartauent 3. City/ToWa Clerk 4. Electrical Inspector 5. plumbing Inspector 6. Other Phone #• Contact Person: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for theiremployees. 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'efuied as "an individual, partnership, association, corporation or other legal entity, or any two or more Of the foregoing engaged in a joint at ferprise, and including the legal representatives of a deceased employer, or the receiver'or, trastee of au 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 xequited." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements ofthi 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=contractors) name(s), address(es) and phone number(s) along with their certifcate(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 au 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 Tndustrial-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 OfFacials 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 affldavit 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 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 02-23-15 wwwmass.gov/dia Ponderosa Pines Shed Specs. 14 x 20, New Englander 4"x 4" pine post and beam wall frame 11)x 12" pine board and 2.5" batten siding 2" x 6" rafters, 24" o c, 10 —12 pitch 1"x 6" roof and floor boards 2"x 6" ceiling joist 16" o c, 1"x 10" pine board ( loft) 2"x 6" p t floor joist, 16" o c with 4"x 4" p. t. runners (4 ) with blocking 4" concrete blocks 48" o c Arch. Shingles (30 year warenty) 72" double door, pine ( gable wall ) 4" header 2 — double hung windows 4" headers 2 —12"x 12" louver vents on gable walls Hot dipped galvanized nails and hardware 2"x 6" p t ramp ['.t MVPC Bo Municipal Boundary Rail Line Interstates Interstate Major Road Roads t r Easements ❑ Parcels Hydrographic Features Streams Wetlands 3 Exempt Lands 1"=85ft 1483 ( 187 WINTER ST 104.C-0094. 262' 1 1513 104.0-009 ` 104.0-0095 197 WINTER ST 104.0-0096 _ Horizontal Datum: MA Stateplane Coordinate System, Datum NAD83, Meters Data Sources: The data for this map was produced by Merrimack ,&ORT" Valley Planning Commission (MVPC) using data provided by the Town of r North Andover. Additional data provided by the Executive Office of . 9� •e CO Environmental Affairs/MassGIS. The information depicted on this map is G for planning purposes only. It may not be adequate for legal boundary to defnifion or regulatory interpretation. THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING ♦ THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY i # OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION 978' 9'3 7 79,4;-d? IV/t- UA WSQN V CERTIFIED PLOT PLAN Scott L. Giles R.P.L.S. LOCATED IN NORTH ANDOVER, MASS. Frank -S. Giles R.P.L.S. SCALE.1"=40' DATE. -311712003 50 Doer Meadow Road North Andover, Mass. MC ALLISTER: 208-95F 110"E EASEVIwam I AREA S58021 ;Lc) moo C4 ASSESSORS MAP 104C, EL 7 PLAN #3002 N.E.R.D., DEED BOOK #5931 PAGE 43,681 S.F. z, ss ......... -u� 11' Fro r% Bol k6f,,A cp EXIST SEWER 6 5pewe r I i,,e. 6,mA&.+Svf% cb cv) EASEMENT 5014A c/) lu _uj ppST. HSE' GA K 25 71'+/ N 1'+/- -c'4 N. c') 00 cv) —4 8,491 N 631 a 0.48' N 57025`4 STREET WINTER W&fer '51u, . 4 a� is IDS 4t,- -s4 ree+, 11' io O%e- r,51%+ O -P 0&.V- 4cm f., .,i5 C) (po"Ifront skrtcfi I CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE�p`t>1 Of THE OFFSETS OF THE BUILDING INSPECTOR ONLY SHOWN COMPLY AND SUCH USE IS FOR THE WITH THE ZONING S DETERMINATION OF ZONING 13972 4L BYLAWS OF CONFORMITY OR NON -CONFORMITY NORTH ANDOVER L WHEN BUILT WHEN CONSTRUCTED. 11 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYP13'OF SEWERAGE DISPx OSAL Public Sewer Tanniug/MassageBody 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"AYLIZD16 Signature_ O CONSERVATION Reviewed on til I Siqnature COMMENTS HEALTH COMMENTS Reviewed on Signature M Zorthng Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planihing Board Decision: Conservation Decision: Comments 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 Main Street Fire Department signature/date COMMENTS -)imension 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 approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G rnin.$100-$1 000 fine Doc.Building Permit Revised 2014