HomeMy WebLinkAboutBuilding Permit #727-13 - 1929 SALEM STREET 5/3/2013TOWN OF NORTH ANDOVER
]_ APPLICATION FOR PLAN EXAMINATION
Permit NO: v� I Date Received
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION
// Print
PROPERTY OWNER
print 100 Year Old Structure
MAP NO: PARCEL:M42-ZONING DISTRICT: Historic District
Machine Shop Villa
yes no
yesno
ves no
TYPE OF IMPROVEMENT
PROPOSED USE
Resi4etitial
Non- Residential
❑ New BuildingV
6ne family
tion
❑ Two or more family
❑ Industrial
Iteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others: t
❑ Demolition
❑ Other
❑ Septic ❑ Well
❑ Floodplain ❑ Wetlands
❑ Watershed District
❑ Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMEu:
I z ki�� -
Ideptification Please Type or Print Clearly)
OWN R: Name: 2ti .a 2 Phone:
Address:
CONTRACTOR N
Address:
i
1// J -1C 411u,
MA
4�.
Supervisor's Construction License: 07�Q6 Exp. Date: g'" 0
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER
Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COS*TT BASED ON $125.00 PER S.F.
Total Project Cost: $ �. S�� FEE: $
Check No.: �-ft Receipt No.: De
NOTE: Persons contracting with nregr er ontraciors do not have access to the aranry fund
G14��
Signature of Agent%O ( r Signature of contrac or
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer
Tannin assageArt ❑
� /Bod Y
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 Reviewed on Signature
4
COMMENTS
HEALTH Reviewed on Sianature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Com
Conservation Decision: Com
Water & Sewer Connection/Signature & Date Driveway Permit
' DPW Tower Engineer: Signature:
......i...J �] O A !l.-...... ....I CSL.... ..A
r
FIRE DEPARTMENT -Temp Dumpster on site yes
Located at 124 Mair"Street
Fire Departinert signature/date
COMMENTS �~
no
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, roast 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 2010
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
Li Building Permit Application
Li Workers Comp Affidavit
u Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o Copy of Contract
u Floor Plan Or Proposed Interior Work
u 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
o Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Mass check Energy Compliance Report (If Applicable)
o 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
Li Certified Proposed Plot Plan
Li Photo of H.I.C. And C.S.L. Licenses
Li Workers Comp Affidavit
Li Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Copy of Contract
o Mass check Energy Compliance Report
Li 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 app: al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submAted with the building application
Doc: Doc.Building permit Revised 2012
Location / 9 d / J,/� � '
No. 72 7— Date
Check # 4116)0
26349
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ '3e, CSI
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
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Bu/ding Inspector
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TLN CONSULTING
STRUCTURAL ENGINEERING SERVICES
505 Middlesex TPK
Unit 14
Billerica, MA 01821
Phone — (978) 362-1804
Mobile — (978) 406-5726
March 21, 2013
Mr. Bob Drouin
Owner
Bob's Home Improvements
250 Sawmill Drive
Dracut, MA 01826
Phone: (978) 452-0987
Cell: (978) 758-0879
Re: Additional Framing Issues
Single Family Residence
1929 Salem Road, N. Andover MA
TLHC Proj # 1301042
rob,
On March 21, 2013 TLH Consulting analyzed the existing floor framing for the existing sun room/ future
kitchen. The plan dimensions for this area measure approximately 16'-0" wide x 16'-0" long. Based on
field measurements the existing floor framing consists of the following:
• 3 '/2" x 5" floor joists spaced at 16 inches'on center that span 8'-0"
• One 3 %2" x 10" girder that spans 16'-0"
• • The floor joists span from the support walls to the girder
The.floor. joists are adequate for the anticipated loads and do not require any additional support or
supplementation. The girder has enough strength to resist the anticipated loads but the deflection will be
greater than the current Massachusetts state building code allows. We suggest supporting the existing
girder at mid span only in a manner similar to what is shown on our sketch SKS-002 dated January 15,
2013.
In addition to analyzing the floor framing in the existing sun room/ future kitchen area we analyzed the
proposed new header that will be located between the proposed kitchen and the ex�I, ting living area. The
plan is to use (2) 1 '/4" x 7'/4" LVL's combined with (1) 1 '/4" x 16" LVL with all LVL's installed flush at
the bottom. This configuration is acceptable and will resist the anticipated loading, conditions and will
have deflections within or less than the code required maximums. The LVL's should be connected with
two rows of Timberlok fasteners spaced at 12" on center.
Thanks for the opportunity to provide our services to you. If you have any questions please feel free to call
us at (978) 362-1804.
tt OF mss
Sincerely, 11 19
,-- P DD L cyG
HEDLY m 2�
sTRUCTURA
No. 41433
Todd Hedly, P.E. ONAL�'�, . .
CcTile
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Massachusetts - Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor
License: CS -090047,
ROBERT D DROUjN "
250 SAWMILLDRIVE ° , '
DRACUT MA 01$26 �?
951. %J
Expiration
Commissioner 09/30/2014
—, ��e �pa��va2arccaea��c a/ ����tcq�u�JelZp�
t Office af.Gonsurrer Affairs & Busii(ess: we.gularibr °.
ME IMPROVEMENT CONTRACTOR
egistration: 147848 Type
xpirstion: 8/15(2013. DBA
BOB'S HOME IMPROVEMENTS;:;_ .. I
ROBERT DROUIN
250 SAWMILL DRIVE g�
DRACUT, MA 01826 Undersecretary I+
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ACORDCERTIFICATE OF LIABILITY INSURANCE 07/0
07/09/2012
PRODUCER (978) 937-5747
G.M. INSURANCE CENTER, INC.
850 CAEIMSFORD STREET
LOWELL MA 01851-
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC #
INSURED
Drouin, Robert
250 Sawmill Road
c
Dracut MA 01826-
1NSURERAb&1= Street. AZer1Ce GrOUP
INSURERB:Assoc. Industries of MA
IN o
INSURER 0:
WSURERE
nnUcversGc
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.
AGGREGATE LIMITS SHOWN MAY HAVE`BEEN REDUCED BY PAID CLAIMS.
iEFFECTIVE
LrTR
L
TYPPOFWSURANCE
POLICYNumam
TE1 1f1
D3A"TCE E>=T N
Loan
A
X
GENERAL LIABILITY
IW7931Y
01/23/2012
01/23/2013
SHO S 1,000,000
X COMMERCIAL GB�RAL LIA91LITY
UPPAPSERENfED
PR S m S 50,000
CLAIMS MADE ®OCCUR
/ /
/ /
NEDEW are S 2,000
MMONALSAOVINdURY S 1,000,000
GET'�ERALAGQMGATE $ 2,000,000
GENL Z 3 EU=TA P P L JESP 8 tPRODUCTS-C01ro�PAM
S 2,000,000
POLICY LOC -
/ /
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mm
AUMNOMLELWBIL17Y
ANYAUTO
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COMBINEDSINGLEUW $
(Eaecddeaq
ALLOVI EDAUTOS
SCHEOULEDAUTOS
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BODLYINJURY. $
ISP—)
WREDAUTOS
MN4YANEDAUTOS
/ /
/ /
BOOILYINJURY
(Pe q S
PROPERIYOAVAGE
(Pei q S
GARAGELJABILITY
AUTOONI-Y-EAACf�DENf 5
ANYAUTO
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OTHERTIM EAACC S
AUTO ONLY: AM i
00CESS"BRELFA LIAEMM
OCCUR FlCLAIMS MADE
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EACH OCCURS $
AGGREGATE $
S
DEDUCTIBLE
S
RETENTION S
B
tNOT CWIFE NSATIONANO
VWC6011893012012
05/11/2012
05/11/2013
X'TpWU %
EAAPI.OYL3f5' LABILITY
ANYPROPRIEfORAARn1ERfEXECunvE
E1.EAWAcaOENT 5 100,000
OFFICBLMFMSEREXCLUDED?
Ifyes. descfte uedw
.SPF_CIALPROVISIONSbekm
/ /
/ /
F-LOISEASE-EAEUPLOYEE 5 100,000
ELDISEASE-FOUCYLMIT is 500,000
OTHER
DESCRUnMOFOPr:RA,nGNSRMMTIOAMIVEM ADDED BY PROVISIONS
The workers compensation policy does not provide coverage for the sole proprietor Robert Drouin
ACORD:2512M1A-P
INS026 (01M.Os_
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
OWPA130H DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL
. 10 DAYS WRITTEN NOTICE TO THE cERTIwATEHoLumNAmEOTo THE LEFT, BUT
FAILURE TO DO SO SHALL U POSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
REM 1'TSAGEN7S OR REPRESEWATIVES.
a ACORD C11RPORATION 1988
Papal 0f2
The Commonwealth of Massachusetts
Department oflndustrialAccidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leeibly
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
6. ❑ New construction
employees (full and/or part-time).*
2. El am a sole proprietor or partner-
have hired the sub -contractors
listed on the attached sheet.
?• E] Remodeling
ship and'have no employees
These sub -contractors have
8. ❑ Demolition
working for me in any capacity.
workers' comp. insurance.
5. F1 We are a corporation and its
g ❑Building addition
[No workers' comp. insurance
required.]
officers have exercised their
10.❑ Electrical repairs or additions
3. ❑ 1 am a homeowner doing all work
right of exemption per MGL
11. ❑ Plumbing repairs or additions
myself. [No workers' comp.
c. 152, § 1(4), and we have no
12. ❑ Roof repairs
insurance required.] r
employees. [No workers'
13.❑ Other
comp. insurance required.]
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
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
Policy # or Self -ins. Lie. #: 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 maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certlo under the pains and penalties ofperjury that the information provided above is true anti correct.
Signature: Date:
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 #:
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 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 ofpublic 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 -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 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
Industrial 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 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 burn leaves etc) said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The Commonwealth ofMassachusPtts
Department ofilidustlia1.A,ccidents
Offive of Investigations
600 Washington Stoat
Boston? MA 02111
TO, # 617-7274900 ext 406 ox 1-877-MASSAFE
Revised 5-26-05 Fax # 617-727-7749
www-Mass,govfdia
