Loading...
HomeMy WebLinkAboutBuilding Permit #383 - 221 CAMPBELL ROAD 11/17/2009 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ' c-, Permit N0: � Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION j P N, /)�7 Cl r > Y �i Print PROPERTY OWNER T _ ' Print MAP N0AC �d PARCEL: ZONING DISTRICT - Historic District. yesno Machine Shop°Village yes, no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial i Alteration V No. of units: — Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic. Well Floodplain -Wetlands Watershed District ' . :Water/Sewer. DES RIPTION F WORK TO BE PERFORMED: rip �t (-<PV-0Cy- r) �den���Piease Type or Print Clearly) OWNER: Name: l Phone: Address:.J41 X4— CONTRACTOR Name: , a 5 Address �4r?tf 1r� � / fUrr �'o S3 SurpeTvisor'sConstruction L#icense: Qua _ Ex".. Date - _ _ P `� Hame Irri:provement License: /cd3 Exp _Date: 11� ARCHITECT/ENGINEER Phone: e 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: $ rte/?�5 0FEE: $ r�7i � Check No.: / 05q Receipt No.: "1(ea� NOTE: Persons contracting with unregistered contractors do not have access to the uaran u g rid g tJ'f .,. Signature,of Agent/Owner gnatu`re of contracto �- Location- No. ocation No. 2Date J „aR,M TOWN OF NORTH ANDOVER 0 w a a � + ; , Certificate of Occupancy $ s''^ t<� Building/Frame Permit Fee $ CHUS y Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # U S 22619 - Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales I Private(septic tank,etc. Food Packaging/Sales 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 Si nature COMMENTS ' HEALTH Reviewed on Si nature I COMMENTS I i zoning Board of Appeals: Variance, Petition No: -- Zoning Decision/receipt submitted yes Planning Board Decision: Comments i Conservation Decision: Comments i Water& Sewer Connection/signature&Date Driveway Permit _ DPW Town Engineer: Signature: FIRE DE-AR ME - Located 384 Osgood Street EN Tein{� Dempster onsite yes located at 1-24�Mafi Street no=- Fi.re D _ epartment signature/da#e s I I ' I I i 1PRODUCERE THIS CERTIFICATE 1818SUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO'RIbHTB UPON THE CERTIFICATE nsn Insure Agency HOLDER.THIS CERTIFICATt DOES NOT AMEND, EXTEND OR 83 Salem St ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Lawrence,MA 1843 COMPAN AFFORDING INSURANCE COMPANY A GRANITEI8TATE INSURANCE COMPANY INSURED - I James Debrscenl i 2 Tanager Way Londonderry, NH 030534000 THIS 18 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR I THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE 18SUED OR MAYIPERTAIN,THE INSURANCE AFFORDED THE POLICIES DESCRIBED HEREIN 18 SUBJECT TO ALL THE TER ,EXCLUSIONS AND C MSONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, i x 00 OF NSURANA GYMPFf"NOA71 IIAMS1111WRATMER I A D 'rL0?TtRi'LWilfiY I 1 PROPRIETOR/ i U $ PMTHIRNDQCUTIVE OFFN:ERS MI NCL❑EIWI a 7434607 5/1112009 1 5111120101 ATLITORY LIMITI Ccwem9eApp1wIoVAQperdmsO*. CN ACCIDENT S 1001 ' IRA POLICYLIMIT $ 300,00 IDISCPSMNOPOPERA I E $ 100,00 RE:THE WORKERS COMPENSATION POLICY DOES NOT PROVIDE COVERAGE F,OR JAMES DEBRECEM. I CERTIFICATE HOLDER CANCELLATION NORTH ANDOVER BLDG DEPT SHOULD ANYOFTHE ABOVE DESCRIBED POLICIES KCANCELLED DUO"THE ATTN:BRIAN LEATHE vwpA-rvN DATETNEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 11 1600 OSGOOD ST DAYS WRITTEN NOTICE TO THE CEI TIFICATI MOLDER NAMED TO THE LEFT,BUT NORTH ANDOVER, MA 01845 FAILURE TO MAIL SUCH NOTICE SMALL IMPOSE NO ORMATION OR LW ILITY OF ANY RIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATM. i AUTHORIZED REPRESENTATIVE I , i I i I i I I i XAORTH Town of, 4Andover N O.383 ..w 1• �y T �O -__- LAKE o dover, Mass., ' • O . COCHICHEWICK AERATED "."P �� IT BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT........... ....��.. ............ ......* ............................................................................... Foundation !� �..has permission to erect........................................ wldings on .. .....� .. ............... Rough to be occupied as........05........ 'f......................... .C.1 chimney ..............:............ provided that the person acce this permit shall in eve res e& onform to the terms of the ica ion on file in P P P g P N P PP Final 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 10 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTR O T �Ts�� Rough .................................... ervice BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. FOURNIER Family Roofers & Painters JAMES DEBRECENI EXTERIOR PAINTING - CARPENTRY - ROOFINGt c ti wE�' << 7� 5 MAPLE ST. THUEN, MA 01844 FREE ESTIMATES _. 978-683-5127 Parkeor ItIA . 11-17-ce,2_ P s AR � ej --�ce-At `Lk-1e'f-S-f P/c1 aeel vies self -/,d )q/ QP�,� TOTAL W ON ACCEPTANCE WHEN STARTED HALF COMPLETE BALANCE WHEN COMPLETE " ALL CHECKS TO ALBERT FOURNIER OR JAMES DEBRECENI - � 1 v `L f Board g Reguiatious and Standards. HOME IMPROVEMENT + CONTRgCTOR. Registcitt©n: 122385 'Ex gra pian. 8/26/2010 Tr# 274007 v ,Type DOA WEAT"ERSEAL JAMES DE8RE 2 TANAGER ENI y, WAY . LONDONDERRY, NS >. H 0 0 Adnitis'tij'foF co of Li nStrUctioGitlin`. lt;r�ttat{jjl Re teens rt SEtt r,i.. st�i�te e' CSS Vis�r/�trtt�tt�'.tYft/i�. �. J ' tn: RF 99685 specialty C7.t tn.tl`tr r , 2 TMS oEe Cees At SONO gR�,yFcEN� Ry NN 0,,O EXpiratio ,_ "� t'�. 9868 201 j " 5 The Commonwealth of Massachusetts Department of Industrial Accidents Offwe of Investigations 600 Washington Street Boston, 2lL4-02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ledbly Name (Business/Organization/Individual): •^ f J ce—c-c n .t Address: Olra City/State/Zip: z_C,'1JO✓td 9r~� E Phone#: / AF19:a n employer? Check t e appropriate box: Type of project(required): � 1. employer with� 4. ❑ I am a general contractor and I 6. E] New construction � employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheen T 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me 'many capacity. workers' comp. insurance. 9 ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I 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. 00frepairs insurance required.) t employees. [No workers' 13. Other comp. insurance required.] ❑ *.:.. appheant that checks box 91:rust 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 their workers'comp.policy information. I am an employer that isproviding workers'compensation insurance for my employees. Below is the policy and job site information. _ Insurance Company Name: f^Cu'1 � Policy#or Self-ins.Lic.#: '7q3-)/61 67 Expiration Date: �l`l a ARM Job Site Address: �� � !/ City/State/Zip: eAQ /W, 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 B q on 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 ofthis statement may be forwarded to the Office of I Investigations of the DIA for insurance coverage verification. I do hereby certify under penalties of perjury that the information provided above is true and correct Sign Phone#: Official use only. Do not write in this area,to be completed by city or town officiaL I 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#: I 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 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-cont-actor(s)name(s), address(es)and phone numbe ( 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 of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street B4oston, MA.0.21.11 TeL # 617-7274900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax# 617-72.7-7749 vmm,-mass.gov/dia 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 I Doc:.Building Permit Revised 2008 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 o 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 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) o Mass check Energy Compliance ance Re ort (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) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ 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) o Copy of Contract o 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 i Doc: Doc.Building Permit Revised 2008 �pART,y Federal Emergency Management Washington, D.C. 20472 ND SEAM, 410 LJ April 06,2010 NORTHANDOVER CONSERVATION COMMISSION MS.PATRICIA PARKER CASE NO.: 10-01-0631A 221 CAMPBELL ROAD COMMUNITY: TOWN OF NORTH ANDOVER,ESSEX NORTH ANDOVER,MA 01845 COUNTY,MASSACHUSETTS COMMUNITY NO.: 250098 DEAR MS. PARKER: This is in reference to a request that the Federal Emergency Management Agency (FEMA) determine if the property described in the enclosed document is located within an identified Special Flood Hazard Area, the area that would be inundated by the flood having a 1-percent chance of being equaled or exceeded in any given year (base flood), on the effective National Flood Insurance Program (NFIP) map. Using the information submitted and the effective NFIP map, our determination is shown on the attached Letter of Map Amendment (LOMA) Determination Document. This determination document provides additional information regarding the effective NFIP map, the legal description of the property and our determination. Additional documents are enclosed which provide information regarding the subject property and LOMAs. Please see the List of Enclosures below to determine which documents are enclosed. Other attachments specific to this request may be included as referenced in the Determination/Comment document. If you have any questions about this letter or any of the enclosures, please contact the FEMA Map Assistance Center toll free at (877) 336-2627 (877-FEMA MAP) or by letter addressed to the Federal Emergency Management Agency, LOMC Clearinghouse, 6730 Santa Barbara Court, Elkridge,MD 21075. Sincerely, y � Kevin C. Long,Acting Chief , Engineering Management Branch Mitigation Directorate LIST OF ENCLOSURES: LOMA DETERMINATION DOCUMENT(REMOVAL) cc: State/Commonwealth NFIP Coordinator Community Map Repository Region i Page 1 of 2 Date: April 06, 2010 Case No.: 10-01-0631A LOMA JFN,NRTAf. Federal Emergencyenc Management Agency Y G Washington,D.C.20472 C fNp SE LETTER OF MAP AMENDMENT DETERMINATION DOCUMENT REMOVAL COMMUNITY AND MAP PANEL INFORMATION LEGAL PROPERTY DESCRIPTION TOWN OF NORTH ANDOVER, Lot 14, as described in the Quitclaim Deed, recorded in Book 1294, ESSEX COUNTY, Page 357, in the Office of the Registry of Deeds, Essex County, COMMUNITY MASSACHUSETTS Massachusetts COMMUNITY NO.:250098 AFFECTED NUMBER:2500980012C MAP PANEL DATE:6/2/1993 FLOODING SOURCE: LOCAL FLOODING APPROXIMATE LATITUDE&LONGITUDE OF PROPERTY:42.637, -71.062 SOURCE OF LAT&LONG:GOOGLE EARTH DATUM:WGS 84 DETERMINATION OUTCOME 1%ANNUAL LOWEST LOWEST BLOCK/ WHAT IS CHANCE ADJACENT LOT LOT SUBDIVISION STREET REMOVED FROM FLOOD FLOOD GRADE ELEVATION SECTION THE SFHA ZONE ELEVATION ELEVATION (NGVD 29) NGVD 29) (NGVD 29 14 -- - 221 Campbell Road Structure X 114.3 feet 121.1 feet -- (unshaded) Special Flood Hazard Area (SFHA) - The SFHA is an area that would be inundated by the flood having a 1-percent chance of being equaled or exceeded in any qiven year(base flood). ADDITIONAL CONSIDERATIONS Please refer to the appropriate section on Attachment 1 for the additional considerations listed below. PORTIONS REMAIN IN THE SFHA ZONE A STUDY UNDERWAY This document provides the Federal Emergency Management Agency's determination regarding a request for a Letter of Map Amendment for the property described above. Using the information submitted and the effective National Flood Insurance Program (NFIP) map, we have determined that the structure(s) on the property(ies) is/are not located in the SFHA, an area inundated by the flood having a 1-percent chance of being equaled or exceeded in any given year (base flood). This document amends the effective NFIP map to remove the subject property from the SFHA located on the effective NFIP map; therefore, the Federal mandatory flood insurance requirement does not apply. However, the lender has the option to continue the flood insurance requirement to protect its financial risk on the loan. A Preferred Risk Policy (PRP) is available for buildings located outside the SFHA. Information about the PRP and how one can apply is enclosed. This determination is based on the flood data presently available. The enclosed documents provide additional information regarding this determination. If you have any questions about this document, please contact the FEMA Map Assistance Center toll free at (877) 336-2627 (877-FEMA MAP) or by letter addressed to the Federal Emergency Management Agency, LOMC Clearinghouse, 6730 Santa Barbara Court, Elkridge,MD 21075. i I i Kevin C.Long,Acting Chief Engineering Management Branch Mitigation Directorate Page 2 of 2 Date: April 06, 2010 Case No.: 10-01-0631A LOMA Federal Emergency Management Agency c- Washington,D.C. 20472 t."IND SCG LETTER OF MAP AMENDMENT DETERMINATION DOCUMENT (REMOVAL) ATTACHMENT 1 (ADDITIONAL CONSIDERATIONS) PORTIONS OF THE PROPERTY REMAIN IN THE SFHA (This Additional Consideration applies to the preceding 1 Property.) Portions of this property, but not the subject of the Determination/Comment document, may remain in the Special Flood Hazard Area. Therefore, any future construction or substantial improvement on the property remains subject to Federal, State/Commonwealth, and local regulations for floodplain management. i ZONE A(This Additional Consideration applies to the preceding 1 Property.) The National Flood Insurance Program map affecting this property depicts a Special Flood Hazard Area that was determined using the best flood hazard data available to FEMA, but without performing a detailed engineering analysis. The flood elevation used to make this determination is based on approximate methods and has not been formalized through the standard process for establishing base flood elevations published in the Flood Insurance Study. This flood elevation is subject to change. STUDY UNDERWAY (This Additional Consideration applies to all properties in the LOMA DETERMINATION DOCUMENT (REMOVAL)) This determination is based on the flood data presently available. However, the Federal Emergency Management Agency is currently revising the National Flood Insurance Program (NFIP) map for the community. New flood data could be generated that may affect this property. When the new NFIP map is issued it will supersede this determination. The Federal requirement for the purchase of flood insurance will then be based on the newly revised NFIP map. i i This attachment provides additional information regarding this request. If you have any questions about this attachment, please contact the FEMA Map Assistance Center toll free at (877) 336-2627(877-FEMA MAP) or by letter addressed to the Federal Emergency Management Agency,LOMC Clearinghouse,6730 Santa Barbara Court,Elkridge,MD 21075. Kevin C.Long,Acting Chief Engineering Management Branch Mitigation Directorate