HomeMy WebLinkAboutBuilding Permit #749 - 324 BEAR HILL ROAD 5/24/2010BUILDING PERMIT o� q
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
1
Permit NO: Date Received ` lC) s v
ADAA7lD nPo'� .��J
Date Issued:
IMPORTANT: Applicant must complete all items o is page
LOCATION 6L f5e-h,ur RA ( ( ) I � v`i 'l Yi h it /� (
_ Print � '
PROPERTY OWNER J�1e, tovt'N Y -x
Print
MAP 210 PARCEL: ZONING DISTRICTn f Historic District yes
Machine Shoo Village ves
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
One famiI
Addition
Two or more family
Industrial
Atelglio
No. of units:
Commercial
Repair, replacement
Assessory Bldg
Others:
Demolition
Other
Septic Well
Floodplain Wetlands
Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
d po (< al A nLog) ono -
Identification
n
Identification Please Type or Print Clearly)
OWNER: Name: agp_/I/�, S�l� �v�, Phone: Q%g 6 3• c;l(o�
Address: 3a
CONTRACTOR Name: r .a
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement
ARCHITECT/ENGINEER h frnu • Phone:
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: $ %O.00!.t FO0 FEE: $
Check No.:�Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty. fund
7,g- nature of A ent/Owner -
g %� �^ �r,�attare of contractor
Location 2
No. Date Id
TOWN OF NORTH ANDOVER
Certificate of Occupancy $ _
Building/Frame Permit Fee $ s
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
23i�8
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
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
COMMENTS
CONSERVATION
COMMENTS
DATE REJECTED DATE APPROVED
Reviewed on I 1 a
— �"je7r�(�iz�gzPoS-2.j �
k.� VG.VIA [z d d' i ca-� W (! CL w tJ U-9 Q_ S V ca"'A c- P i (7 c.J
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HEALTH Reviewed on Signature
i
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
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 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
❑ 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/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
❑ 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
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 2008
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REFERENCES
ESSEX NORTH
REGISTRY OF DEEDS:
DEED BOOK 9573, PAGE 90. LOT 62
PLAN No. 9085 ----
ASSESSORS: LOT 63
PARCEL ID
210/064.0-0109-0000.0
COVERAGE:
TOTAL AREA = 46,055 S.F. 100%
EXISTING COVERAGE = 2,193 S.F. 4.8%
EXISTING OPEN SPACE = 43,862 S.F. 95.2%
NO CHANGE
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LOT 66
LOT 59
LOT 60
1447-1550
155.0 EASEMENT
20 �pE pRA1NA=
1 1 .-
1
1 1
1 1
1 1 LOT 67
1_ AREA=46,055 S.F.
1 J
1 ,P
1_ 1
� 1
1O 1
11 1
1 11
EXISTING DECK (REMOVE OPOSED 18'X36'
A80VE GROUND POOL r�
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PROPOSED 618 S.F. 1 _ _ _
RAISED DECK & STEPS
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41.0
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DRIVEWAY
EASEMENT
GRAPHIC SCALE
40 D 20 40 80
( IN FEET )
1 inch = 40 ft.
000'""'00
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LOT 68
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PLAN OF LAND,�W
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NO_ ANDOVER, MA.
'01 TE
NO.324 BEAR HILL ROAD
SCOTT L. GILES R.L.S. 13972
PREPARED FOR: JANE M. SOLOMAN
ZONING:
SRB
PERMIT PLAN
DESIGNED:
ELD: BRM
BRADFORD ENGINEERING C O .
3 WASHINGTON S Q _
HAVERHIL_L_ MA_ 01B-30
SHEET 1 OF 1
DRAWN. WGC
REVISIONS
BY
CHECKED: RG
SLG
PHONE.
(978) 373-2396
F°X` (978) 373-8021
bradford.engr@verizon.net
SCALE 1 " = 40'
DATE: MAY 5, 2010
N
NORTHANDOVER\DWG\324BEARHILLRD.DWG
FILE NO: 138753
REFERENCES
ESSEX NORTH
REGISTRY OF DEEDS:
DEED BOOK 9573, PAGE 90. LOT 62
PLAN No. 9085 ----
ASSESSORS: LOT 63
PARCEL ID
210/064.0-0109-0000.0
COVERAGE:
TOTAL AREA = 46,055 S.F. 100%
EXISTING COVERAGE = 2,193 S.F. 4.8%
EXISTING OPEN SPACE = 43,862 S.F. 95.2%
NO CHANGE
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C:5 OD
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LOT 66
LOT 59
LOT 60
N47,16 5p"W
185.00 EASEMENj
20 SDE DRAINAGE �
1
1
1 1
1 1
1 1 LOT 67
1_ AREA=46,055 S.F.
1 =�
1 C°'
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10 1
11 1
1 11
EOSTING DECK (REMOVE\f--PROPOSED 18'X36'
ABOVE GROUND POOL
V.
1 O
PROPOSED 618 S.F.
RAISED DECK & STEPS
CO N
2 �
X1.0
32.9
1
DRIVEWAY
EASEMENT
GRAPHIC SCALE
40 D 20 40 80
( IN FEET )
1 inch = 40 ft.
LOT 68
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DH/SB FND.
DH/SB FND.
PLAN a �I O F LAND
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NO_ ANDOVER, NAA.
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NO.324 BEAR HILL ROAD
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SCOTT L. GILES R.S. 139
PREPARED FOR: JANE M. SOLOMAN
20N1NG: SRB
U—ERMIT PLAN
DESIGNED:
FIELD: BRM
BRADFORD ENGIISIEERING CO.
3 WASHINGTON S Q .
I -I A V E R H I L L_ MA. 01S,30
SHEET 1 of 1
DRAWN: WGC
REVISIONS BY
CHECKED: RG
APPROVED- SLG
PHONE 978 373-2396
Fes` 978 373-8021
1IIL*ord.engr@verizon.net
bradford.engr®verizon.net
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LDATE
MAY 5, 2010
NORTHANDOVER\DWG\324BEARHILLRD.DWG
FILE NO:
138753
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,AORTH TOWN OF NORTH ANDOVER
OFFICE OF
BUILDING DEPARTMENT
o a *+ 1600 Osgood Street Building 20, Suite 2-36
North Andover Massachusetts 01845
Gerald A. Brown Telephone (978) 688-9545
Inspector of Buildings Fax (978) 688-9542
HOMEOWNER LICENSE EXEMPTION
BUIDING PERMIT APPLICATION
Please print
DATE: .//,9 /o
JOB LOCATION:
Number Street Address Map/Lot
HOMEOWNER Vv- M 5oJ oykbpt l F6r3 8f l & ( M,�? qc�
Name Home Phone Work Phone
PRESENT MAILING ADDRESS 3 & U, M L. I ( 1U6 d
City Town
State
/7Y S
Zip Code
The current exemption for "homeowners" was extended to include owner -occupied dwellings to two units or less and
to allow such homeowners 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 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 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.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Revised 7.2009
.Form Homeowners Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
The Commonwealth of Afassachusetts
Department of Industrial Accidents
Office of Investigations
..600 K ashinb ton street
Boston, MA 02II1
Workers' Compensation Insurance Affidavit Builders/Contractors/El
3phcant Informationectricians/Plumbers
Name (Business/organizationA dividual):
Address: &,,d 91, //
City/ State/Zip: 4
Phone #: y1,� . �a3 ?�/ &
Are you an employer? Check the appropriate box:
L ❑ I am a employer with 4. ❑ I am a general contractor and I
2. ❑employees (full and/or part-time).* have hired the sub -contractors
I am a sole proprietor or partner- listed on the attached sheet $
ship and have no employees These sub -contractors have
working for me in any capacity. workers' Com
[No workers' comp, insuranCe 5 p• Durance.
❑ We are a corporation and its
I am a homeowner doing all
required] officer; have exercised their
3. work right of exemption per MGL
myself. [No workers' comp. C. 152, § 1(4), and we have no
insurance required.] t employees. [No workers'
Pomp. msuran
N
Type of project (required): .
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. (] Building addition
10.0 Electrical repairs or additions
11. [3 Plumbing repairs or additions
12.❑ Roof repairs
-
ce reawred ] 13 ❑ Other
ny "'^licsut that Checlti box -I mus! also nil ec!' the heioa
secri s^at W.,
' Homeowners who submit this affidavit indicating the;, ai-e , .. O he ire o cotn�Y Lc =f —ahon.
doing a1..JGZIi and +'-'•'•'"',••-
+Contractors that chw=: this box must attached an additional sheet showing hireours
ide contractors i{mst submit a new affidavit indicating such.
the acme of the sub -contractors and their warkerc' g
T_
cmPlOYcr mat is Providing workers' compensation
information. insurance for my employees. Below is the policy and job site
Insurance Company Name:
Policy # or Self -ins. Lic. #..
Expiration Date:
Job Site Address:
Attach a copy of the workers' compensation policy declaration . aae (Showing City/State/Zip:
Failure to secure coverage as required under Section 25A of MGL C. 152canlead to the imposition of crer iminal matron date).
e policy
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
penalties of a
of up to $250.00 a day against the violator. Be advised that a copy of this Investigations of the DIA for insurance coverage verification statement maybe forwarded to the Office of
-� ••�• ="y ecru ,timer the pains and penalties of perjury that the formation provided above is true and correct
D
Si�natu
_.. ate.:_.._
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 Plumbing
6. Other inspector
Contact Person:
Phone #:
Information an- d 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 suchemployment 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 co=npliance 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 um -til 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-contractor(s) 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' comp =sation 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 store to sign and date the affidavit. The affidavit should
be retir.ued to the city or tov.Ti that the application for the permmtQr license is being regaiestsd not the Depart of
Industrial Accidents. Should you have any questions regardiz? g the lav, or if you art r e�^uired to obtain a workers'
compensation policy, please call the Department at the number= listed below. Self-insured companies should enter their
self-insu=ce 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 additiom 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 peri nits 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 bum leaves etc.) said person is NOT required to complete this affidavit
The Office of Investigations would hlre to than you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call
The Departmeat's address, telephone.and.fax number:..
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
500 Washington Street
Boston, MA 02111
Tel. 4 617-72.7-4900 ext 406 or 1-9 77-MASSAFE
Revised 5-26-05
Fv, T 617-72,7-7749
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