HomeMy WebLinkAboutBuilding Permit #371-15 - 29 RUSSELL STREET 10/17/2014 NORT#1
BUILDING PERMIT 3�oy�teOe;�tioL
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION E a
47 a
Permit No#: Date Received
1 t
��Ssgc►+us�t�y
Date Issued! � r
IMPORTANT: Applicant must complete all items on this page
LOCATION
Print
PROPERTY OWNER. �c-
�, Print 100 Year Structure yes f Q
MAP PARCEL: -- ZONING DISTRICT: Historic District yes
Machine Shop Village yes n
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ,K One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
,Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
Identification- Please Type or Print Clearly
F OWNER: Name: Rtc,L%4-e.(
Address: 'Z9
Contractor Name: Phone:
Address:
w
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER 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: $ z.;5 C>e3 FEE: $
Check No.: Receipt No.: 2 4S
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
c
Signature of Agent/Owner Signature of contractor
Plans Submitted ❑ Plans WaivedEll 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 Signature
COMMENTS
HEALTH Reviewed on Signature
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 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
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
i
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/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)
i
❑ 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
Doe:Building Permit Revised 2014
F
Location
No. (t,..
.+ Date
IMP
- TOWN OF NORTH ANDOVER q,..
I
. Certificate of Occupancy $
Building/Frame Permit Fee '"
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#
28154
kilding Inspector y'
NORTh
Town of
No. 451 I
� 2 h
y IE ver, Mass, O64 2b 14
T O LAME .�
COC NIC NE WIC/(
�,9 A°R•�reo �Pa�,��(5
S U
BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
M%%CAR" BUILDING INSPECTOR
THIS CERTIFIES THAT ............................................................ ........... ......................................
Foundation e
has permission to erect .......................... buildings onZ.01.... �..... . . . ..............
Rough
to be occupied as
p ...............16.X.1.16......... ...................................................... Chimney
provided that the person accepting this permit sha in every respect conform to the terms of the application 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
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 66NITU§ ELECTRICAL INSPECTOR
�. UNLESS CONSTRUCTI A Rough
Service
................... ......... .................:: .................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Buildinz 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 October 17, 2014
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SR Horizontal Datum:MA Staleplane Coordinate System,Catum NAD83,
Roads Meters Data Sources:The data for this map was produced by Merrimack
C.Easements f N'�TM q Valley Planning Commission(MVPC)using data provided by the Town of
C `�`tp '.rO North Andover.Additional data provided by lne Executive Office of
13 MVPC Boundary ,r�s •� O Environmental Affairs/MassGIS.The informalior depicted on this map is
ParcelsO L for planning purposes only.It may not be adequate for legal boundary
i� - definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER
MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING
4 ; THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY
•i "; OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT
#o� Z i ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
THIS INFORMATION
7JS�
1"=59ft -�
The Commonwealth of Massachusetts -
Department of IndustriglAcczdents
Office ofInvestigations
IV 600 Washington Street
Boston,MA 02111
www.mass.gov1dia
Workers' Compensation Insurance davit: Builders/Contractors/Electricians/Plumbers
Applicant Information (� Please Print Legibly
Name(Business/OrganizatiorAndividual): 1l xAnn e_ ,
Address: �� fb-,SSC_k 9•
City/State/Zip: IQ., AN-.Azx r q7?
Are you an employer?Check the appropriate box: Type of project(required):
J.❑ I am a employer with 4. ❑ I am a general contractor and I '
- 6. E]New construction
employees(fall and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7• ❑Remodeling
ship and'have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers'comp.insurance. 9. ❑Building addition
[No workers'comp.insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.E1 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 12.0 Roof repairs
insurance required.]i employees.[No workers' 13.[M Other t%FCY_ 4 CCL �- ,,Wmt
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such.
tContractors that check this box must attached an additional sheet show4ng the name of the sub-contractors and their workers'comp.policy information.
lam 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.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 may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
X do hereby cert Mder the painsan realties ofperjury that the information provided above is true and correct.
Simafore: Date: /o !7
Phone#: 9 7S/71 ,SYG
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 employeiis defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a j oint 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 employes."
MGL chapter 152,§25C(6)also states that"every state or local lic-ensing 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-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 maybe 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 an questions y v y shoes re ardin the law or if you are required to obtain aworkers'
q regarding Y q
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
I
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 bum 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:
Tho Commonwealth of Massachusetts
Ike .artment of Industrial.Accidents
Office ofIavestigafiions
600 WmWngton.Street
Boston,MA.02111
Tel#61.7-727-4900 ext 406 or 1-877:MASSAFE
Revised 5-26-05 Fax#617-727-7749
www-mass,gov/dia
°°r UIQ`N0R.'HAND OWip
x
OFFICE OR _
• x :'X600 DsgoodStraetBiulding pT 6
North Ai7•d0'VeZ' r
,N.tassachusetts 01845
Gerald A.Brown - Telephone(978)58$945
TuspeeforofJ3uitdings - Faze (978)68$--9542 '
HOV b)W-ER-LICENSE EXEN.[PTION
please�iinf
- .IRATE: Q • k-x
SOB LOCATION; n�— e' -e. 4,-
Number SireetA.ddress
' - • - N.CapfLot
• IXOVEDWNER µ
- Name. . Home Phone - .
W6&2?hone
PRESENT VAILING.ADDRESSState .
dip Codl
The current exemption for"•homeowners"was extended to inehzde owner occupied
'CO allow su;h hornPo;?ners to ea
ga divelings to i�vo units oX;ess and
be aa?�dividual•forbire-Wino does not ossess a 1'c-
acts as snpervisor). u' uLataiwding (Code Section p � Gnse,provided that owner
DBFIMTION OFROMEOWNER.
Pereon 8
who wns a
() Q parcel ofland on which he/she resides or zntends to reside,an which there is,or is xnfended to
bi;,s one or two family sfructures. A persona who constructs more that-One home iu.a twa ysarperio d shall not be
considered a homeowner. .
The undersigned"honneowner"assumes responsibility for comp a
It aces
Applicable codes,by-laws,nu es andzegalatiom. P wzfilt the Stat Duilding Code and other
The undersigned"komeownez"car[,fies that he/she lmdemtands the Town of North Andover Building Depattment
minirmun iuspecfion procedures and requirements an
requirements, dthat he/size will comply withrsaid procedures and
MAMOWNERS SIGNATURE
APPROVAL OF BUJLDING 0:
ICTAL
Revised 7.2009
Foy Homeowners E mmpfion
')3OAIZI3 OFAPPEATS 688-954Ir r
OOITSER'4AT70N 688-9530 DEALTI 688-9540 PLANNING 688-9535
t%O R TINT
Town of ndover
I No. Z
h ver, Mass Q��iIC
� cocHicHewicw y1•
A°R.,TEo ►�P�',�.c5
s Ll
BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
W��T71! BUILDING INSPECTOR
THIS CERTIFIES THAT ................................... ........... ......................................
has permission to erect buildings on�j. '� Foundation
.......................... ......... ....5*#mA&k..........
Rough
to be occupied as
p ...............16-K-14......... ,� ...................................................... Chimney
provided that the person accepting this permit sha in-eve res respect conform to the terms of the application p p p g p ry p pp � 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
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
! `PERMIT EXPIRES IN 6b ELECTRICAL INSPECTOR
UNLESS CONSTRUCTI Rough
Service
.................. .. ...................-.. .................... Final
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.
G '
9K WZ4 PG 56
Record&Return to:
Michael&Nicole Lesofsky
29 Russell Street
North Andover,MA 01845
MASSACHUSETTS QUITCLAIM DEED
Locus: 29 Russell Street;North Andover,MA 01845
1,BARBARA J.GALLAGHER,of North Andover,Essex County,
Massachuse ,�f ru�ation paid andin full consider(t. o�����
HUNDRED . AND AND 00 100 DOLLARS ,
MICHAEL J.LESOFSKY AND NICOLE M.LESOFSKY,husband and wife,as
tenants by the entirety,of 29 Russell Street,North Andover,Essex County,
Massachusetts WITH QUITCLAIM COVENANTS
A certain parcel of land with the buildings thereon,located on Russell
Street,North Andover,Essex County,Massachusetts,and being shown as Lot 6
on a plan entitled"Plan of Lots in North Andover,Mass."Owned by J.J.
Segadelli,Inc.,dated May 21,1962 and recorded with Essex North District
Registry of Deeds as Pian No.4517,bounded and described as follows:
O
NORTHERLY
By Russell Street as shown on said plan,one hundred eighteen(118)feet;
EASTERLY
By Lot 7 as shown on said plan,one hundred thirty-one and 31/100(131.31)feet;
SOUTHWESTERLY
By Lots 3 and 4 as shown on said plan,one hundred forty-five and 71/100
(145.71)feet;and, M'
WESTERLY
By Lot 4 as shown on said plan,seventy-five(75)feet. `=
r
Containing 13,790 square feet,more or less,according to said plan. :
Subject to restrictions and reservations of record,if any,insofar as the
Q
same may now be in force and applicable. " ca
Meaning and intending to convey the same premises conveyed by deed of
J.J.Segadelli,Inc.dated November 9,1962 and recorded in the Essex North
District Registry of Deeds,Book 973,Page 178. See death certificate of James M. 0-�
Gallagher recorded herewith. 00r
tv
Witness my hand and seal this �S day of June,2006.
IW�c�u�eRt+;l<J�xx� F�N St�aas�
iffized and cummiled ou tbis
in�frum�nt. ARA J.GALLAGHER'
THE COMMONWEALTH OF MASSACHUSETTS Essex,ss.
On this I SI-day of June,2006,before me,the undersigned notary public, I
personally appeared BARBARA J.GALLAGHER,proved to me through
satisfactory evidence of identification,which was A14 Orrvnr.S L+c pns e
to be the person whose name is signed on the preceding document,and
acknowledged to me that she signed it voluntarily for its stated purpose.
0-'g
Nota ub c
My Commission expires:
I'd IS
Residential Property Record Card
PARCEL_ID:210/057.0-0002-0000.0 MAP:057.0 BLOCK:0002 LOT:0000.0 PARCEL ADDRESS:29 RUSSELL STREET FY:2014
e 1 Ins' Date: 10130/201
PARCEL INFORMATION �7ax Class: 11111 7 Sale baste X'6613V66� �Page.`"' 0056o ��yp n
Rd Condition: P Meas Date: 10/301200
Owner: 7ot.Prn r� 1 COs...",Sats ype �P�".. , :Cerilboc _ � Traffic:, Entrance - X
LESOFSKY,MICHAEL J. Tot Land Area. 0.32 Sale Valid. Y ' Water: Collect Id: RRC
LESOFSKY,NICOLE M. !j!,;fafttoE" GAL, GFNER Inspe-tAe2s C "
Address: �
29 RUSSELL STREET Exempt-B/L% 1 Resid-B/L%1001100 Comm-B/LP/o Indust-B/L% I Open Sp-B/L% I
NORTH ANDOVER MA 01845
RESIDENCE INFORMATION LAND INFORMATION
Styl® C�TOtR�rrSs< 7"«4dlalh Fn Area:-,72fl Attic: , NBHD CODE 5 NBHD CLASS:5 ZONE R4
_..
Story Height. 2.00 Bedrooms. 4UpFnArea 750 Bsmt Area: 720 SegTY_P�� GQite 'NlethodSgF} _ Acres-,;tnu�YlN V81ti® Class
..
toof: " lilt Sa11is" 1 Addn�4rea< � ��z Fri Esm't Area 1 P 101 S 13790 0.320 168,315
Ext Wall: WS Half Baths 1 Unfin Area. Bsmt Grade
Nlasov --Trim , -� DETACHED STRUCTURE INFORMATION
Exi.BatFiFrx 0 'Tot Frnr�
--_ nIt�'Mssr- �11Nsr 2 1r Y�E3fiE 0radit i d'/.GoodJIF1Pj97W, Crass
Foundation CN Bath Qual T RCNLD 130617 ..,w
p
`'}t[fcitZua( T xffYrBuiiti ,,F. Id7adj ,SE S 80 0.00 1984 A A ///82 400...
Heat Type HW Ext Kitch Year Built" 1962 Sourid Value VALUATION INFORMATION
Puei. ASfidg130�6�4 Current Total: 299,300 Bldg: 131,000 Land: 168,300 MktLnd: 168,300
F tae
Fireplace: 1 Bsmt Gar Cap Condition: AG Af{'StMil Prior Total: 299,300 Bldg: 131,000 Land: 168,300 MktLnd: 168,300
�ntra�AC N Bsratf ski .�Pc Cnrripiete Att�aRT W2, "mss �.
tt
Att Gar SF oG�Ood P/F/E/R: 1100 100178
Porch Tvoe Porch Area Porch Grade Factor
E 168
W 160
SKETCH PHOTO
i
10 160Sq.R 10 720 Sq.Ft R
24D�68
4
16
i
Fill
30 Sq.Ft
c
29 RUSSELL STREET ,
Parcel ID:210/057.0-0002-0000.0 as of 10/15/14 Page 1 of 1
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PLAN OF Lo-rs IN 04
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J. J. GEGADELLI INC. IN.
OF JAS
SCALE 1'-40' MAy 2t, 1962
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