HomeMy WebLinkAboutBuilding Permit #814-14 - 299 DALE STREET 5/12/2014TOWN OF NORTH ANDOVER
1 APPLICATION FOR PLAN EXAMINATION
Permit NO://,,,, Date Received
14
Date Issued:!t "J � H
IMPORTANT: Applicant must complete all items on this page
LOCATION=
�,� Pn f
PROPERTY OWNERC)(AT
Print _ 100 Year old Structure
MAP NO: PARCEL:—.A
ARCEL: ZONING DISTRICT: Historic District
Machine Shop Villa
e
les yes
I no �I ...
.TYPE OF IMPROVEMENT-
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ One family
)KAddition
❑ Two or more family
El Industrial
❑ Alteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑
❑ Septic ❑ Well
_Other
- ❑ Floodplain ❑ Wetlands
❑ Watershed District
_ LM Water/Sewer
DESCRIPTION OF WORK TO tat t'tK1-UKMtu:
Identification Please Type or Print Clearl )
OWNER: Name: I K L5 19 E)/_& C.14 77—/ Phone:
Address: 2 % 0A L � 57—
CONTRACTOR Name: CC(./ � A la) Vt
Address:0\/,A r- �� '�/Vi-i�G��� %��/-•I.
Supervisor's Construction License.- Exp. Date- / `—1
Home Improvement License: %'� Exp. Date:
ARCHITECT/ENGINEER N //.a 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: $ FEE:
�21
Check No.: Receipt No.:
NOTE: Persons contract' g ith unre , to contractors do not have acces to z a ty and
;Signature of Agent/Owner Signature of contractor
Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
Building Department
The fol'pwing is -'a -list of_the required1orms to be -filled out#or:the appropriate.permit to.be obtained.
Roofh g, Siding, Interior Rehabilitation Permits
B,ailding Permit Application
o Workers Comp Affidavit
o Photo Copy Of H.1.C. And/0'r C.S.L Licenses
o 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
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
Copy Of Contract
❑ Roor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraufic Calculations (If Applicable)
❑ �k,Mass checEnergy Compliance Report (If Applicable)
L3 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)
Li 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)
❑ 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 apu•�al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be subm.f ed with the building application
Doc: Doc.Buiiding Permit Revised 2012
Diiiiension-
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-.Ch'apter 166.Section-21A -F and G min.$100-$1000 fine
NnTFA"nnrl DATA - (For department usel
Doc.Building Permit Revised 2010
f
® Notified for pickup -
Date
Doc.Building Permit Revised 2010
f
-: Plans'Submittet Plans Waived ❑ :<' ...`. Certified Plot Plan .. Stamped Plans ❑
TYP,1J OP SEWERAGEDiSROSAL'
...
Public Sewer PJ
Tanning/Massage/BodyArt ❑ ..
Swimming Pools ❑
Well ❑
Tobacco.Sales
-,,Food Packaging/Sales ❑
-Pr vate•(septic tank, etc_ ❑' . _:.
=Perriiaiieinttunpster on Site ❑
_. THE..FOLLOWING SECTIONS FOR"OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF'- U FORM
..."DATE REJECTED-.-:.- DATE: _
LANNING'& DEVELOPMENT" ❑ ❑
COMMENTS
)(�7
ONSERVATION Reviewed on — Si ` nature
G
COMMENTS
HEALTH Reviewed on Signature .
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes ..
Planning Board Decision: Comments
= q
Conservation Decision: Comments
!Nater & Sewer COnnectionisignature & Date 'Driveway Permit
DPW Town Engineer: Signature:
Locatea M4 Usgooa Street
FIRE DEPARTMr NT- '- Tehip Dumpster on site yes no
Located7bt 124 Main Street
Fire Depar`tme4t's1gn4tu're/date` `
'COM'MENTS -. -
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No.
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Check # 1-1
27564
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee.
Foundation Permit Fee $ _
Other Permit Fee $
TOTAL $
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May 8, 2014
Town of North Andover
Office of the Planning Department
Community Development and Services Division
1600 Osgood Street - Suite 2035
North Andover, Massachusetts 01845
Application of: Michael and Deb Chittick
299 Dale Street
North Andover, MA 01845
Property: 299 Dale Street, North Andover, MA 01845, Map 64 Parcel 14
BACKGROUND
On May 7, 2014, the applicant submitted a request to construct a farmer's porch on the front of
their dwelling located at 299 Dale Street. The property in question is located within the
watershed protection district general zone. Based on the letter dated May 8, 2014 submitted by
John Sullivan III, P.E. the proposed work will be further than 325 -feet from a wetland resource.
Therefore a Watershed Special Permit is not required.
Because the proposed work is within the watershed protection district certain conditions are
required to complete the project.
FINDINGS OF FACT
• The proposed porch is more than 325' from a wetland resource area, thus located outside
the non -discharge area of the Watershed Protection Zone.
• The porch will be 6' 6"x38' in size and will be approximately 2 -feet off the ground. It
will be constructed using six sonotubes that will allow runoff to discharge to the ground.
The proposed porch is within the Watershed District General Zone but outside the Non -
Discharge Zone therefore the following conditions apply:
CONDITIONS
• Proper erosion control should be in place prior to construction ad should remain throughout
the project until completion.
• This office will perform an inspection during the construction of the porch as well as after the
porch completed.
Curt Bellavance,
Community Development, Director
Sullivan Engineering Group, LLC
Civil Engineers & Land Devefapment Consultants
May 8, 2014
Town of North Andover
Planning Department
1600 Osgood Street
North Andover, MA 01845
Re: 299 Dale Street, North Andover
Watershed Waiver Request — Proposed Farmer's Porch
To Whom It May Concern;
On May 8, 20141 personally conducted a site visit at 299 Dale Street to determine the proximity of any
wetland resource areas to a proposed farmer's porch. The proposed farmer's porch will extend six feet out
from the existing front of the dwelling and there are no wetland resources areas within 325 feet of the
proposed work. There were two specific wetland areas to the north and east of the site that were physical
measured in the field and both were over 325 feet from the proposed farmer's porch location_
As such, the builder is seeking a waiver from the Watershed Special Permit application process. If you should
have any questions or concerns please feel free to contact me.
Very Truly
John
22 Mount Vernon Load Boxford, Massachusetts 01:92.1 — (978) 352 -2821 -Phone — 978352 -7871 -Fax
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�AN11tJS{Li � �7EL_�t�IAS � �i'SsOG!-ETES
t r.j E E Q S AGS H -P"ECT S
4 1 -n' NJ c>,=, -�/ E Q `a T 1-'! 4:' . 4'. Ov E iZ
All electric to be installed per code. Six recessed lights and bath fan light combination to
be installed. Owner to provide any decorative surface mount fixtures and vanity mirror
light. One Cable TV and one Telephone outlet included.
Insulate per energy star stretch code.
Install gypsum board sheetrock, tape, sand and prime
Install new window trim and baseboard to match existing.
Install vanity and granite counter top supplied by owner
Interior paint walls and trim as needed. (Colors to be selected by owner)
Tile bathrooms floor (tile to be selected by owner, $4.00 per ft. allowance)
Carpet family room floor. ($30.00 per yard allowance)
Cleanup and Removal of all debris.
TOTAL CONTRACT PRICE $48,000.00
Payments to be made as follows:
Deposit
$9600.00
Demo complete
$9600.00
Frame Complete
$9600.00
Mechanicals Rough
$9600.00
Interior Paint
$4800.00
Upon Completion
$4800.00
* Exterior Paint work is not included at this time. We will provide this estimate at a later
date.
i 3
5-,/Z I P -�
iTN P A - 0
Contractor's Signature:
L a� i
Date: r '7
Acceptance of proposal: The above price, specifications and conditions are satisfactory and are hereby
accepted. You areauthqfize to o th wo as specified. Payment will be made as shown above.
-%
Owner's Signature Date: �1
The Commonwealth ofMassaehusetts , -
DepartmentofInriustrialAccidl nts
Office oflnvestigations
quo 6#4 Washington Sheet
.Boston, MA 02111
www.mass gov/dia
Workers' Compensation bsurance davit: BupdersfContractor/Electrxcians/Pliim ers
Applicant informafion Please Print Led h
Name (Bus ness/Organizationlindividual): C, A pl ('i - % /U Pit .r ✓ P �� _C
Address: " C 0 � I�T�
City/State/Zip: 1 �/ F Phone
�- -7
Are you an employer? Check the appropriate box:
Type of project (required):
1. ❑ I am a employer with
4. ❑ lam a general contractor and I
6. ❑ New construction
employees (fall and/or part-time).*
2. [l I am a sole proprietor or partner-
have Hired the sub -contractors
listed on the attached sheet.
�- El Remodeling
ship and'haveno. employees
working for me in any capacity,
These sub -contractors have
workers' comp. insurance.
S. ❑ Demolition
9. El Building addition
[No workers' comp. insurance
5, [-fib are a corpora] on and its
10.0 Electrical repairs or additions
required.]
3. El am a homeowner fining all work
officers have exercised.theix
right of exemption per MGL
11.[] Plumbingxepairs or additions
myself. [No workers' comp.
c.152, §1(4), and we have no
12,QRoofrepairs
insurancere ed. i
�
employees. [No workers'
13.❑ Other
comp. insurance required.]
'!Any applicant that checks box01 must also fill out the section below showingtheir workers' compensagoupolicy information.
('Homeowners who submit this affidavit indicating tfiq go doing all work and then hire outside contractors must submit a new affidavit indicating such.
TContractors that check this box must attached an additional sheet sliowingthe name of the sub -contractors and their workers' comp. policy information.
lam an employer that isproviding workers' compensation insurance for my employees Below is thepolley andjob site
information.
Insurance Company N
Policy # or Self ias.Lic.
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 requiredunder Section 25A ofMGL o. 152 can lead to the imposition of criminalpenalties 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
ofup to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of-
Investigations
fInvestigations of the DfA. for insurance coverage verification.
Mo hereby etrtIM, rider, the pains and penalties q f perjury that ilia information provided above is true and correct.
Official use only..Do not write in this area, to he completed by city or town official
City or Town: Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. BulidingDepartment 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.
Pursuarit to this statute, an employee is defined as "...every person tri "the service of another under any contract ofhire,-
express or implied, oral or written."
An eWfoyer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the i'oregoiiig engaged in a j oint enterprise, and including the legal representatives of a•deceased em to ex or the
receiver or tnistee ofan individual, partnership, association or other legal entity, employing employees However the
owner of a dwelling house having notmore than three apartments and who xesides therein, or the occupant ofthe
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."
ti J
MGL chapter 152, §25C(6) also states that "every state or Meal licensing agency shag -withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth fox. 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'
cceptable 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 certificates) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLp) with no employees other than the
members orpartners, arenotrequiredto canyworkers' compensation. insurance. If au LLC orLLP doeshave
employees, apoliey is required. Be advised thatihis affidavit may be, submitted to the Department of htdustrial
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 fox the, Permit or license is being requested, not the Depar in.ent 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 pemsit/license number which will be used as a reference number, in addition, an applicant
thatmust submitmultiple, permit/license applications is 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 Ilse city ox town may be provided to the
applicant as proof that a valid of ldavitis on file for future permits or licenses. Anew afHavit must be filled out each
year. Where a home owner or citizen is obtaining a license ox permit not related to any business or commercial venture
U.e. a dog license or permit to burn leaves eta.) said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance fox your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone acid fax number:
Tho GQ o-awoaXthofMumachmetlS
Department offaduddal Acexdenta
ofrwe offAvesagaoxta
6G Washlvgtm Street
Boston, MA 02111
7.1'e1, # 617-7-2,7-4900 -4.900 e 406 ox 1-877 MASSAF`F,
Revised 5-26-05 Fax # 617-727-7749
" w�vc€.z�aa�s,govfcli`a
C���te cpo�nzinaoazcu o�C%l�cr��a�urtelG3
Office of Consumer Affairs &'Busi
ness Regulation
TxgME
IMPROVEMENT CONTRACTOR
istration: 777832 Type:
piration: :2./1272b16: Individual
.::
GERARD WELCH
I
GERARD WELCH
19 COUNTY RD
iANDOVER, MA 01810 Undersecretary
Massachusetts - De0brtmen $obi
Fuafety
Board of Building Regulatto
tt1'grtis
ConstructionSupen'isoigCn1.11mo.. ! F,t -7
License: CS -0078$4l''
GERARD E WELC21k1
PO BOX 248 !
N ANDOVER MA
�-�►' Expiration
Commissioner 04/18/2016
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: I ""Date Received `
Date Issued:
IMPORTANT: Applicant must complete all items on this
LOCATION - - ` a -- --- - - -
� P ri
PROPERTY OWNERO(AT1
Print 100 Year O) Structure
MAP NO: PARCEL;ZONING DISTRICT: Historic District
Machine Shop Villa
('es no
yes no
.TYPE OF IMPROVEMENT.
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ One family
)gAddition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:-
❑ Commercial
13 Repair, replacement
ElAssessory dg
❑ Others:
❑ Demolition
0 Other
❑ptic ❑Well'
❑ FI odpl. ❑ tlan s
❑ Watershed District
-Cn Wates/Sewer
--
- -
DESCRI
OWNER: Name:
Address: 2 Ola L
CONTRACTOR Name: f
Address:
tui m rr-mrumivicu.
Pled., pe or Print Clea)
(- a 177`- C 1rly
I, / l
' iV 7 Ll Ex Date-
Supervisor s Construction License: _ - p- _
Home Improvement License: l - - _ _Exp. Date:- 4'2_� -- /
ARCHITECT/ENGINEER Xi /%a 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: $ 2 5 FEE: $
Check No.: Loi Receipt No.:
NOTE: Persons contract' g ith unre te, contractors do not have acces to a ty i
Signature ,of Agent/Owner " Signature of .contractor
Plans Submitted _Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATI0
I Date Received 14.
Permit NO:
Date Issued: .
IMPORTANT: Applicant must complete all items on this page
LOCATION - ,
h.
y
Pript
PROPERTY OWNER��
-T Print' s:• 160 Year OI structure yes no
MAP NO': PARCEL:O ZONING DISTRICT. Historic District yes no
Machine Shop Village. _ yes o
.TYPE OF IMPROVEMENT.
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ One family
)',Addition
0 Two or more family
❑ Industrial
0 Alteration
No. of units:
❑ Commercial
0 Repair, replacement
0 Assessory Bldg 7
❑ Others:
0 Demolition
❑ Other 7 N ____)
❑ Septic 0 Well,
0 Floodplainee��s
El Watershed' District
.10 Water/Sewer
DESCRIP I IUN UI-,WXPKM 1 W 13crr-1rWnnnF-v.
j1dein'tification P 2OWNER: Name: M` —1
Address: -27
�1a
CONTRACTOR Name: LL r E
Address:
or Pr t Clear!y)
a / C 1c
%J 4AA.,-) 0V4
e:
- - - - - r
Supervisor's Construction License: t/,V7 Ali' Ll Exp. Date: L/
Home Improvement License:- - Exp. Date: J 1.
ARCHITECT/ENGINEER 1%a Phone:
Address: Reg. No.
FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F.
Total Project Cost: $ FEE: $
Z.
Check No.: Receipt No.:
NOTE: Persons contract' g ith unre a to contractors do not have ac ces to t a ty and
Signature of Agent/Qwvner Slgj1ature.of contractor,
Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑