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HomeMy WebLinkAboutBuilding Permit #302-2017 - 30 DAVIS STREET 9/21/2016 � NORTFI "�BUILDING PERMIT TOWN OF NORTH ANDOVER ,0 ; . APPLICATION FOR PLAN EXAMINATION Permit No#:��� 1'� Date Received IhI6ADRdTED y �SSAC HU`��� Date Issued: / I ORTANT: Applicant must complete all items on this page LOCATION .3 V f S Pring -- j PROPERTY OWNER u �? Print 100 Year Structure yes no MAP ' PARCEL: `1 ZONING DISTRICT: ..Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family [I Addition ❑Two or more family 11 Industrial El Alteration No. of units: ❑ Commercial N-151epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic ❑Well ❑ Floodplain Il Wetlands ❑ Watershed District Ei Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Erint Clearly OWNER: Name: LS / Phone: Address: Contractor Name: Phone: - Email: Address: 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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons ntracting with nr gist d contractors do not have access to the guaranty fund *- ignature of Agen 8'w�neFF­ _ ~Signature_of contractor Location -3 U b fl l S No. �jd a41 I Date %'/a /A;0/(-, • - TOWN OF NORTH ANDOVLR 1 Certificate of Occupancy $ Building/Frame Permit Fee $ 30 — . 30 — Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# Building Inspector/ J v J _ 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 Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes r Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature& Date Driveway Permit DPW Town Engineer: Signature: . t FIRE DEPARTM-1 NT - Temp Dumpster on site yes oca e 3n400s ood Stree 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 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 o 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 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/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) Li 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 o Building Permit Application ❑ Certified Proposed Plot Plan o 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) Li 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 Doc:Building Permit Revised 2014 NORT1� own of 2 t s ndover O - t* No. - h ver, Mass, C OCHICKlWKK y1. �s,9 A�RAre Okr S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System - THIS CERTIFIES THAT BUILDING INSPECTOR has permission to erect .......................... buildings on ... .....b4l�CJ........ .......................... Foundation Rough tobe occupied as ................................................................................................................................... Chimney provided that the person accepting this permit shall 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS TI Rough Service ... . . . ............. ..... .......... Fina BUILDIN NSP CTOR 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. TO, OF NORTH, ANDOVER _ _�_ OFFICE OF _ BUILDING DEPARTMENT m 1600 Osgood Street,Building 20, Suite 2035 3., North Andover,Massachusetts 01845 Gerald A. Brown Telephone(978)688-9545 Inspector of Buildings• Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION BUDING, PERMIT APPLICATION Please print DATE:. JOB LOCATION: ` i S 6, O Number S6ei Address Map/Lot HOMEOWNER U U IV� �S�L � � S� 4_9�`� (� �'� � 9I J Name Home Phone Work Phone Ls PRESENT MAILING D ADDRESS D V "s 16 , ANNV9 9 MA dl� � City Town State Zip Code The current exemption for"homeowners"was extended to include owner occupied dwellings of one or two family dwellings and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. 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 dwelling, attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner. (780 CMR Section 110.R5.1.2) The undersigned"homeowner"assumes responsibility for compliance with 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. - XHOMEOV,TNERS SIGNATURE , APPROVAL OF BUILDING OFFICIAL Revised 8.2015 Form Homeowners Exemption BOARD OF APPEALS 638-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 683-9535 uumeuenier?i i za i uz. i race vaiia inrougn Ivtonaay, jury 4, Lu i o """""' rdyu I ui c Customer UOte Quote Center #1728102.1 Store 3480 SALEM, NH www.hdquotecenter.com t - (603) 894-1900 289 SOUTH BROADWAY SALEM, NH 03079 Date quoted: Pro Associate: Customer: Monday, June 27, 2016 JAMES BEAUPRE Bruno Szelest (603) 894-1900 (978) 688-8960 Price valid through: prodesk-3480@homedepot.com Monday, July 4, 2016 Job Description: „ $i 679.70' PACKAGE TOTAL: Valid through Mon,Jut 4,,2016,does not include,tax." QTY UIVI - description Delivery Availabllity 2 EA 4x4-8'#2/Btr Pressure Treated (MCA Ground Contact), SKU#256276 Store 3480 0 business days 2 EA Quikrete Forming Tube 8"x4' (692201), SKU#285266 Store 3480 0 business days 6 EA Quikrete 80 Lb Concrete Mix(Gray 4000 psi 110180), SKU# 169765 Store 3480 0 business days i Continued on next page i 01 inf=(-iznfar ft177R1 i17 1 *** Priya vnliri fhrni inh Mnnrinv "h ilv A 7011 R *** n--- 4 -1 • uuoreLenter*I f zo l u/-. l race vaso inrougn tvlonaay, juiy •+, Lu 10 ------ raye c ui c � t Quote ## 1728102.1 m � Customer: Bruno Szelest QTY UM Description Delivery Availability 6 EA 2 in.x 10 in.x 8 ft.#1 Ground Contact Pressure-Treated Lumber 1001787260 106001 Store 3480 0 business days 210081 M40 21081, SKU# 1001787260 3 EA 3-Step Pressure-Treated Pine Stair Stringer 106069, SKU#430148 Store 3480 0 business days 1 EA Veranda Traditional 6'Vinyl Rail 36"Rail Height(White w/Square Balusters& No Brackets Store 3480 0 business days (Actual Size:67-3/4"x33-1/4") 73003985), SKU#724146 2 EA Veranda Traditional 6'Vinyl Rail Stair 36" Rail Height(White w/Square Balusters& No Store 3480 0 business days Brackets (Actual Size:67-3/4"x33-1/4") 73003988), SKU#829436 1 EA Veranda Traditional Vinyl Bracket Kit(White 2 Top&2 Bottom 73014296), SKU# 1001303912 Store 3480 0 business days ""1 2 EA Veranda Traditional Vinyl Bracket Kit Stair(White 2 Top&2 Bottom 73019000), SKU#513390 Store 3480 0 business days 14 EA Veranda ArmorGuard 1 in.x 5-1/4 in.x 8 ft. Nantucket Gray Square Edge Capped Composite Store 3480 0 business days Decking Board BRDVC NG 8, SKU#345915 1 EA FastenMaster#14 6 in. External Hex Flange Hex-Head Wood Screws(12-Pack) FMTLOK06- Store 3480 0 business days i 12(Package Quantity: 12, Product Weight(lb.):4/5), SKU#141504 Veranda ArmorGuard 2-1/2"Stainless Steel Deck Screws(Gray 175 pcs SCREW VER SS 1 EA TUB-GRY), SKU#538453 Store 3480 0 business days 8 EA LUS210Z Simpson Strong-Tie 18 GA 2x10 Double Shear Face Mount Joist Hanger(ZMAX), Store 3480 0 business days SKU#865889 _ $ 679..70 ?"R E; t / PACKAGE TOTAL: Valid thg h MonJul 4 2016.Does not include tax. *Stated'ead t'fmei are valid only if paymemt is received em the eltiate date. Home Depot is a supplier of materials only. Home Depot does not engage in the practice of engineering, or general contracting. Home Depot does not assume selection or choice of materials for a general or specific use,for quantities or sizing of materials,for the use or installation of materials, or for compliance with any building code or standard of workmanship. ni infa('P_ntar$17781 n9 1 *** Prim valid thrrn rnh Mnnriav .1111v A 7(11 R ACtF Sales: 800.448.3636 Phone: 804.271.2363 NEXT GENERATION Fax: 804.743.7779 O LET'S GET IT DONE STORMWATER MANAGEMENT SOLUTIONS acfenvironmental.com � Site Development and Retrofit . Low Impact Development . Green Infrastructure FOCALPOINT(high flow biofiltration) - R-TANK(modular subsurface storage) - PAVE DRAIN(paving,drainage,storage) - FABCO(decentralized treatment) ii i -.- O i V North Andover MIMAP September 20, 2016 050:0.-004 056.0-0051 056.0=0052 35 MAGNOLIA,DR - 7.41ELM6REST;'RD 056:0=0050 056:0-0.046' 9,MAG NC+LIA.D R 056:0-0.045. p�we' 84 ELMCRESTI'RD, Ma9��1�a� 46 MAGNOLIA_,DR 056 0 0044 056:0-0047 056:0.-0048: 40 MAGNQLIA;DR, 056.0-0049 32,MAGNOLIA DR 056A=0039 4 iMAG NOLIAZR 043.0.0039 1 056:0-003,8 1 056:0=0037 54,4DAVIS'.ST' 056..0-00.36 46 DAVISST 05.6:0-0035 -381DAVISIST' 056.0-00.3.4 ; X30 D_ AVIS.ST' 056.:0-000 R4 22 DAVISiST :043:0-00.43 1 — 1-+� AVIS ST Dav15�5tCeet` 5'1.-DAVIS'STr 45 DAVISIST 43:0-.0042 '391DAVIStST 33-;DAVISsST 056:0-0004 21 DAVIS ST XTDAVIS'�ST 056:0-0005 043:0-0009 056,0-0009 056:0-0006, 056:0.0007 056:0=0008 0,43.0-0010 372.MAINiST 056.0-0011. 056:0-0015 -380 MAIN S_T 056';0=001,4 056.:0=0032 57LINGOLN!S 0 MVPC Bo Zoning Overlay Zoning ©Municipal Boundary ©Adult Entertainment Dishic Busine s 7 District Q Machine Shop Village Ove 0 Busine s 2 District Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, Rail Line ®Watershed Protection Dist 0 Busine 3 District Meters Data Sources:The data for this map was produced by Merrimack Interstates Historic Mill Area 0 Busine s 4 District vkoli Valley Planning Commission(MVPC)using data provided by the Town of —I Medical Marijuana ®GeneraBusiness District Of ac r 'qA, North Andover.Additional data provided by the Executive Office of —SR Q Downtown Overlay District 0 Planne Commercial Dev ? tt� •�� 00 Environmental Affaim/MassGIS.The information depicted on this map is 0 Historic District Corrido Development Dist Roads Osgood Smart Growth(40 0 Corrido Development Dist for planning purposes only. It may not be adequate for legal boundary 17,Easements n Hydrographic Features 0 Corrido Development Dist A definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER ` MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING ❑ Industri 11 District Parcels Streams Industri 12 District t * THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY O Industri 13 District �o OF THESE Wetlands DATA.THE TOWN OF NORTH ANDOVER DOES NOT -: �� ♦ ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF 0Industri I S District 9 r ❑ Exempt Lands Residece i District '11 go�Arlo .tj THIS INFORMATION Reside ce 2 District ,SSACHUS C: R-ide ce 3 District de ce 4 District 1"=80 ft e .de ce5 District YYY de ce 6 District '--e esidential District North Andover MIMAP September 20, 2016 P IDMe „+� r46 MAGNOLIA 1- 4 ' 056.0-0048 � 40 MAONOLLA�DrR 32 MAGNOL�I�A�DR 056.0-0038 056 0-0037` i 056.0-003.6 x 1 4`6DAYIS ST a a, 050035: :38 DAMS ST �z- 056:0-0034�` 30�,DAUIS 57'i✓ F22 DA1/IS ST j l , �a��5 45 DA1/I5 S 17 39 UAd/IS ST ' 056A-0005 33 UA�hIS ST 21 UAYIS ST 2+7 DA�/IS ST 05'6.0-0006 (056.0-0007 043.0-0009 056.0-0008 ............ 043.0-0010 056.0-0011 0 MVPC Bo Interstates —I Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, —SR Meters Data Sources:The data for this map was produced by Merrimack Roads t NORTIy q Valley Planning Commission(MVPC)using data provided by the Town of O ,,ao � �. North Andover.Additional data provided by the Executive Office of t i Easements ,r t +e 00 Environmental Affairs/MassGIS.The information depicted on this map is J Parcels — A for planning purposes only.It may not be adequate for legal boundary definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING # • THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY ^ # OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT 00� rw •� ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF ^o�ATIo'1+'�.q THIS INFORMATION SSACNuS� 1"=57ft ^�• The Commonwealth of Massachusetts Department of IndustrialAceldents 1 Congress Street,Suite 100 - Boston,MA.02114-2017 V9� www mass.gov/dia Woi;kers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITT)NG AUTE[ORITY. ..Please Print Le9iibly Apphcant Information , Name(Business/organizationandividual): '(f II IZ 1/ /` �/n Address: City/State/Zip: y 6 Phone#: Are you an employer?checicthe appropriate box: Type OfzprOJBCt(required): 1.[]I am a employer with employees(full and/or part-time)." 7. ElNew'donstr&tion 2.Q I am a sole proprietor or partnership and have no employees Working forme in 8. El Remodeling ��R any capacity.[No workers'comp.insurance required.] 9. 0/ Demolition r�'Y7' A 3.[X1 am a homeowner doing all work myself,.[No workers'comp.insurance required.]t 10 E]Building addition 4•❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 1LE]Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 51-11 am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 11 Q Ro6f repairs These sub-contractors have employees and have workers'comp.insurance.t 14. Other 6.Q We are a corporation and its'officers have exercised their right of exemption per MGL c. 152,§l(4),and we have no employees.[No workers'comp.insurance required.] 1b6k#1 must al *Any applicant that checksso n. fill out the section below showing their workers'compensation policy informatio 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 state whether or pot those,entities,have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name- Expiration Date: Policy#or Self-ins.Lie.#:. 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 MGL c.152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do herehy cert! under thepains and enalties ofperjury that the information provided above is true and correct: A4Date: v �Siafore: � �� � � � � hone#: Official use only. Do notwrite in this area,to be completed by city or town official City or Town: PermitAUcense# Issuing Authority(circle one): 1.Board of.Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#• Contact Person: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for theiremployees. 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 enferprl'se,and including the legal representatives of a deceased employer,or the receiv&br 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 b6 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 r'eq'uired." 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=contractor(s)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 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-insura'nc'e 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. # 617-727-4900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia