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HomeMy WebLinkAboutBuilding Permit #814-12 - 303 HILLSIDE ROAD 5/11/2012BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION y� _ Permit NO: _ Date Received �4"�q.,TED ►PP� cS Date Issued: rl I /// 2 IMPORTANT: Applicant must complete all items on this page LOCATION C Print PROPERTY OWNER Print - 'MAP NO: PARCEL: / " ZONING DISTRICT: Historic District yes- no !Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Non- Residential New Building a family (LAddition Two or more family Industrial teratio No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic - Well Floodplain Wetlands Watershed District Water/Sewer t.✓ OWNER: Name: AMrocc• '30 3 RIPTION QF WORK TO BE PREFORMED: {�ra \ [)n Pease Jype or Print Clearly) Ie- f, �//S CJ2 CONTRACTOR Name: Phone: Address: . Phone: ar 7f V-73- 7c�, 3g Supervisor's Construction License: Exp. Date: Home Improvement License -Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ it/ °y FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner 4� Signature of contractor 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 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 NU I t5 anci UA 1 A — wor ciepartment use ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH COMMENTS Reviewed on Signature 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 USgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Location 6u /� ' // J / C' ec go/ No. ?/41 / z Date 5 / i Check # 25295 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ yd — Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building Inspector TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT :: 1600 Osgood Street Building 20, -Suite 2-36 North Andover, Massachusetts 01845 Gerald A. Brown Inspector of Buildings Telephone (978) 688-9545 HOMEOWNER LICENSE EXEIv[pTION Fax (978) 688-9542 BUIDING PERMIT APPLICATION Please print DATE: V/vL,7,) I �— JOB LOCATION: �(�3 Number d I50MEOWNER 1>0 Name PRESENT MAILING ADDRESS Q+ -Y Town Home Phone �,?3 -7 K 3X Map/Lot Work Phone Zip Code The current exemption for `4homeowners,, was extended to include owner -occupied dwellings to two un to allow such homeoti=,mers to engage an i_ridividual•for hire who does not possess a license, its or less and provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Persons) who awns 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 enders minimum inspection procedures and req requirements, uirrnents and that HOMEOWNERS SIGNATURE�t/ APPROVAL OF BUILDING Revised 7.2009 Form Homeowners Exemption the wu of Forth Andover Building Department comply with said procedures and BOARD OF APPEALS 688-9547 CON'SERVA170N 688-9530 HEALTH 688-9540 PLANNING 689-953i The Commonwealth of Massachusetts - Department oflndustriglAccidents Office oflnvestigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print L,egibrly Name (Business/Organization/lndividual): •p.,i 1 l �G- � T , Address: City/State/Zip: Phone #: 572- S- 5 1— Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with 4. ❑ I am a general contractor and I 6. n New construction employees (full and/orpart-time) * have lured the sub -contractors 7. emodeling 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. x ship and'have no employees These sub -contractors have 8. emdlition working for mein any capacity. workers' comp. insurance.g, k ding addition [] [No workers' comp. insurance 5. El We are a corporation and its Electrical repairs or additions required.] 3. Erl am a homeowner doing all work officers have exercised their right of exemption per MGL 11.❑ Plumbingrepairs or additions myself. [No workers' comp. c.152, §1(4), and we have no 12.D Roofrepairs insurance required.] employees. [No workers' 13.❑Other comp. insurance required.] 'Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing 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 Policy # or Self -ins. Mc. #: 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 of MGL o.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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby cert u# der thI prjins andpenalties ofperjury Aat the inform ation pro vided above is arae and correct Phone 4: ` Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Zo / Z 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 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 ofpublic 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. Man 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 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 D epartment 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 (ifnecessary) and under "Job Site Address" the applicant should write "all locations in (city or town)" A copy of the affidavit that has b eon 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. Anew affidavit must be filled out each year. Where a homeowner 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: Tho Commonwealth ofM ssachv.:seits 1Mep.artmeut of Zndustdat A,ccndonts gfMe o1'Tuvesti atiox�,s 60 WaslaiVaa Street Boston? SMA, 021. X x TQL # 61.7-727,4900 oxt 406' or 1-877 UA.SSAFB Revised 5-26-05 Fay # 617-72 7- 774'9 www mass,gova'a i cis e o w° cn ° or w° -(U a�' U w o � ate' w U w°' w x � w�' � w z 04 � w� ° cn Q o co e O :u A 71 0 u C/) O ppkv�/ FL1 • r.a 0 6 O Q CD 0 c Z Z CD Q. O CO) ® C 0o pm I O CD .� ■y m cm C2 w r .0 G_ �... .0 � A C ; w c o 0 a� c 0 c v 0 O O © W i� wU) ) as r. b w xW, a' a:•QC W co ' y C x co `` ... CD O Q v H � arm W cTo � z -1 i 2 0 G3 O CD L O o � Z o Q O y C CD I C C CO) O A03 m � L- CD G3 H = � O � O � co co 0 Q cvv o a a ca o=o Cc Cc w -10a CL o o CO2 t5 C CD CL c C.3 CO) cc .0 C r Q. t c o a� c c v O O C H O C ~ O a:•QC ' y C `` ... CD CD CF �ca :,. 0 CL CD 43 O O C.2r.+ ca Cl �' y co 3 �. O •>> cm a p p y O CO) O m O Qf C O.V t) y y ' m C" CM C2 �O y o V y �. c J 'o c ao F. .L O O � N -m c = m d �••' p ~ +•� y m ~ :/i r.+ ca = m Z y . •NJ C •m La p CO3 'r m •y Z O LU v®C0.32 � ~ caR O 'O O 0 = cc � CL4- -1 i 2 0 G3 O CD L O o � Z o Q O y C CD I C C CO) O A03 m � L- CD G3 H = � O � O � co co 0 Q cvv o a a ca o=o Cc Cc w -10a CL o o CO2 t5 C CD CL c C.3 CO) cc .0 C r Q. t GENERAL BUILDING NOTES/CHECKLIST- NOT LIMITED TO ITEMS BELOW POST ALL LOT NUMBERS, ADDRESS, AND PERMIT (COPY OK)..or no inspections INSPECTIONS: (Minimum) Excavation, Footing, Foundation, Frame, Insulation, Final. FOOTINGS: Continuous Full 2x4 Keyway Continuous strip footings for interior c0i4: FOUNDATION: Rebar as required Anchor bolts or straps Damproofing Foundation drain - pipe/stone/fabric filter/cox,, 'let connection. FRAME: Fireblock - over girts/plates between floor joist Penetrations for plumbing, heat, elec, etc. Walls at stair stringers. Windbrace corners and center bearing partitions. Size ridge to provide full bearing at rafter cuts. Hip and Valley rafters - watch bearing at walls. Ridge & Hip - Provide proper connections. Cathedral roof rafters provide proper connections and use "Hurricane Clips" tie to plate. Stair stringers - watch cuts and heal support. Joist hangers - fully nailed w/ hanger nails. Sill plates 2-2X6 (1 PT) w/sill seal. Girts - solid brick or steel plate bearing at foundations '/ " air space at sides in foundation pockets. Lateral bracing at ends. Certified calculations. required for Beams/LVUs Trusses. Solid bearing support for Headers/Beams etc. Check headroom clearances - stairways, under beams Attic Access. (min. 22x30 w/3' headroom above). Crawl space access. (min. 18x24). Bath exhaust fans to have metal duct to exterior (not in soffit). Firecode S/R wood frame of "0" clearance fireplaces & stoves Window Schedule or Every Habitable Room Must Have: Natural light equal to 8% of floor area. '/� of required glazing shall be openable. Bedrooms required min. 20x24 egress window or door. Vent attic spaces - "proper vent", soffit and required ridge vents. Firecode under stairs if used for storage FIREPLACES: Separate permit required. Inspections at Footing - Smoke Chamber - Finish Smooth parging, clean joints, 8" solid @ combust. DECKS: Lag to house, provide flashing. Rails min. 36" high, Baluster max space 4" on center. Over 8' above grade, use 6x6 p )sts w/lateral bracing. Lag all posts and rails. Pier footings down 48", Conc. )ad at stair base. FINISH: Handrails returned to wall/newall F. -t. Guardrails required alongsi s stairs. Exterior grading complete. Certificate or occupancy requir occupying structure. Temporary Stairs required for inspection. Re-inspection fee - $30.00 (Be Ready). Certificate of occupancy required prior to occu-,-ructure. GENERAL BUILDING NOTES/CHECKLIST- NOT LIMITED TO ITEMS BELOW POST ALL LOT NUMBERS, ADDRESS, AND PERMIT (COPY OK)..or no inspections INSPECTIONS: (Minimum) Excavation, Footing, Foundation, Frame, Insulation, Final. FOOTINGS: Continuous Full 2x4 Keyway Continuous strip footings for interior columns FOUNDATION: Rebar as required Anchor bolts or straps Damproofing Foundation drain - pipe/stone/fabric filter/cover and outlet connection. FRAME: Fireblock - over girts/plates between floor joist Penetrations for plumbing, heat, elec, etc. Walls at stair stringers. Windbrace corners and center bearing partitions. Size ridge to provide full bearing at rafter cuts. Hip and Valley rafters - watch bearing at walls. Ridge & Hip - Provide proper connections. Cathedral roof rafters provide proper connections and use "Hurricane Clips" tie to plate. Stair stringers - watch cuts and heal support. Joist hangers - fully nailed w/ hanger nails. Sill plates 2-2X6 (1 PT) w/sill seal. Girls - solid brick or steel plate bearing at foundations '/ " air space at sides in foundation pockets. Lateral bracing at ends. Certified calculations. required for Beams/LVL's Trusses. Solid bearing support for Headers/Beams etc. Check headroom clearances - stairways, under beams Attic Access. (min. 22x30 w/3' headroom above). Crawl space access. (min. 18x24). Bath exhaust fans to have metal duct to exterior (not in soffit). Firecode S/R wood frame of "0" clearance fireplaces & stoves Window Schedule or Every Habitable Room Must Have: Natural light equal to 8% of floor area. '/z of required glazing shall be openable. Bedrooms required min. 20x24 egress window or door. Vent attic spaces - "proper vent", soffit and required ridge vents. Firecode under stairs if used for storage FIREPLACES: Separate permit required. Inspections at Footing - Smoke Chamber - Finish Smooth parging, clean joints, 8" solid @ combust. DECKS: Lag to house, provide flashing. Rails min. 36 " high, Baluster max space 4" on center. Over 8' above grade, use 6x6 posts w/lateral bracing. Lag all posts and rails. Pier footings down 48", Conc. pad at stair base. FINISH: Handrails returned to wall/newall post. Guardrails required alongside open cellar stairs. Exterior grading complete. Certificate or occupancy required prior to occupying structure. Temporary Stairs required for inspection. Re -inspection fee - $30.00 (Be Ready). Certificate of occupancy required prior to occupying structure Cd 06 O as aC/5 o a O U U o v O C7 �+ O U w W O, C7 Cdo w A rx z Un v Q Un E H � atom LLJ Uo CLM z a 01, cots O co O v Z co O. O y A+W C cm I O O CD O 'E m CD Q CD CD a•+ 10 O � M CD D O 03 o a a cmQ CO) c = c C� w —ice a� C Z CD 0 CL V CO) O C C C c CO)CL LLI 0 U/ U) 19W W 19 W U) o as c :r o � c L H � : C ' w O vccv c. ev o c :Ea • L ' � C O. y c :o s cm A� : c CL - . E c a ca A ":cc; rA O H O cc Z) ma cm CM CD nCos_ o or . o,�Z O • O. 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