HomeMy WebLinkAboutBuilding Permit #138-2017 - 304 CHESTNUT STREET 8/11/2016 O1 �aORTt
BUILDING PERMIT tT�Eo "
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TOWN OF NORTH ANDOVER
T APPLICATION FOR PLAN EXAMINATION
.1(71611
Permit No#: Date Received R4TED � ty
�Ssgct+ustit
Date Issued: (III?
IMPORTANT':Applicant must complete all items on this page
LOCATION _�C� e-�1°S�NI/�T
Print
PROPERTY OWNER
Print 100 Year Structure yes no
Historicistrict yes
MAP _PARCEL: ZONING DISTRICT: Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building V.O<e family
edition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement- ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other -
g ���-
❑°Septic Uj1Nel1 D'Floodp n- pU�letlands Wate shy
_p�lNaterlSew 1�
PERFORMED:
DESCRIPTION OF WORK TO BE ED:
Identification- Please Ty e or Print Clearly
OWNER: Name: j.-,�vff-
/ Fig/ Phone:
Address: U —Sr
Contractor Name: r Phone: _ !kZ3"
Email: D04 9 Me
x
Address: .-S a
Supervisor's Construction License:GS _dVQ 8 —Exp. Date: 7 � 'off l`�
Home Improvement License: Exp. Date: 7-9
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: $ /a, 12
FEE: $
Check No.: -1(51 Receipt No.:
NOTE: Persons contracting 'th unregistered contractors do not have access to the guaranty fund `
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Location C,r i Ip�_ 1ti
No. i 3 _2 Date a l t
• • TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $4,1—
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ •
Check# ;�wt—�7�
g
r Building Inspector
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL,
Public Sewer Tanning/Massage/BodyTE7
g Pools ❑
Well ❑ Tobacco Sales kaging/Sales ❑
Private(septic taulc,etc. Permanent Dempster on
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On V >�
Signature_
COMMENTS � J
i
CONSERVATION Reviewed on / �nqtu�re ���.
'I
COMMENTS
db v- o l 110.f✓
HEALTHReved on Signature
COMMENTS
Zoning Board of Appeals:Variance, Petition No:
Zoning Decision/receipt submitted yes
s
Planning Board Decision: Comments
Conservation Decision: Comments
Water& Sewer Connection/signature&Date
Driveway Permit _
DPW Town Engineer: Signature:
Located 384 Osgood Street
FSE, -D�EPAMEN�T��,�emp�Dumpster
Located�at 124 MainRStreetvi
Fire Department-signatureldate "•
'YJ+.J4^lFrl�4��4t a' 7rt .:.rfli4d '!5LY°'� _ 4 - G `:
,.1•,. -t' . _cyst. �,�'t�. �` i . .� ::.�.y,{>al {.y r.`' e��r.�.-"'�f��*"�j ;"t:t'F?'}'°q`X'
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)
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❑ Notified for pickup Call Email
Date Time
Contact Name -
- I
Doc.Building Permit Revised 2014
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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
OTE: 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
OTE: 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
2012 IECC Energy code
Engineering Affidavits for Engineered products
OTE: 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
r Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWER-AGE DISPOSAL
Public Sewer Tanning/Massage/Body Art ❑ Sw romi g Pool ❑
well ❑ Tobacco Sales ❑
Food Packaging/Sales ❑
Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF m U FORM
PLANNING Q& DEVELOPMENT Reviewed On Signature_
fLoat-
COMMENTS �✓�' 6"1 akoac,
CONSERVATION Reviewed on / Signature
�COMMENTS� p��
HEALTH Revfdwed on Signature
COMMENTS
Zoning Board of Appeals:variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water& Sewer Conn ection/Sig_n_ature&Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
«n�
FEDEFA,R�+T�M,11tN�T ,Temp�Durnpster on site
Located at 124 MainStreet fs' {��4 �•'• � a- ° v
•Fird(Departmenf signatNO&
ure/date
'•'. - y ,•. ` • r.�. r i,,. r..�.�._,"t. (.`"`, �'A •.rr y4a4.�`7La i7�y�� 'f'S
COMMENTS i;;:�s�
.►
The Commonwealth of Massscchusetts
f Department oflndustriaZAccidents
I Congress Street,Suite 100
=' Boston,MA 02114-2 017
www.mass.govIdia
,y.
'Workers,Compensation Insurance Affidavit:Builders/Contractors/EIectriciam/i'lumbers.
TO IM FILED—VnTH THE PEPJVHr ING AUTMOR'Ty.
ApplicantMormation Please Print Le2ibLv
Name(Business/Orgmizatimfndividual):
Address:_ 14
City/State/Zip: n atgPZ. Phone,#: 9729
Areyou an employer?Checkf&appropriate box: Type of project(;r gimired):
1.Q i am a employervft :.. ! employees(frill and/or part time).* 7.- []New construction
8.
2. I am a sole proprietor or partnership and have no employees workixig forme,in �emodeliri
g
y capacity.[No workers'comp.insurance required] 9, ❑Demolition
3.Q I am a homeowner doing all workmysel£[No workers'comp-insurance required_] 10 $uilc�ing 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 11.❑Electrical repairs or additions
proprietors with no employees. 12 Q Plumbing repairs or additions
5.[1 I am a general contractor and I haQe hired the sub-contractors listed on the attached sheet. 13.'[]Roof repairs
These sub-contractorsliave employees andhave workers'comp.insurancej
6.Q We are a corporation pad its offi.�ers'have exercised their right of exemption perMGL c.
14.[]Other
152,§1(4),and wehaveno.ernploye€s.[No workers'comp.insurance required.]
'Any applicantthat checks box#1 must alsofill outthe section below showingtheirworkers'compensationpolicy iufom.atien
i Homeowners who s bn ittlm af&davit indicating they are doing all work and then hire outside contractors must submit anew affidavr indicating such
Tcontractors that check this box must-aitaghed an additional sheet showing the name of the sab-contractors and state whether ornot those entities have
employees. If the sub-con ac Ors liave employees,tliey must id their workers'comp.policy number.
Iain an employer that is providing workers'compensation insurance for my employees.'Below is thepolicy acid job site
lyzYb nation.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: ?O q _C /3`'�MIV City/State/Zip: A/.tn LeZ ,
Attach a copy of theWoxkers compensationpolicydeclaration page(Showing the policynumberand exjpirationdate).
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 S'T'OP WORK ORDER and a fine of up to$250.00 a
day against st the violator.A,copy of this statement may be forwarded to the Office of Tuvestigations of the DIA for insurance
coverage verification.
I do hereby cer under'the airs and penalties afperjury that the information provided above is Prue and correct
Signature: Date: 0'
Phone#: �—
Official use only. Do notwrzte in this area,to be completed by city or fawn official
City or Town.: PerimirMicense#
Issuing Authority(circle one):
1.Board ox 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 7.52 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 bf hire,
express or implied,oral or written."
Ari 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 enf&prise,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 anotherwho 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 to cal licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the eommonWealZ 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!he-boxes that apply to your situation and,if
necessary,supply sub=contractoi(s)name(s),address(es)and-phone,number(s)along with their certificates)of
insurance. I invited IJiabiiity Companies(LLC)or Limited Liability Partnerships(LLP)withno employ
gas'other than the
members or p artaers,are not required to cany workers'compensation insurance. ff an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit maybe submitted to the Depar finent of•Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. ne affidavit should
be returned to the city or town that the application for the permit or license is being requestednot 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 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. Anew 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
0-c.a dog Hearse orpermit to bum 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 Accid-ants
1 Congress Street, Suite 100
Boston,MA 02114-2017
Tel.#617-727-4900 ext.7406 or 1-877-MA.SSAFE
Fax 4 617-727-7749
Revised 02-23-15 vmw.mass.gov/dia
r , - NORTH q r
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No. 104
ver, Mass
COC MIC NlWKM V
U BOARD OF HEALTH
Food/Kitchen
PER IT T LD Septic System
I BUILDING INSPECTOR
THIS CERTIFIES THAT ......... .,... ............................. ......................................... .....
has permission to erect .... ............... buildings on'. . .......� •• , fg ,,, Foundation
.�. ,Y..41�...... .t .��.... .• Rough
to be occupied as .. .. ...................................................... Chimney
provided that the person a cepting 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
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONST T10 Rough
Service
..... . . ... . ... .. ....... ........
""" Final
BUI NG I PECTOR
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.
t;
Dav!4 Morin
Romo`.ling Contrcdor
365 Sutton Street
North Andover, MA 9:$45
(978) 475-2572
Lic OOM
Proposal Submitted To Phone / Date
Address t_ Job Name
Job Location
Architect Date of Plans Job Phone
We hereby submit specifications and estimates for:
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7171
� � if�.J !..�L �,�+�.<.����Li ���'Lf-'��A `e.l •.✓� 4�„�//f�9-M1
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WE PROPOSE hereby to furnish /material and labor—complete in accordance with specifications below,for the sum of:
,1 f/� ! f' `, /. ( pG/ /to,17Gf dollars($
Payment to be made as follows rye/
r �
All material isuaranteed to be as specified.All work to be completed in a workmanlike Authorized
manner according to standard practices.Any alteration or deviation from above specifications Signature
involving extra costs will be executed only upon written orders,and will become an extra
charge over and above the estimate.All agreements contingent upon strikes,accidents or Note:This proposal may be withdrawn
delays beyond our control.Owner to carry fire,tornado and other necessary insurance.Our by us if not accepted within days.
workers are fully covered by Workman's Compensation Insurance.
Acceptance of Proposal:
The above prices,specifications and conditions are satisfactory and are hereby accepted.
You are authorized to dote work as specified.Payment will be made as outlined above. SignatureV `s T :�,
Date of Acce tante �� _ +—� Signature
•
North Andover MIMAP 304 Chestnut St August 12, 2016
060.0-0100 l `nsy_
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—I Horizontal Datum:MA Stateplane Coordinate System,Datum NA083,
—SR Meters Data Sources:The data for this map eras produced by Memmack
,AORTq Valley Planning Commission(MVPC)using data provided by the Town of
- Roads Of,t`rp q�0 North Andover.Additional data provided by the Executive Office of
i r Easements ? .� e O Environmental ARairsrMassGIS.The information depicted on this map is
Parcels 3' L for planning purposes only.It may not be adequate for legal boundary
--•- 9 definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER
MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING
THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY
i "s # OF THESE DATA THE TOWN OF NORTH ANDOVER DOES NOT
Y a r / ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
.� o�,rro'�rT`�-b THIS INFORMATION
,SSACMustit
1"=33 ft
8/11/2016 Town of North Andover
Base Map 11 Zoning 11 2012 Aerials Utilities Search Selection j Legend Location Markup
Help Mobile Scale V= 62 Select •11 Parcels •�
(show all) •
i060y0„--0100 Owner Prop_ID jAddress
BURKE,MARY BYRON'',098.C-0071-0000.0 304 CHESTNUT STRE
060.;0=O_01, 7y4 CHESTNUaTeST'
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098.:6-0004. 09&C:Og55 �r7 Print
Ownerl BURKE,MARY BYRON
/ Owner2
R,-3 4 -R—!UT STj �' Address 304 CHESTNUT STREET
PropertyID 098.C-0071-0000.0
Lot Size 25265 S
Fiscal Year 2016
Land Use Code 101
Last Sale Date 19970324
Book/Page
Total Valuation $473000
Building Type CL
098 00005 y Year Built 1988
Finished Area 2194 sq.ft.
• More Info: Click here for Assessor website
Assessor Map NorthAndoverAssessorMap98C_26x36.
+ C1stmt SteoeWater Tie: CHESTNUT_STREET_0304.pdf
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098;0 OQ08
09&C=0067
Property Search Page • Go 4.1.0(production) AppGeo Save Map as Image • 1
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David M. Morin
Sara McCallum
Owers Closet Works
365 Sutton Street Closet Systems &Custom Designs
North Andover,MA 01845 Phone/Fax(978)687-5947
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David M. Morin
Sara McCallum
Owners Closet Works
365 Sutton Street Closet Systems &Custom Designs
North Andover, MA 01845 Phone/Fax(978)687-5947
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David M. Morin
- ers-
365 Sutton Street
North Andover,MA 01845
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'� , C,�c U%onr�mc9FrUet�r�a�C���ll�1�c%r{�e�ld
ice Of-Consumer A--l`airs&3psiness Regulation
Q ME IMPROVEMENTCONTRACTOR
egistration: 182620 Typ ;
XP ration718%20-.a
dniiividiiaC .�
DAVID M.MORIN
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DAVID MORIN
365 SUTTON ST --
N.ANDOVER,MA 01845
Undersecretary
Massachusetts Department of Public Safety
L91 Board of Building Regulations and Standards
License: CS-040898
Construction Supervisor
tir:,
DAVID M MORIN
366 SUTTON STR`EET:3 ,1��
NORTH ANDOVER MA 0,4445, =.
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Expiration, ffI
_Commissioner 07/04/2017 I