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HomeMy WebLinkAboutBuilding Permit #266-15 - 35 OLD FARM ROAD 9/16/2015 t$UILUINU rttcmi i �� gt;,,. o� TOWN OF NORTH ANDOVER ° �� APPLICATION FOR PLAN EXAMINATION H Permit NO: Date ReceivedA`_9fi '� , SS4C NU`�� Date Issued: Y IMPORTANT: Applicant must complete all items on this page OCAT0O„N _ ., a O OWNER o P.fnt t . PR PERTY <: Al Print IAP N7: RA L: 203IN {715 R1CT �stoistri0eyes &,. .3 . Machin 'jie.Sop V ale y` TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building X One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ❑ Well Fli odpla i El Watland °' ❑ Watershed District ❑ Waferts , lLFD E C4(— Fez ez E S T A w-Dit0C, V "T0 Scti,F- dl= AOOvF- (,72ovxlo sWJrAK(AJ G- Identification Please Type or Print Clearly) OWNER: Name: D '�fZPhone: Q-18-_79y- -Loo Y Address: 3 5 ©L-D f A 2m kooq-D CONTRCT R Name one Address: x °Supervisor's Cor strwction Lide6se Exp. Date`: JN Horne Improvement l�cen`e Q 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: $ S d O FEE: $ C� Check No.: 14AJge Receipt No.: ' NOTE: Persons cont actin ith unre contractors do not haveccess to the guaranty fund �. Signature of Agent/Ow er ' Signature.of contractor I e 'a 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 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 4, DPW Town Engineer: Signature: t 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) Ue4 ❑ 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 ❑ 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) ❑ 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:Building Permit Revised 2014 Location 3--. I Cl !'1 No. Cp Date q/ . - TOWN OF NORTH ANDOVER . • Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# Y �� v .0 100 BuiCding Inspector FRANK q P-1 ..0 A OF&140 I 9 _ q ATTCTTTqT 6 ?00? 1 1 L. kyllUX140 nuff rlD A NjIV Q f-TT 1p.q, No 41 3 _ss\ SUR,10" I Cf!ATP- 1"=,10' I "In T-)-PP-P UP A T)(-)-%XT P f) A(!' NIAOIQA5 NO. AINTDO'�TR, (07Q� 4183-226AIZ U) vo T-Kr-77 3 U;i;,V 1 tvA i i-0 i.k-,u liv-1 AT TCTTTqT 6 ?009 E 1 0u LJ 1-A-I JL A CPT TIT T i-i iii VV V Ad -�Z-U,� UiAj i,U'%-A i iuA MIA-P 35 , PARCEL 70 -'N Z7 d-'IT T-% T' A Tl It Ar 7-1 t-"t A T--% DEED BJ'C_. 5)b-19, Yui. 2.'4;-U_' 'DT ANT 5MI6 NC R`1 H A' IN'i )C)V V R MA 35 OILD FARIM ROAD DDTTPARFT) T70-P I TT' _­ l !_ A ^1 A DAVID CSL JAdVild—t -t3RU­WKfN-, B T lJl A I P V IIA 438.2.�' _v__0 jn f%T TN TT", 1;U L;I`iii i 35 A- 43.7t LAI nix PARCEL71 411 1 �WDITr 0 pk /--I TAT C% A T%A n hi 1v ri J) /J) (V)l 0 ARFA=45,000 -F v a IN cr l j pm ift fexM VN AL 111 I -TT 4 f-.-, T­=� „TT�-­t T :T._ -1 r ar-L a vv Pq j vv i I ii iii-r- UiN in u BY LAWS OF NOR:I'h ANDOVEi,MIA. A­i­l'HE'1'1j\4E OF CONSIRUCIJON. _jTJU nrrcrlr -UrMl MTtA TT-C%D 'r=T T'U -17'r TT nT TTT T-gmt-1-116�TVrMf­rnD Ii 1.L3)_�.L S vv 1*4 13 kNE r%-.,-L\. I H-E u E Of 111E BUILDING S I-A-I U1, T y-, M, _L.�_Lo -N u'_driNiiNl_; -VJ-TEI�q C�-_Tn� -T C'ONFO r-11"IMHU Y NON-Cul UKA/li 1 Y vv H UIN 0 1 RUC 1.rEID. g i-?; J WORTH \ own of t E .� ndover o - � .. No. h ver, Mass, C OC NICHE WICK Z1,9 A°RAreo.flP�,��(5 `S U BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System THIS CERTIFIES THAT Dalj%d.....T ....... BUILDING INSPECTOR ... . .... 1 Foundation has permission to erect .......................... buildings on 6 1... Rough to be occupied as Q ...... .. ... .....1n� ��! ... '. .... ........ .. ic ................................... Chimney provided that the person accepting this permit shall in eve spec 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 gMQ- Tk ELECTRICAL INSPECTOR UNLESS CONSTRUCTIRough Service ............... . .... ........ .................... Fina 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. T Commonwealth o,f'ffassachaseft ,.. Depift nto,�'.�td'�c�rI41 Accic e t� • , Office r�,f Innes igafeons 6`00 Washftion Street Rosion.,MA 02111 m muss govIdAz WQxkex ' openao�lfnsac A 'icavx :Jniscercl�oacox / Ic �eezasl�'iiiniex� pp :oapt�orerna€aion 'X ase PrintitbXY Name(Businesslorgauizagoulf &iduat):_ Ci ty1S�aE�/ No q4oupov�(, Phone 4: ��$—-7 9�- -L09 Y Are you an.ernployer?CIeeMlz6 appropriafebType ofpxoject(requfred): 1.Q T am a onaployax with__ 4, ❑X am a general confractox and T 6.jIgew c6nstxac111DA F employees(iulland(oxpaxi✓time).T haven0dthesub-contxactoxs 2.C] T am a sole proprietor ox paltn.ex listed on the attached sheet� 7. ��emodelv�g OMP and`haveno.employees These sub-conixactoxs have 8. Demolitzoxt workbag fox me in anycapacity. workers'comp.insurance• 9. ❑Building addition [No workers'comp.ijsuxance 5. ❑We axe a corporation and it's 10. Electricalre airs or additions xecluix'ed.] ofxcers have exexcised.their � p 3. Z am a homeowner doing allwork right oL exemption perMOL 11..[]d'l= ngxepairs or additions myselr. yowoxkers'comp. c.152,§1(4),and we have,no El Rioofxepais irtsuranc€;xecpzixed.�; omployeea"[N'oworkexs' 19,[]Other comp.insurancexequired.� e.AnyapplicantthaiecksboxZmustalsolldntthesectionbel6wshowingtfieirvTorkers'compensationpolicyinfozmation. omeovrnersvr$a submittbisaf davitindicatiug ieyiredpingallworkandtfienhireoutside contractorsmustsubmiEanewaf dapitindica�igsuch. xContcacfors that aheekthis bob must attached a�z additionat sheet showingthe name oche suT�-contractors andtheiFworkers'comp.policy information. apz an exnpl`oyevt galprovzclir� workers'cornpellsatran znsurarzceformy eWroyeegBeroty istriepaliey artcrjob Ae info�rnatio�z. . Iusuxance CompanyName:_ YOlicy#ox Selr"-ins..Bic.#: Expixatio�x Date: l'ob Site.address: City/Statelzip: Affach a copy a£4eworkers'comp ensatlowpoltcy declaration page(showing-Me policy'number and e�Vration.date). yailure to secuxo covexage as xegkeclunder Section 25A ofMOL o.1.52 can.lead to the imposition ofof fine up to$1,500,00 and/ox one-year impxiso MOntz as well as PKpenalties in the faxxa of STOP OR ORb and a fug e of-up to$250.00 a day agalnstthe violatoz: Be advised that a copy&this statem.entmay be foxgtardedto the Office oz• investigations oft7ie,DTA.for ins xance coverage veTIffrR ion. da Xiereby er .f1' ert eiiarns� of perply triattlie Mforraation,provlded a ove' tare amfeorxeet Si atare• Date: °I l(0 2a I y 0jrrcial usa mry, Do not write in this area,to be completed by city or town ofeiaf City or Town: �'ezxaiflLicense# Issuing.A nth.orRy(circle 6310: 1.T3aaxd o ealtkr 2.Buildiizg�eparfinent .Ciiy/xowA Clerk 4.FlectricalInspector s RlutnhingTnspectox f.Other - - Information and instructions Massachrlseffs Generaliaws chapter 152requires allemployexs fapravidewoxkexs'compensationforfbeixexnployees. .Pursuant to this staMe,m ernployee is domed as"..,evexgperson iz~the service of another ander any contract o Jaixe; • express orhnplied,oral orwxitfen" Art ewvlgq j5 def uod as"an individual,partnership,association,corpoxation or otherlegal entity,or any trio oxrnore' of the fdxegoing engaged iu a joint enterpxise,and iucludingthe legalxepxesentatives ofa•deceased cmplQ ox, the receiver ortrdstee oj.anis Mdual,part erslip,association ox otherlegal enfity,employing employees. M-wevexihe owner of a dwellinglzousehavingnatznore tlxauthxee aparEmenfs andwha resides 1�bexeiu,oxfhe occupanto�tt7�..e dwoli ghouse Of another who employs persons to do maintenance,construction oxxepak work on such dweuinghouse ox antTregrounds orbuilding appuxLenanttherefo shallnotbecause ofsuch employanentbe deemedto be an employe:" MOL chapter 152,§25C(6)also states that"every state or local ge-ensing agene sSralz wifSsTzoXd the issuance or renewal of a license ar permit to operate a business or to construct buildings in the co ntrrtonwealtlzfor arty applicant who has not pro duced-acceptable evfftce of compliance With the bzsurance coverage recZuired;' A ddifionally;MGL chapfex 152,§25C(7)states"Neithexthe eommonwealfh nor any of its political sabdivi`sions shall enter into any contract for the performance ofpublic work until accepfable evidence of compliance with the insurance requirements of this chapter have b e on pros onto d to.th-e contracting aufhorify°' Applicants Please ill out the workers'compensation affidavit completely,by checking the boxes that apply to your sitaatzon anal,if necessary,supply sub-contractors)naine(s),addresses)and phone numbex(s)along with the cextihcafe(s)of insuxanco. limited LiabihiyCompanies(LLC)or LimitedUa-bjlitypaxtnerships(LIP)with no employees other thant o members or partners,are.notregakedto cany•workers'compensation insurance. If an C or UP doeshave employees,apolicy xegruxed. Be advised thattbis affxdavitrnay be submittedto theDepartznenG of Industrial Accidents for coni tmation of insurance coverage. Also be sure co sign and date the a�davi: The afitdavit should ba xetumed to the city or town that the application fox thepermif or license is being requested,not the Debartm.ent of IndustrialA.coidents. Shouldyouhaveany questionsregaxdiagthe law oxifyouaxeXaquiredtoobtain aworkexs' eompensafioszpolicy,pleasecallthel,7epa?-tmentatfhemzmbexlisfedbelow SelfinsuxerlcompaniessltouZdenfexfheix ' self~insurance license number on the appropriate line. +City or Tom O£dcials I'leasebesuxethattheafYdavitiscompleteaudpxirotecllegibly. ThoDepartmenthaspxovidedaspaceatthehottom offlte a£trclavitfoxyouta ill out ire,the event the Office ofluvestigafzonshas to contactyouxegardingtho applicant Please be-sure to frllinthe permit/lzcensenumberwhiclzwill be used as a xezexence number. In addition,an applicant thati�ust submitmultiple permit/license applications in any givenyear,need only submit one affidavit indicating current PORGY 100maaiiou(If necessaxy)and under`Tbo Site Address' trio applicantshouldwxzte"alZlocationsi�z (city or town.)- A'copyoftlieaffidavitthathasbeenofciallystampedoxmarkedbyfilacityoxtownmaybeprovidedtothe applicantasptoofthata.validaf�davit•rsan�le�oxtutoxepezmifsorlicenses. Anew afxdavitxuustbDwQdbut each year.Where ahomo owner or citizenis obtaining alicense oxbonuitnotrelated to anybusiness ox commercial venture (i.e.a dog license orliern*to burn leaves etc)said p ersoa is NOT required to complete this affidavit. The Office ofin-vesdgatione•would Eke 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 aird faxnumbex. TIM CQ4x�wtaltlt ofIt-Qww a(,,AV ttq 1)aPaxtMG1xt Qf hfi,� ial Acoldo :fa OWC-0 QUAVoRgAvolm 64G WaMugm Street ' f 617.7-27-4.-00 Qx406 Qr z-a7?"-U AFS _ Pevjsed5 z6�os FM#617"727"7749 taOHrk I"VV 1\ "r 1\"IN lll 1-111411]]V E11% 0 OFFICE OF BUILDING DEPARTMENT a 1600 Osgood Street Building 20, Suite 2-36 North Andover, Massachusetts 01845 ^6R�ilC tea,1' Gerald A. Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE: hL, I JOB LOCATION: 3 '� OLD F-04LM f-0 4 D Number Street Address Map/Lot HOMEOWNER DAV - D B OW63 9`1�--77�_Zoog 9_7$-()Y-6R'0W Name Home Phone Work Phone PRESENT MAILING ADDRESS 3 IFAA-M RD, No27)4 r9NDov£(z kA DI YNR City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) 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 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 understands the Town of North Andover Building Department minimum inspection procedures and ' ements and t 3e 'll comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homeowners Exemption BOARD OF APPEALS 688-95.11 CONSERVATION 688-9530 1IE.A1..T11 688-9540 PLANNING 688-9535 i Above Ground 56 in POOL (48" high) 7ft? 0 0 12ft Deck surface aft? ♦ 2ft 0 (D 2ft? 6ft 18ft Dave Brown ' s Pool Deck September 2014