HomeMy WebLinkAboutBuilding Permit #305-12 - 368 WAVERLY ROAD 5/1/2018 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: '� �y Date Received
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION U '2 C Y If IV.- ' J� �'1 r4—
Print
PROPERTY OWNER , �+ /-t` r Unit#
Print
MAP NO:—PARCEL: �' ZONING DISTRICT: Historic District yes o
Machine Shop Village yes o
100 year-old structure yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
P _� _
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'MVP tick (® Weld t ❑�Floodpla�n� { Wetlands WatersheclDistnct
_.-_�._-
'_h®Water%Sewers' �_. _ -
.�� DESC 0` � WOR$�O N EUe ED:
(Identification Please Type or Print Clearly) ���-
OWNER: Name: AtI4.4 Phone: 9-7r-
Address: 36
CONTRACTOR Name: dji/t-e- 1--"r111 &A Phone:
Address: PRy t�F tvCt /YZ./� � �M ra Ue� ✓(��/
Supervisor's Construction License: E9 6 7 Exp. Date: 0 g2
Home Improvement License: 70(9 Exp. Date: o
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.
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Total ProjectCost: $ 560 � FEE: �
Check No.: /76 / Receipt No.: <' (�,F?
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 4 0
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:Garrn�tr ira:nf`4'nanttllin/11Af� � . .:- - ' -= ., ,< �_� lana ure o contractor.. ..
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
I
HEALTH Reviewed on Signature
COMMENTS
i
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
c
DPW Town Engineer: Signature:
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.$1o0-$1000 fine
NOTES and DATA— For department use
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Notified for pickup - Date
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I, Doc:.Building Permit Revised 2011 June/mi
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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
a Flo n error ork
❑ En
MOTE: 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
o Photo Copy of H.I.C. And C.S.L. Licenses
o 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
VOTE: 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,
nust be submitted with the building application
Doc: Doc.Building Permit Revised 2008mi
Location
No. - �^ 2 Date /0 ? ��
NORTH TOWN OF NORTH ANDOVER
_ F s
Certificate of Occupancy $
�'Ss�c�usEt� Building/Frame Permit Fee $ Sy`
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # 1761
31
24683
Building Inspector
NORTH
And -
own o over
0%
o , '� lover, Mass.,
O ' LAKE 1
I� COCHICHEWICK
%ADRATED pP�`�,�5
S U BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT.........!Pa.... ..v/a............r' .............................................. Foundation
has permission to erect........................................ buildings on . .3.19......... ...........J`............................................... Rough
r
to be occupied as............................... f /. � .. .. acs Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final,
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 CONSTRUCTION ST TS Rough
46-V................................R Service
BUILDING INSPECTO
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
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.
[E SEE REVERSE SIDE :Smoke Det.
GENERAL BUILDING NOTES/CHECKLIST-NOT LIMITED TO ITEMS BELOW
POST ALL LOT NUMBERS,ADDRESS, AND PERMIT(COPY 0K)..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. 2240 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 5"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.
NORTH ANDOVER BUILDING DEPARTMENT
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
at: a& Wcis that the debris resulting from this work shall be
disposed of in a pr erly licensed solid waste disposal facility as defined by MGL
c 11, S 150 A.
Also, note Permits are required under Fire Prevention laws Chapter 148 Section
I OA.
The debris will be disposed of in:
7 sc;�
(Location of Facility)
Signature of Permi pplicant
//
Date
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CONTRACTORS PROPOSAL
Page# of pages
PROPOSAL
ICN O (Z �r'j M . tiF1
Proposal Submitted To:1 o to L t d Job Name Job# ,^
Addre3 / V C n n obbL9catiorflvfU U ,
to Y 2n.
Nt Nnv (Z M tq . 0 I Q (- S,— Date f 0 _ Date of Plans
—7^
Phone#7� / Fax# Architect
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We hereby submit specifications and estimates for: /?do ` r- — • tJ e' 'rN 'C T
a ; N c, f a 4 Q co( t. H o u S-c rlti
cr- ( �2_ e��(r���.�e .� �cp fr� �� �� � ga-rtTe »
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�We propose hereby to furnish material and labor—complete in accordance with the above specifications for the sum of:
Q
$ / U 6 Dollars
with payments to be made as follows: 5-0 �@ 0 S t 7O C/✓ C Q('j
Any alteration or deviation from above specifications involving extra costs will Respectfully submitted:
be executed only upon written order,and will become an extra charge over and
above the estimate. All agreements contingent upon strikes,accidents,or delays -
beyond our control.
Note—this proposal may be withdrawn by us if not accepted within days.
'" ACCEPTANCE OF PROPOSAL
The above prices, specifications and conditions are satisfactory and are
hereby accepted. You are authorized to do the work as specified. Payments Signature
will be made as outlined above.
Date of Acceptance: A) Signature
A-NC3819/T-3850
'•' it
1
litRCachusetts- Depatiment o{•Public Satet}
Board of Building Regulations and Standard
Construction Supervisor License
ilicense: CS 28267 ;._
Restricted to: 00
'DONALD G STONGE = r e~r
6 MOULTON RD -
-. �1
WINDHAM, NH.03087
3____
Expiration: 11/3!201.1
('anmai�siuncr Tr#: 11987
.✓fie �oo�v�rzorewea a�✓�aoaael�udeCCb
j Office of Consumer Affairs&Business Regulation
j HOME IMPROVEMENT CONTRACTOR
Registration: 1,170219 Type:
Expiration: 9/28/2013 Individual
DO LD G.ST.ONGE
DONALD ST.ONGE
6 MOULTON RD
WINDHAM, NH 03087
�` Undersecretary
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information a Please Print Lelzibly
Name (Business/Organization/Individual): r d ��^(� n13
�•t�
Address: %� c /
h�a t�(f d,�, h- t,�'{�� h ,cit $ �/il
City/State/Zip:C [M AA/4.cfe, //�I o`3 Z 7-�Phone#:Ld 3-91 C?, 3 7G 6 _ 2-7 9 - -7-71-
Are
7-71^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. ❑New construction
mployees(full and/or part-time).* have hired the sub-contractors
2. P1 I am a sole proprietor or partner- listed on the attached sheet. # 7• ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers' comp.insurance. 9. ❑Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions
myself [No workers' comp. c. 152, §1(4),and we have no 12.0 Roof repairs
insurance required.]t employees. [No workers'
comp.insurance required.] 13.0 Other
*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 are 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 showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.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 required under Section 25A of MGL c. 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 may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and Kialliesrjury that the information provided above is true and correct.
Si natur --- Date: �Phone#: �` lI1 �l4��� 6 l q— 3-7
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
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#•