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HomeMy WebLinkAboutBuilding Permit #842-14 - 40 MARBLEHEAD STREET 5/20/2014t BUILDING PERMIT. �? a��,,. •d °L TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINA ON Permit NO:�Date Received Arap Date Issued: 9SSACHus�� IMPORTANT: Applicant must complete all items on this pane LOCATION 39/!Jp MARBLEHEA0 ,SDRC ,alb. AtJ=1M,A, dla/t{ 5 Print PROPERTY OWNER M&U 10 TZ . WE aST C Print MAP NO: PARCEL.. 4Q ZONING DISTRICT: 1 , _-Historic District yes Machine Shop Village ves &Z TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family 1)(Addition ;(Two or more family ❑ Industrial Alteration No. of units: 2 ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well n Floodplain 0 Wetlands D Watershed District ❑ Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: Address CONTRACTOR Name: - Phone: Address: Supervisor's Construction License; Exp. Date: Home Improvement License: Exp. mate: ARCH ITECT/ENGINEER =KOtVbgy%k oesIOIAPhone: °'`� •�l�{ (D� Address: 21 Wl OCz.AE 4A • N MA_Reg. No. ALO 44 +! FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ _ 49 0 1 o0o -e ID 0 FEE: $ 6 I Check No.: 42 44 Receipt No.: IYOTE: Persons con rac 'ng it unregistered contractors do not have access to the guaranty fund f r TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION. Date Received Permit NO: TYPE OF IMPROVEMENT, PROPOSED USE Non- Residential Residential ❑ New Building ❑ One family ❑ Two or more family ❑ Industrial ❑Addition No. of units: ❑Commercial ❑ Alteration ❑ Repair, replacement El Assessory Bldg ❑Others: ❑ Demolition - [I Other 1 � loodplain ❑Wetland's Watershed [ p Septic D Well, a ❑ Water/Sewer _. OF WORK TO BE PERFORMED: DESCRIPTION Identification Please Type or Print Clearly) Phone: OWNER: Name: Address: Home lmproyement License; ARCHITECT/ENGINEER Phone: Reg. No. I Address: 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 contracting with unregistered contractors do not have access to the guaranty fun Signature�offAgent/Ownerr.:. Plans Submitted Li Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ e Building Department The fol owing is'a list ofitho required,forms to be filled outfor:the appropriate. permit to .be obtained. Roofivg, Siding, Interior Rehabilitation Permits o Building Permit Application o Workers Comp Affidavit Li Photo Copy Of H.I.C. And/or- C. S. L Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work o 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 L3 Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses L3 Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o 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 apo,• al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Bui?ding Permit Revised 2012 - Plans Submitted ❑ Plans -Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ :TYE,1_O){;SEWERAGE:DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ .. Swimming Pools ❑ Well ❑ ..Tobacco Sales ❑ Food Packaging/Sales ❑ - Private (septic tank, 'etc._ - Permanent Dimpster on Site El .-THE...FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM -DATE REJECTED.- DATE:APPROVED `PLANNING&.DEVELOPMENT` ❑ ❑ COMMENTS CONSERVATION Reviewed on COMMENTS HEALTH Reviewed on Signature COMMENTS 0 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 Tow;_, Engineer: Signature: uocatea oo4 us ooa Street :,FIRE -DEPA*Rf INT .:,=: Temp Dumpster on site:. yes no Located at:,124,Mair Street -_ .- Fire Departme►it signature/date COMMENTS `:`_ -Dim-ensio Number of Stories: Total square feet of floor area, based on Exterior dimensions. _Total land area; sq. ft.: EL- ECTRICAL: Movement of. Meter l.o:catiOn-,'w=est-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 i Doc.Building Permit Revised 2010 HIM Location 3? A/0 r Date �;2 No. 'rlq -/ �, C h e c k # zn� 27596 TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee TOTAL Building Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 80,000.00) m $ - $ 960.00 Plumbing Fee $ 120.00 Gas Fee 100 comm. I $ 11©;01,0;0) Electrical Fee $ 120.00 Total fees collected $ 1,300.00 38-40 Marblehead Street 842-14 on 5/19/2014 Adding 2 Car Garage with Room Above ov%v x O <CDN a D (D o CD 0 CD n X71 rt rt n a ;u C o o r- o. 0 m -h =r y <D 0' CO) p N m CD 2 �• O �. o_ o --i to G .t CD oo C-' \\•v✓/ Z C S• CD -0 �D C z '� FM cc o Cn CD O y C cnto h D CO) a . CD a1 z X = 0CLO CL Cr 2) ;Z. °° ni Z = �D — Q)� O CDo O z _ (n:d ca CD Z � Z 2) =vU) D-� � \.1i ♦y �V Vi CD .�. v CD C •� Z C <D Cn� O CDz y CD O < 0 0 CD C) O VI � W T ZI T V1 Z7 T ;T7 T n :m T V) T O ( fD (D fD - C O I �+ m D m z j 1. O m S D A O M �' O O 00 S m m A tzi� m O z 3' O C 00 S C tzi+ m O � 3 RLS 3 O 000 S 0 7 CL O O W C Z to m n �o 'a n N 3 O O- \ f1 S W O 0 S mD 2 4 0 c fD01 PROPOSED ADDITION - SCHEDULE OF ELEVATIONS: GARAGE FLOOR: 98.63' BALDWIN ROOF RIDGE: 122.42' ADDITION HEIGHT. 23.79' TAX MAP 8 LOT 5 0� N/F MOUNTAIN REALTY TRUST C;'�1 Zai PROP. 2 CAR �� 98x54 GARAGE W/ 5 ROOM ABOVE 286 Ex. Grade (Typ) ZONING INFORMATION- ZONING DISTRICT. R4 UBLI —40' WIDE) S16°15 03"E 64.34' N 73`06'28"E 18.97' 036" 030" Ex. Driveway 32.9' 26.0 o (6 0) N `*4 99x53 33.0 2.5' 4.4' 8.0' 90.8' o co I a Co`* Ex. Conc. Walkway BH >, I LOT AREA= NI i 20,259 S.F. cv I X37„W N L X,WL,- �o �I N28°�4 , U2n-2'. 66.92' Ex. Garage #36 MARBLEHEAD ST. TAX MAP 8 LOT 10 REQUIRED PROVIDED STREET w � cn 00 o � o Qoo 90.8 FT (P) f - o C,4I X7.3' Jaow M z ZEx. Deck � ox a � ~ 20.3' - ZONING INFORMATION- ZONING DISTRICT. R4 UBLI —40' WIDE) S16°15 03"E 64.34' N 73`06'28"E 18.97' 036" 030" Ex. Driveway 32.9' 26.0 o (6 0) N `*4 99x53 33.0 2.5' 4.4' 8.0' 90.8' o co I a Co`* Ex. Conc. Walkway BH >, I LOT AREA= NI i 20,259 S.F. cv I X37„W N L X,WL,- �o �I N28°�4 , U2n-2'. 66.92' Ex. Garage #36 MARBLEHEAD ST. TAX MAP 8 LOT 10 REQUIRED PROVIDED STREET ::1N P) -,j V�1 Ln #42—#44 MARBLEHEAD ST. p TAX MAP 8 LOT 11 MAX. HEIGHT Cn 23.79 FT (P) MIN. SIDE SETBACK (L) 15 FT 90.8 FT (P) MIN. SIDE SETBACK (R) C,4I 15.5 FT (P) o 30 FT 15.5 FT (E) � {' o cn V D 0 x) Z y D 00 m Z r- 2 0 p M �a N N ::1N P) -,j V�1 Ln #42—#44 MARBLEHEAD ST. p TAX MAP 8 LOT 11 MAX. HEIGHT 35 FEET 23.79 FT (P) MIN. SIDE SETBACK (L) 15 FT 90.8 FT (P) MIN. SIDE SETBACK (R) 15 FT 15.5 FT (P) MIN. REAR SETBACK 30 FT 15.5 FT (E) N/F HARGREAVES RECORD OWNER. ASSESSOR MAP 8, LOT 40 DA V/ID R. WEBSTER 38 MARBLEHEAD STREET NORTH ANDOVER, MA 01845 DEED REF. BK 11890 PG.- 272 (E)=EXISTING PLAN REFERENCE. (P)=PROPOSED PLAN NO. 13854 I CERTIFY THAT THE STRUCTURES SHOWN WERE LOCATED PLOT PLAN OF LAND BY AN INSTRUMENT SURVEY AND EXIST ON THE GROUND AS SHOWN. J8-40 MARBLEHEAD STREET A'/7 - -LA- %A NORTH ANDOVER, MASS saxoWTA201 ”; JOHN D. SULLIVAN III, P.E. 22 MOUNT VERNON ROAD BOXFORD, MA 01921 (978) 352-7871 SCALE: 1"=40' DATE: 4/24/14 Gerald A. Brown Inspector of Buildings Please print TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 North Andover, Massachusetts 01845 HOMEOWNER LICENSE EXEMPTION DATE: May 19, 2014 Telephone (978) 688-9545 Fax (978)688-9542 JOB LOCATION: 38/40 Marblehead Street Map 8/Lot 40 Number Street Address Map/Lot HOMEOWNER David R. Webster (978) 681-6528 (978) 239-3449 Name Home Phone Work Phone PRESENT MAILING ADDRESS 707 Waverly Road North Andover MA 01845 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 requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 The Commonwealth of Massachusetts DepaYtment o, f lzidustrigl Accidents Office offnvestigations 600 Washington. Street Boston, MA 02111 -www.mass.govIdla Workers' Compensation Yusurance Affidavit: Buikie>r°sfContractors/Electr icianslPlumbexs Applicant Information n Please Print Legibly Name (Businessiorganization!individual): Address: 3490 - `40 V0 -CA V.b le 1 � 9 5 t e, 4— Gi ey'r- CiV/State/Zip: Nflv f K 4v ciy e i- M4 Phone #: q-7 8' 5 s3 x4 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 f employees (full and/orpart-time)* 2. El am a sole proprietor or partner- have liked the sub -contractors listed on the attached sheet 7• E] Remodeling ship and'haveno.employees working forme in any capacity. These sub -contractors have workers' comp. insurance. 8. E] Demolition �, Building addition [No workers' comp. insurance 5. ❑ We are a corporation and 10.❑ Electrical repairs or additions required.] 3. 1 am a homeowner doing all work officers have exercised.their right of exemption per MGL IL[] Plumbing repairs or additions myself. [No workers' comp. c.152, §1(4), and we have no 12.Q Roofrepairs insurancere ed �'. � employees. [No workers' 13.❑ other comp. insurance required.] 'Any applicant that checks box#Y must also fill put the section below showingtheir workers' compensationpolicy information. Homeowners who submit this affidavit indicatingthey 2•re doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that checkthis 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 worykers' compensation insurance for my employees Below is the policy and joh site information. Insurance Company Policy # or Setif ins. Lic. #: Expiration Date:. Job Site Address: City/State/zip: Attach a copy o#the workers' compensation -policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required.under Section 25A of MOL o. 152 can lead to the imposition of criminal penalties of a fine up to $1,50 0.00 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 ofthe DIA- for insurance coverage verification. X do /aeyebyera t a lie ick ins andpe,alties afperjury that the information provided above is true and correct. e � n�+o ICI IA^e ..,,l Phone #: Official use only. Do not write in this area, to he completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building (Department 3. CitylTown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person; Phone #: Information and Instruction s 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 ofbire, express orimplied, 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 oxtrdstee 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 ofthe dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house ox on the grounds or building appurtenant thereto shall not because of such employment be deemed to bean 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 of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented tot the contracting authority." Applicants Please fill out the workers' compensailon affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phonenumber(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. If au LLC or LLP does have employees, a policy is required. Be advised thatthisaffidavit maybe submitted tothe Departuientof 1'ndustrial 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 andprinted 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 fdl 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 "rob 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 b e 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 crliermit 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 Co onweaffli ofM_:assacThu.,atq Avaftent offadmWal Accident Office of1Rvesfigatx0ns• 60 Washlugm BoAon,MA02111 TQL # 61.7-7-27,4.900 ext 406 or 1•-877-MA.SSAFF, Revised 5-26-05 Fax # 617-727-7749 Www.M,1agov1c.ha. TOWN OF NORTH ANDOVER AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142 A requires that the "reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units... or to structures which are adjacent to such residence or building" be done by registered contractors, with certain exception, along with other requirements. Type of Work: Renovation and Addition Address of Work 38/40 Marblehaed Street Owner Name: David R. Webster Date of Permit Application I hereby certify that: May 19, 2014 Est. Cost $150,000 Registration is not required for the following reason(s): For office Use Only Work excluded by law Permit No. Job under $1,000 Date Building not owner -occupied x Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FIND UNER MGL c. 142A. Signed under penalties of perjury: hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: May 9 ,2014 Date Owner Name T The Cb. onwealth of Mass.achusefts Departmeht of Fere Services Office of the State Fire Varsha•l P. 0. Sox 1075 State Road, Stavi, NU, 01775 PERMIT ,f7Yz Date: f North Andover Termit No Dig SafeNumher ( City of Town) (if Applicable.) In accordance with the provisions of M`GLI 4 g Chap•ter_J ()_ as provided in section- S 7 7 G MR 34 Start Date � /f 'This Permit is granted to: Full name of person, Firm'or Corporation Pennissionto locate dumpster for construction/renovation/demolition of building. Comments:' dumpster must be. 25 ` from structure if unable to place with required Reslrictioos:clearance dumps -ter must be covered with plywood or tarp end of 'work -day at 15%.4 Give location by street and no., or descnb i such manner as to provied adequate identification of lbcatioa ) FeePaid$ 50.00 Fire_ Chief This Permit will expire- i / ( S ignature of tcaa-rgrantmg permit g permit ( Title )