HomeMy WebLinkAboutBuilding Permit #218-16 - 407 WOOD LANE 5/1/2018 � ) P �' ,. r ,, NORT►1
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: ( 40 Date Received
Date Issued:
�9ssac►+us�t�y
IMPORTANT:Applicant must complete all items on this page
LOCATION YQ7 l(b Za .4 P
Prin
PROPERTY OWNER
Print
MAP N(&PARCEL ZONING DISTRICT: Historic District yes no
Machine Shop Village yes o
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building )(One family
NAddition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑Other
❑ Septic ❑Well 0 Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer
30XN
A no ope–
W
Identification Please Type or Print Clearly)
OWNER: Name: Phone: I 6Q3 h9l MY
Address:
CONTRACTOR Name: Phone: C -,
Address: 12)
1 r - CAS ie �S c_ 6 L&A O/ ? <
Supervisor's Construction License: Exp. Date:
C- M-3 06 <
Home Improvement License: Exp. Date:
Ll b#T L
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BOLDING P .�0 �. OF THE TOTAL ESTIMATED COST Mep ON$125.00 PER S.F. "
Total Project Co FEE: $
Check No.: Receipt No.:
NOTE: Pers s contracting with unregist co tractors do not have t t fund
Signature of Agent/Owner—U f y gnature of 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 ❑ ❑
COMENTS
CONSERVATION El E 1 0 ALP)/ �.dA
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH ❑ ❑
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
Located at 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS
i
W.
r .
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)
❑ 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
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)
* Building Permit Application
Certified Proposed Plot Plan
Photo of H.I.C. And C.S.L. Licenses
Workers Comp Affidavit
;ae 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
9:
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Location l7
r^
No. Dat
s
• TOWN OF NORTH ANDOVER
w •
Certificate of Occupancy $
Building/Frame Permit Fee $�
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ f
Check# \
�i ilding Inspector
NORTH
own of EAndover
No.
h ver, Mass,LAKS
O
coc Nlc KtwlcK y1•
p�RATE0
S U
BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
THIS CERTIFIES THAT U.t.Y%.4... ..............M...... . BUILDING INSPECTOR
w Foundation
has permission to erect .......................... buildings on ...404... 0-
�/
".
� # Rough
to be occupied as .....Wit....x. ........ ......&rwio.n............................................................ Chimney
provided that the person accepting 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
I UNLESS CONSTRUCTIT S Rough
Service
................. .. ... .............. .. ............................ Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Buildinz 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 Approvedby the Building Inspector. Burner
Street No.
Smoke Det.
2015-08-19 08:16 Install Sales # 2382 603 681 4226 >> P 1/1
CONTRACT# 00034 221
MASSACHUSETTS SERVICES SOLUTIONS INSTALLED SALES CONTRACT
LOW[' AUTHORIZZED REPRESENTATIVE NUMBER } CUSTOMER .f�
/f es. & ('/, f!a/e-1 L."/-,/ (,'C, T //""? ,- >i-1
STORE NO.' STREET ADDRESS STREET ADDRESS
r f
CnY STATE/ ZIP/ STATE /ZIP
TELEPHONE _ TELEPHONE
DATE / LOWES' HOME CENTERS.LLC'S PAA HIC NO.:948668 ,CARD �c cHREG
�e FEIN:56-0748358
This is only a quote for the merdwdree and services printed below. This becomes an agreement upon payment Upon payment,the entire agreement,Including the specifically completed pages of this
document,the Terms and Conditions included with this documem and any other addenda and attachments hereto,shaft be referred to herein as this"Contract."
PLEASE READ ALL TERMS AND CONDITIONS ON THE REVERSE SIDE OF THIS PAGE AND FOLLOWING PAGES BEFORE SIGNING. '
INSTALLATION STREET ADD} CITY STATE ZIP
<:,r. �,v / � r`' � 1s- f c/ .r/1 f F�� � / ,� /l/G c`. t'� li,-�-f f,..'1 •-�-
PHOTO RELEASE:Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photographs of the Premises where
Installation Services Will be performed and all work performed at the Premises related to this Contract,and irrevocably grants to Lowe's all right,title and
interest in and to the photographs for use in all markets and media,worldwide,In perpetuity_Customer authorizes Lowe's to copyright,use and publish the
photographs in print and/or electronically,and agrees that Lowe's may use such photographs for any lawful purpose,including,but not limited to,marketing,.
advertising,publicity,illustration,training and Web content. By initialing here,Customer agrees to the foregoing. [Customer to initial to the left].
Contract Total cli
Are permits required for this installation?: [ ]Yes [ ] No *applicable tax included 06)Q
NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamplet Renovate Right By signing this Contract, Customer
acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure
from renovation activity to be performed in Customer's dwelling unit.
NOTE: If rotted wood Is discovered during installation additional charges will apply.You will be given a quote and a change order
must be completed and signed by the customer for any additional charges. Customer must initial.
'Any work or material not specified is not included in this contract Any changes or additions will be at an additional charge for the material and labor.
WAIVER OF LIEN and ONE YEAR WARRANTY(TO BE SIGNED BY INSTALLER)
1,the undersigned Installerflndependent Contractor,having been employed by the Customer who signed the Certificate of Completion below do hereby certify that the work for this project
will be or has been completed in a workmanlike manner and to the Customers satisfaction.In consideration of the receipt of one dollar and other good and valuable consideration,and to the
extent permitted by applicable law,I hereby waive and relinquish all liens and all rights and claims of liens which 1,the undersigned,now have or may hereafter have for labor or materials
furnished,and further certify that all work performed and materials furnished,if any,by any other party or parties upon the order of the undersigned,have been fully paid for.Further,I the
undersigned,agreg to cause the prompt release of arty mechanic's lien(s)which may be filed against the Customers.premises by,any subcontractor,laborer,mechanic or material supplier
claiming the right to-file such.a lien through work related to the Customers Contract with Lowe's.In addition to arty wartanties provided by law or specified elsewhere,including the Customers
Contract with Lowes,the undersigned,further warrants that all work furnished for this project shall be free from defects either in material or workmanship.If any detects in material or
workmanship shall be discovered in the work furnished or material used during the course of the work or within one year from the date of the Certificate of Completion,the undersigned agrees
to replace or correct such defective work or material,free from all expense to Lowe's and the Customer in a manner satisfactory to the Customer.
I further represent that I have given Customer the option of retaining some or all of the surplus materials or having some or all of such surplus materials removed from the Customers
premises.
If applicable to the performance of the work required for this project,I,the undersigned Installer/independent Contractor,do hereby certify that I have complied with all requirements of the
Lead Renovation,Repair,and Painting Program Rule("LRRPP Rule),40 C.F.R.sec.745.80 et seq.,or any applicable state laws or program regulating lead-based paint safe work practices,
including compliance with all information distribution,notice requirements and work practice standards in performing the work required for this projecL I certify that I have provided the
Customer with all documentation required to be supplied under the LRRPP Rule or state program,shall retain all records required by law,and have attached to this document copies of all of
the records required to be retained by the LRRPP Rule or applicable state program.
Signed and delivered this day of
(seal)
Installer Print Name
CERTIFICATE OF COMPLETION
1.1,the Customer,certify that the InstaUerslindependent Contractors or their sub-contractors,have fumished all Goods and/or services,that installation,repairs and alterations or improvements
("the installation services)have been completed as set forth in mylour contract with Lowe's,and that I have been offered the opportunity to request that Lowe's allow me to retain some or all of
any unused,receipted surplus materials rather than have such surplus materials remain the property of Lowe's.
2.Buyers initials(Buyer INITIAL ONE only)
There were no such surplus materials.
accepted all surplus materials I wanted.
I declined to receive any surplus materials.
Date:
Owners Signature Owners Printed Name
i
REFERENCES: PROPOSED ADDITION
DEED BOOK 840 PAGE 110 _
PLAN NO. 507
N f F F-I TZGERA L D LOCATION: 407 WOOD LANE
9?
80. NORTH ANDOVER ,MA.
Cq/C DATE: SEPTEMBER 11, 2014
9s,
OFFQ, SCALE: 1"=20'
ZONING DISTRICT: R 4
`V \ MINIMUM SETBACKS:
O
^h �
ah ��• FRONT YARD = 30'
SIDE YARD = 15'
'� ^^ REAR YARD =30'
1 CERTIFY THAT THE DWELLING IS LOCATED ON THE
Cl) p Q' GROUND AS SHOWN, AND THAT THIS PLAN IS THE
ryh RESULT OF AN INSTUMENT SURVEY.
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38 5 N F KRES
N�NorAll �agss
�vd ` 4500• STEPHEN y0
O P.
DESROCHE coU No.27699
O -799' \ 40" /
QPROFESSIO L LAND SURVEYOR
->96-
A�RC' DATE:
10,
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PREPARED BY
L 0 TS (.36-38)
� AREA=18,05 7 s.F. ENGINEERING & SURVEYING
SER VICES
70 BAILEY COURT
t 155.60' DEED
155.60' CALL. HAVERHILL, MASSACHUSETTS 01832
TELEPHONE: (978)-556-0284
GRAPHIC SCALE W O R D L A N E IN CONJUNCTION WITH
0 20 40
NEPONSET VALLEY SURVEY
( IN FEET)
1 inch - 20 ft.
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-o: Attn:Gerry Page 2 of 4 2015-08-12 20:54:12(GMT) From: Jennifer Gra,
6k 14176 8g319 #6050
03-31-2015 1 10:54a
OUITCUUM DEEti
Sandra Haft Inc.. a Massachusetts corporation, of North Andover, Essex County,
Massachusetts
its ti+:sbawia Roderick and Vanessa K McGratty,as joint tenants whin rights of
survivorship,of 407 Wood Lane,North Andover,Essex County,Massachusetts 01845
with guitdaint ctibenanto
The land in North Andover in said Fssex County, with the buildings thereon,
situated shown as sots Numbered 36,37 and 38 on a plan of land entitled"Plan of
Green Hill. f ,, od E.'.l �. e ,.1 ._At dov ,.Massachusetts, John
o Franklin, CE.,mid pOw being recorded ,Dirstt ct Essex Registry of
Deeds as l'Iga. act Nturt :507.; i ... xts. ko.. r are bounded and
describedas.wbo
. WT :Y by`Woodliq' ft*� QW: hw€tel. fifty five and Altos,
NORTHERLY : ,.. . fveyand.:
48.1409(17$4e)'feet;
EA.SMRLY by Lb435 iwshovvnm sai E:plan„ i y h 9a}.fait;
SQUTHERLYby WW.of 0vrnets=known,.fi r five and 251100s
EASTERLY by said land of owners ttnhown,forty five(45) feet;avid
Son
H&SSACH0SS7TS sin ME EXCISE TAX
Easex North Registry
Acte: 03-31-203,5 @ 10:54am
Ct19. 137 Doc#: 6950 Page I oft
Iee: $1,653.00 Cans: $362,500.00
o: Attn: Gerry Page 3 of 4 2015-08-12 20:54:12(GMT) From: Jennifer Gra,
E� 141* 76 Pq320 #6956
SOUMRLYby said loh i d of owners unknown, sixty and 5110s (50.5)
feet.
Said premises contains '17,979 square feet, more or less, acid all
measurements are as shown on said plan.
This coriveyanoe is made subjectto restrictions of record insofar as the me are
now in force and applicable.
For title,see Deed recorded at the Essex North Registry of Deeds at Book 13937,Page 251.
This conveyance is in the ordinaiy.COUM of business and does not constitute a sale of all or
substantially all of the assets ofSaidra IWIZ,%C.in M4vxhuseft
Witriess the exec Aon and the co�omte seal of said corporation dis&-) day of March,
2015.
Sandra lHaft,Inc,
By
J;4
toldra F* A&
Presi&w and:
COMMONWiALTH OV MASSACIRUSEM
)5"K 4SS
2015, Wore =6 tho
Undemigned notary put-dic,penOWIy hdra 4.11142;-PmWent Treasurer,
et Ssmidrtk #'#Oi 1U.0a ptOv.Od .fO'IAC:Aw*. swdfracpry evid-e a. 0��W4a�
Whk-h iWe.W.Dtivoes.Uomr.A.3 Stato.-Ww 0 Iasspom.0.Oihtr 166W
Wf E)1 Odw, to be..lbs PawAnwhose Wame.is Iilei
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bhWher v=uW.to t*hiaqw We'201 and deW in-WAN oltswd.*a
:aW fije.act
and deed
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The Comnionwealth of'Massachusetts
Departinent of IndustrialAceidents
''" Office of Investigations
'
1 Congress Street, Suite 100
V Boston, MA 02114-2017
w►viv.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbel•s
Applicant Information Please Print Le i�bly
Name (Business/Organization/Individual):. r C � ��✓ �
Address: � rCA)
City/State/Zip: Phone#:
Are you an employer? Che k the appropriate box: Type of project(required):
1.❑ I am a employer with 4. F� I am a general contractor and I
/employees (full and/or part-time).*
have lured the sub-contractors �' ❑New construction
2. am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g, (�Demolition
71working for me in any capacity. employees and have workers'
y. ❑Building addition
[No workers' comp. insurance comp. insurance.'
required.] S. F_� We are a corporation and its 10_❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.Q Roof repairs
insurance required.] ' c. 152, §1(4),and we have no
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.
Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I ane aaneemployertthat is providing workers'
CoiilpeiYSatloiY IiSlraidefor my ePtoyees. Below as the policy andJob site
information.
Insurance Company Name:
Policy#or Self-ins. Lic. #: Expiration Date:
Job Site Address: Ci.ty/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 Iead to the imposition of criminal penalties of a
fine up to S'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 5250.00 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 a ification.
I do hereby certify un aids penalties perjury that the information provided above is true and correct.
Signature: Date: ale J�
Phone
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#:
V9 Massachusetts Depot Ment of Public Safety
'.,lord pf Sbiiding keg 'Iations.an� StandirdsW
- 4-tats•t�tt+�.sicpi fit€p::rti=,>t ,
CS-095306 §a
GER"O CASERTA ri J ,f
5 Bitch Lane _ 7
Topsfield NIA 01183
Exp;ftitlC�
Commissioner
'03/04/2016
C-f�el�rz-�iza>rrueccll�cC/lc��rc�uve/f
Office of CcnsumerAffairs&Busincss.Reguiatio-u. 1
r�
40ME IMPROVEMENT CONTRACT
registratiOR
on: 961645
xpiration: 1/ Type-
92/2016 Individual
GERARDO CASERTA :
GERARDO CASERTA
5 BIRCH LANE
TOPSFIELD,MA 01983
—�
Undersecretary
w
License or registration valid for individul use only
before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
10 Park Plaza-Suite 5170
Boston,MA 02116
Not valid without signature
s