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HomeMy WebLinkAboutBuilding Permit #477-2017 - 41 SUMMER STREET 11/4/2016eale q11a0J5 BUILDING PERMIT I/ TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received mat Permit No#: - 9 01 m _ — Date Issued: 4 - 9�Ol So IMPORTANT: Applicant must complete all items on this !"�A rte\ e r SZ, PR©,PERT QUUNER<�fr.,c e�► Cr�c Ti4±s1e�1 �J► 1,�r� �_ -�- _ e 90© Ye aTF-C y Pnnt�Lugo- ' ��. _ PAREL �= Z®N1NG DIS, �R1CT MAPC�> _H�storic{Dist�ict� yes - — f NoRTN\ o SAT LEU ;6 6 0 i0 h r x•20.9 0RATEo TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building krOne family KAddition ❑ Two or more family 11 Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: K Demolition- Se!'Qen��rd�. ❑ Other, _. Septic ❑ 11Vell# _ ❑ Floodplain OiUVetlands :. "— ❑71Natershed� r astnct= _ - T *rWater/Sewer __ _ _ A__ _. _ DESGKIF I IUN Vr WUMIN IV 6C rcmrvr"w'"I L OWNER: Name: v; - Please Type or Print Clearly I „J ; C ,14:1 Phone: Address: lk\ S v k'.n vvx e C S,c , -Y1006 A v`a o"'Ief one 84, Constructlon� License. _ __ _ Exp D'ate,�o _ ARCHITECT/ENGINEER Phone: r -3V1)3 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.- by FEE: $ (Poo "=..Receipt No.:Check No.: C �n / 3 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund nature of:Agent/Own'er. _ Sigraturewof 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 PLANNING & DEVELOPMENT Reviewed On j 2 Signature— COMMENTS i na g ture_ COMMENTS ON - / CONSERVATION Reviewed on 11 ' a� (l, Signature (� COMMENTS HEALTH u COMMENTS i�s (N -t- C -x— - ) - Reviewed o nature 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 Town Engineer: Signature: {Located at110-24�11%Iain�S.tr_eet�, w ?Eire Dep„ar=t1`m.ents gnature/.date_ ��COMMEN, f IS � Dimension Number of Stories Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. 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 NU I t5 and DATA — (For department use) ❑ Notified for pickup Call Email f z Date Time Contact Name Doe.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 t TOO W > 0 z cr 0 Z LL 0 64- V3. z fq U - TOO a) 64- V3. (a fq U - TOO a) U - C: a) ca a) cj 0 ff 31B 0 CD (1) LL m E CL co 0 (5 c . 1. LL o —Q) C', cv a- 0 co, -j i5W = :3 r— TOO Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ '''50,000.00 m $ - $ 600.00 Plumbing Fee $ 75.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 75.00 Total fees collected $ 850.00 41 Summer Street 477-2017 on 11/4/2017 Take down porch and build new J JO 2CL LL O Q 0�0 Y \ O LL T n U O_ V) u Z Z Q J m C O m "OL 7 LL W v C E U to LL W CA ? Z m C JG d L D @ cc 0 aO of ? V U W J W ,L � at U i V1 t9 LL w F- u d Z y Q ..0 O OC LL W a W 0 W L LL E m O Z �..� v V7 N O u O V1 ■ e� O m '�s +- .Q i EL O E * K o cn V r S�E n L � d. /y Y= O Y. al, jv W �. • ' .0 t _ V IF: E Z r O �: L C r N �0Pa Qy - W. o d v► /y tN Cicn L O• * * V 3 .r 0 - ` N Cc J m a � t ..: �. �3�M°'N o� > o E o c Q c a cn 0 a� `�' 0 O CD pn cmm > c _ l-a0�_ CL CD m L ' 0 "'' c L 0 ' v O O c a O to -W cc W.v m d co :E W 0 'a O O .e.- U -d N C O N O - v v O W L U (D V 0� m N Q U)H .a o "' O Z H t = o U > HE 2 Z mm co O Z ui LU U) az w� � U CO W m Z 0 W :a C9 0 J m ti Ai Z gq r S E O o Z C QD (DO .E m m d � cc .0 O �m �0 0 o CL a CL C Q Off,,, V J � �CL O = Z 0 CL V � CL U) Donald Belanger Inspector of Buildings Please print DATE: / 0 / fa 1 /(. TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street, Building 20, Suite 2035 North Andover, Massachusetts 01845 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Telephone (978) 688-9545 Fax (978) 688-9542 JOB LOCATION: L41 5 U M M S T `n o l Ay,vgf (e S 1 b ri- Number Street Address Map/Lot HOMEOWNER Siw.(.,k\ —31.3 Name Home Phone Work Phone PRESENT MAILING ADDRESS `jI Sv w. K City Town State Zip Code The current exemption for "homeowners" was extended to include owner occupied dwellings of one or two family dwellings and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. 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 dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. (780 CMR Section 110.R5.1.2) The undersigned "homeowner" assumes responsibility for compliance with 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. _41*� HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 8.2015 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 •The Commonwealth of Massachusetts Department of IndustrialAccidents Congress Street, Suite 100 Boston, MA. 02114-2017 X7.1, SV. yt www mass.gov/dia Workers' Compensation Insurance Affidavit: Buildexs/Contractors/Eleciricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. -Please Print Le 'bl A ' licant Information 1 Name (Basess/���ndividual): it t Cir•`, :' Address: City/State/Zip: -no r a `t L� Phone #: z= •' Are you an employer? Cfieck the appropriate box: Type of: project ()vequired); em to ees full and/or part time). 7. [( Nevi contraction 1.❑ I am a employer with P y 2.❑ I am a sole proprietor or partnership and have no employees Working for me in 8. Remodeling any capacity. [No workers' comp. insurance required.] 9, ❑ Demolition 3,Wam a homeowner doing all work myself [No workers' comp. insurance required.] t 10& -Build ng addition 4.0 I am a homeowner and will be, hiring contractors to conduct all work on my property. I will I1.❑Electricalrepays or additions ensure that all contractors either have workers' compensation insurance or are sole 'in repairs or additions proprietors with no employees. 12_[] Plumb, g p 5. ❑I am a general contractor and I have hired the sub -contractors listed on the attached sheet. 13'. Q Rb6f repairs These sub -contractors have employees and have workers' comp. insurance # 14.0 Other 6. ❑ We are a corporation and its, officers have exercised their right of exemption per MGL c. 152, § 1(4), and We have no employees. [No workers' 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 attache additional sheet showing the name of the sub -contractors and state whether or not (hose entities have employees. if the sub-conixactors have employees, they must provide their workers' comp. policy number. I compensation insurance for my employees. -Below is file policy and job site X am an employer that is providingworkers information. Insurance Company Policy # or Self -ins. Lic. #:, Expiration Date City/State/Zip: fob Site Address: sation policy declaration page (showing the policy number and expiration date). Attach a copy of the workers' compen Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a Jule 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do Hereby certify and r tliepains and Zties of perjury that the information provided above is/true and correct. 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 Phone Contact Information and Instructions 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 of hire, express or implied, 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'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 ofthe dwelling house of another who 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 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 to the contracting authority." .Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub'contractors) name(s), address(es) and phone number(s) along with their certificates) 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 an LLC or LLP does have employees, a policy is required. Jae advised that this affidavit may be submitted to the Department of Industrial 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 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 "fob 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. A new 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 (i.e. a dog license or permit to burn 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 Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MA.SSAFE Fax # 61.7-727-7749 Revised 02-23-15 wwwmass.gov/dia Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan Rr Stamped Plans ❑ TYPE OF SEWBRGE 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 & DEVELOP E ° . MENT Reviewed On � � Z Signature_ COMMENTS 1� CONSERVATION Reviewed on II a j l / Signature COMMENTS HEALTH COMMENTS Reviewed on Signature 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 Town Engineer: Signature: FIRE DEPAR�MENT� "Located 384 Located at124� " dMiStets - — — �;� Main Street ;aye Osgood Street �Ftre ,FWment slgnatu ` ate�J, ire/d �OMIVIENTS�_.� j . 1I CERTIFIED PLOT PLAN PREPARED FOR. VINCENT & KATHLEEN S1 W/CKI AT 41 SUMMER STREET NORTH ANDOVER, MA. NORTH ESSEX REGISTRY OF DEEDS. • BK. 9111 PG. 78 ASSESSOR'S MAP. 65, L 0 T 62 . ZONING. R2 SCALE. 1"40' DATE.- SEPTEMBER 26, 2016 NOTE.• EXIS77NG BUILDING DIMENSIONS TAKEN TO CORNERBOARD. PREPARED BY JOHN ABAGLY & ASSOCIATES, PROFESSIONAL LAND SURVEYORS 9 BAR7LETT STREET, NO. 252, ANDOVER, MA. (978)-688-4899 JOB NO. 6291 CERTIFIED PLO T PLAN PREPARED FOR. VINCENT & KATHLEEN S/WICKI AT 41 SUMMER STREET NORTH ANDOVER, MA. NORTH ESSEX REGIS77?Y OF DEEDS. • BK. 9111 PG. 78 ASSESSOR'S MAP. 65, LOT 62 ZONING. R2 SCALE.-1 `=40' DA 7E. SEPTEMBER 26, 2016 NOTE.• EXIS77NG BUILDING DIMENSIONS TAKEN TO CORNERBOARD. �O 1� � o 0 z Z Q J LOT A 44,242 SF. / Poo •� � sz_ PROPOSED 32.0' ADD/770N 33.8' 4-0.1' 'O• 19.5' 's _ ° 73.3' 17.2' �' \ \ m Z \ \ 0 �i OF F, AtjSSgO NO. 35773 F� L LOW PREPARED BY JOHN ABAGIS & ASSOCIATES, PROFESSIONAL LAND SURVEYORS 9 BAR77-ET7' STREET, NO. 252, ANDOVER, MA. 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