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HomeMy WebLinkAboutBuilding Permit #531 - 42 OLYMPIC LANE 3/2/2010Permit NO: S-31 Date Issued: J A //0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received 0—/a IMPORTANT: Applicant must complete all items on this page LOCATION +-Z --7 ' L C"' L P*,�>> Pmt PROPERTY OWNER �tcb� r-�-VtD P-=' I venni MAP NO: 491,013 PARCEL: It19 ZONING DISTRICT: Historic District yes Machine Shoo Villaae ves 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 Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: //V Sr0?-LL 1 AJ Com- /4 ! S 'x 30' ®VOp-L. Pool PE -)z ��-•� .�D s�-r"C P - � OWNER: Name: Jas Address: 42 e Type or Print Clearly) CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement Licen Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. V-387 -&&V,9 FEE SCHEDULE: BULDING PERMIT. $12.00 ER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $„?3_ .FEE: $ S Check No.: 1760 NOTE: Persons contracting with Signature of A Receipt No.: �22 a?p do not have access to the guaranty fund of contractor y s - C Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL ��fj -F Public Sewer Tanning/Massage/Body Art Swimming Pools Gp©L,,W)> 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 COMMENTS HEALTH Reviewed on C I C. °ter COMMENTS ! S .3 0 �� I -- �-�i�. 5z7-�Z� J 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: Locatea 3134 US ooa 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 ❑ Notified for pickup - Date Doc:.Building Permit Revised 2008 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/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 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: Doc.Building Permit Revised 2008 Location No. �.�/ Date D r HORTN TOWN OF NORTH ANDOVER • OOL Certificate of Occupancy $ Building/Frame Permit Fee $ �2 1 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 6 0 .3a BAding Inspector E9 * C� W s. � Oct o a U .oCd Uw U aMD w°' w x o W W a�' cn w O a�' w ;14 q m' V)) o cn O FM4 Jo O z uiW f'- W V LIM, C/3 n' c C3 Q o � HV O y,r C O C.3 C.3 • +:mom m �� Ea 'r O O. Cc C.) $ \: t � � QC N _R L m o Z' 3 co m m J C C � m N R E`" m aV L co 0 C= m O :AL2 oco m N C = O O_,,, p o. H C:, COD a w N N C 0 v m m 12 m m 0 m c �C N CD r 0 Z 0 0 T 4 U O 0 CD O Z CD CL C3y 0 cm CA O CD CA 'gCD C2 CD oO CO CL H � CD C O L- Q o a a. cm CO2 C o cc CL o W C.0 Z j CL C-3 vs � C C C CO) 0 : -cc= .y MD 1; C �_ A C .� �E " C C2 m '— m 010 Cp r- N O CL a w N N C 0 v m m 12 m m 0 m c �C N CD r 0 Z 0 0 T 4 U O 0 CD O Z CD CL C3y 0 cm CA O CD CA 'gCD C2 CD oO CO CL H � CD C O L- Q o a a. cm CO2 C o cc CL o W C.0 Z j CL C-3 vs � C C C CO) 0 LM • • I = WFq \ • I & i MIN W!U=WvjwbANIAi.I . I NA Cot /SO IOLYMP,C t AS E5UILT I IBJ NOWH `MDOV-R Fob SG�.LE i"_ 4o' DA -r -F--, MA*Y 2t,tq?q Ft AOI. 4 - GGE�.�►.tQ.S i ASsvc1�.TES S H OF BENJAMIN C. �o OSGOOD, A CIVIL NO. 45891 n 0 LOCUS MAP NOT TO SCALE This is to certify that New England Engineering Services, Inc. has inspected the subsurface sewage disposal system installed at 42 Olympic Lane, North Andover, MA. The system has been constructed within allowable engineering tolerance of 310 CMR 15.00, the approved design plans dated 9/13/05, and local requirements, except as noted herein. INVERT ELEVATIONS DESIGN ACTUAL FOUNDATION EXISTING 96.41 TANK IN 95.75 95.95 TANK OUT 95.50 95.68 D -BOX IN 95.15 95.30 D -BOX OUT 94.98 95.14 A 94.88 95.04 B 94.88 95.02 C 94.88 95.02 D 94.88 95.02 BOTTOM OF BED 94.34 94.40 TOP OF INFILTRATORS A 95.34 95.51 D 95.34 95.51 E 95.34 95.48 H 95.34 95.48 SYSTEM TIES 1 TO TANK 34.5' 2 TO TANK 32.5' 1 TO D -BOX 71.8' 2 TO D -BOX 67.9' 1 TO A 80.0' 1 TO E 96.0' 2 TO A 75.0' 2 TO E * 77.4' 1 TO D 70.2' 1 TO H * 88.3' 2 TO D 65.4' 2 TO H * 68.2' INSPECTION PORTS 1 TO X 91.0' 2 TO X * 74.9' 1 TO Y * 82.7' 2 TO Y * 65.0' *- UNABLE TO FIELD MEASURE FROM DIMENSIONS SCALED FROM AS BUILT. 20' 0 C. DEC 0 1 2005 0' TG*O'UF NORTH AtSt AS -BUILT SEPTIC SYSTEM 42 OLYMPIC LANE NORTH ANDOVER, MA ASSESSORS MAP 106B, PARCEL 110 SITE SCALE: 1"= 20' DATE: NOVEMBER 23, 2005 SALEM ST NEW ENGLAND ENGINEERING SERVICES, INC. 60 BEECHWOOD DRIVE NORTH ANDOVER, MA 01845 (978) 686-1768 DRAW CHECKEDU Pznx ':1081SABN 11-23-05 BY: S.G.B. BY: S.E.P. & B.C.O. Jr. LIMIT OF INSPECTION PORTS (TYP.)� _a3•�5 DISTRIBUTION BOX— \ 4 TP1 N/F KAVANAGH 15 0 GALLON d¢j G S PTIC TANK ( p�o� 35'4c780 0 i to TE G ENCHMARK: TOP OF SILL AT HOUSE CORNER. 0 ELEV. 100.00 (ASSUMED DATUM) I _ z 1 lfl Z C 7 t-+ CJ1 W O CO CD N o W o -41' " 0 � r ✓ \—TP2 PORCH EXISTING ME BEDROOM DWELLING SILL ELEV• 42 OLYMPIC LANE ASSESSORS MAP 106B, PARCEL 110 47,957 S.F. APPROXIMATE LOCATION OF EXISTING PRESSURE WATER SERVICE L=150.00' R=285.00' 0 OLYMPIC LANE N/F WE r )e ' (V S bore- qA u,)/d foo L DATE: BOARD OF HEALTH _ NORTH ANDOVER, MASS. 01845 978-688-9540 APPLICATION FOR SOIL TESTS MAP & PARCEL: Ot- . 61 .= AUG 0 4 2005 I iviL-PWT. LOCATION OF SOILTESTS: FRAE OF DW"-tLU(4- CV OWNER•�Os TEL. NO.: C1 l to 62 - 3V7 4� ADDRESS: 4z- 01-N WI P 1 C-- ENGINEER•tAqwkACV AreEfi8k TEL.NO: x%43- Ccs(- t7Co$ CERTIFIED SOIL EVALUATOR: `,EiQ T }MAN C, 0S&100N 1K i I itoyyt is Intended use of land: Is Ills:X Repair testing Residential Subdivision Undeveloped lot testing In the Lake Cochichewick Watershed? Yes Single Family Home Commercial THE FOLLOWING MUST BE INCLUDED WrM THIS FORM: Upgrade for addition T No x 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of $425.0_0 per lot for new construction. This covers the minimum two deep holes.and two percolation tests required for each disposal area. Fee of $360.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may, perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Pull payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. N.A. Conservation Commission Approval: Date Received: Check Amount: Check Date: i� erow� �ukl i� (k �PM1 �� tii,3C� North Andover MIMAP 42 Olympic Lane February 1, 2010 I 106.50010 ♦ I 106.B-0151/ 106.11-0212 / 106.11-0211 106.50146 I I I I I I 1 1 106.50106 I �• �FftDb�WM61 - Rall Line Interstates Interstate - Major Roads Roads C. Easements - Tralls C3 MVPC Boundary 0 Municipal Boundary O Parcels Hydrographic Features Streams Wetlands Exempt Lands 1" = 171 ft 106.50108 ♦ 106.50110 106.B4109 106.50111 106.50046 106.50142 e ♦ 106.B- A41 106.50143 / 106.50144 106.50022 �ll .. a31ti.. �:: •" �llti. •. "_ •• •_::: alit..:_::. �I tr. •� �'�-'-v�1u.106.50112 106.11-0200 106.50207 106.50206 106.50205 106.50116 106.50113 1 .501 106.50114 106.0140 106:501 14.50139 ♦ 106.50120 X06.50138 Horizontal Datum: MA Stateplane Coordinate System, Datum NAD83, ♦ po*Tli ,,1, 106.&0210 pf •,1110 '�•� O� 106.50209 �U. 106.50208 A definition or regulatory Interpretation. THE TOWN OF NORTH ANDOVER •." ..::_ '- .._._.y •.:: ...... _ •::. . .. �allt..:::::=•� ';`•�.. flu �....::::=_ �tlu:_:..�_::. , ?• 4-:'=: �-• - :.1,.:-�.,::::•"'• ..yl,=: ..... .;:_••.:: ::.._� ....._ t ...•. ..:: :::_:'al; •; �-�..;_•�:::_:..il; • --:::.. : ,.._: .:_'111. •.::_: -1.. •�lka. ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION 021: _;._..:_tt .�........... :.'•.1.af.l.ulu�. a•:4:.c:r_:-..:_...`_..„:?-1J:!-_r:, -:: ' �klu 13.._.1:t.:i._ .-:_f::l.0 .•_::.:._•_:.•.::' :•1:a: `•.. .�a_..l.t�. •.„. _,_, _-- • lu.♦.;.••:- •: :u • •.:::__:: .-.:. ' 106.50148 ..::.: ..... ..... ..... ..._. _. - •• - - 106.50147 '- _.• ..._. 106.50146 I I I I I I 1 1 106.50106 I �• �FftDb�WM61 - Rall Line Interstates Interstate - Major Roads Roads C. Easements - Tralls C3 MVPC Boundary 0 Municipal Boundary O Parcels Hydrographic Features Streams Wetlands Exempt Lands 1" = 171 ft 106.50108 ♦ 106.50110 106.B4109 106.50111 106.50046 106.50142 e ♦ 106.B- A41 106.50143 / 106.50144 106.50022 �ll .. a31ti.. �:: •" �llti. •. "_ •• •_::: alit..:_::. �I tr. •� �'�-'-v�1u.106.50112 106.11-0200 106.50207 106.50206 106.50205 106.50116 106.50113 1 .501 106.50114 106.0140 106:501 14.50139 ♦ 106.50120 X06.50138 Horizontal Datum: MA Stateplane Coordinate System, Datum NAD83, Meters Data Sources: The data for this map was produced by Merrimack po*Tli ,,1, Valley Planning Commission (MVPC) using data provided by the Town of North Andover. Additional data by the pf •,1110 '�•� O� provided Executive Office of Environmental Affairs/MassGIS. The Information depicted on this map Is tea• _ L 110 for planning purposes only. It may not be adequate for legal boundary A definition or regulatory Interpretation. THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING ♦ THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT • ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION 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 Name (Business/Organization/Individual): Jr-:�,Sc�,,� Address: �- �jjt_Y r� L. t is . City/State/Zip: Phone #: 1 `,;70-,30r2- o Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5• ❑ We are a corporation and its required.) officers have exercised their 3. A I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Any applicant that cheers box #1 must also fill out the section beige» showi—­ their w� Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. El Demolition 9. F-1Buildingaddition 10. ❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12-ElRoofrepairs 13.Other— &/ �, —_ b ^s compensation twucy rnrormanon. T 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 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 insuranceS-overage verification. I do hereby certify under thinser�,.�� a information provided above ' &a and correct Si natur . _ Date: / Phone #: Ze — Z9 7-- 4e� �O 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 #: 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 of the 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 be 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-contractor(s) name(s), address(es) and phone number(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 an LLC or LLP does have employees, a policy is required. Be 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 "Job 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 bum 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: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-72.7-7749 www.mass.gov/dia Shop online at NamcoPod.com NO INTEREST UNTIL 201 Cf) w ry U ry cn z cn X III ry LLJn ry n '1� U) W Z I-- / W Ln J O O W c) O S O S . I �fl I i i i i / C, / W Z Q W J > O p- Z O � d Q _ CN N d J = W U O W W N O W dt Z � w w Q � J w O J O > a- U 0 O O z O W d Q Cf)N a_ O d w O p of N O LL. a- Q- Z � cn v U Q m I w Un U n III cn 0 U N w Q J F-- Q W U p u7 w J Q r' w O O J > a U 0 G - p p Z p w a Q N c d a- a- O � 0 w O c p [if N O w U N w Q J F-- Q W U p u7