HomeMy WebLinkAboutBuilding Permit #430-2017 - 43 WEST BRADSTREET ROAD 10/24/2016 rORTij-
+{ �' BUILDING PERMIT
I� TOWN OF NORTH ANDOVER ° o
APPLICATION FOR PLAN EXAMINATION
Per it NO: 17 Date Received to - a-4 • �®ab
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Date Issued: 1a • ®l(0
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IMPORTANT:Applicant must com Tete all items on this page
LOCATION 4 e �M�
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PROPERTY OWNER � ��✓ ��
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MAP NO: PARCEL:Q 0Y--)ZONING DISTRICT: Historic District yes
Machine Shop Village yes (nho)
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
0 New Building ❑ One family
0 Addition 0 Two or more family ❑ Industrial
❑ Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
0 Demolition 0 Other
d Septic ❑ Well 0 Floodplain ❑Wetlands ❑ Watershed District
0 Water/Sewer
1,0,3-b ot 4q 1 -505 —
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Identification Please Type or
Print Clearly) �} ( �(2
OWNER: Name: �J mI�� rQ�y ° Phone: �i 7 19u✓���w�
Address: 11d
CONTRACTOR Name: Phone: q 4Lf'7 -V1
Address: Ac�(a I Main ZLJ&Sb Ak+ o t 91 (o
Supervisor's Construction License: � S S^ j Exp. Date: '
Home Improvement License: u/I i Exp. Date: 26/'
/ `7
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 Project Cost: $ _ FEE: $ q 0
Check No.: .B Receipt No.: .3 f 6 7 �}—
NOTE: Persons contracting with unregistered contractors do not have access to a guaranty fund
ignature of Agent/Owner Signature of contractor 1
BUILDING PERMIT "oRTK
o�gSt.En #6V6
TOWN OF NORTH ANDOVER o A -
APPLICATION FOR.PLAN EXAMINATION
Permit No#: Date Received Esq �A.tTED
SSACHIJS�C
Date Issued:
EVITORTANT:Applicant must complete all items on this page
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PROPE�RIY OWNER a ..
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10D Year Stru
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M. PARCEL: ° � Z®NIN�ST;.RICT� Historic®istnct x' eyes nog-
^' IVlachine:Sho Village es �,no
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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 0 Well ❑ Flood Iain 0 Wetlands D+Watershed Distnet
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DESCRIPTION OF WORK TO BE PERFORMED:
x.
Identification- Please Type or Print Clearly
OWNER: Name: Phone:
Address:
Contractor Name:� ,x �. Phone: y f�
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Address x
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�Fiomealrnprov menttLicense •�. _ r:' .��,�::-�:����.�� Exf :Date f,�.�.�.. � _�_<,•-
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
Total Project Cost: $ FEE: $
Check No.: Receipt No,,-
NOTE:
o,,NOTE: Persons contracting with unregistered contractors do not have.access to the guaranty fund
Signaturef.Ag nt/Ovvner Signature of contractor•=
wa
Plans Subimitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑
TwE&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 SINN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
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
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 - ..
limension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
I ELECTRICAL: Movement of Meter location, mast or service droprequires approval of
Electrical Inspector lyes No
®ANGER ZONE LITERATURE: lies No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA— (For department use)
i
❑ Notified for pickup Call Email
ate Time Contact Name
Doc.Building Pennit Revised 2014
i
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
r
Roofing, Siding, Interior Rehabilitation Permits
❑ Building Permit Application
❑ Workers Comp Affidavit
o 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
o 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)
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)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Copy of Contract
o Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
DOTE: 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
l
Doc:Building Permit Revised 2014
i
Location W• f A D' IC-,; e
No. /0- ;Lt` Date OIG
• TOWN OF NORTH ANDOVER
(krrk Certificate of Occupancy $
:-- Building/Frame Permit Fee
Foundation Permit Fee $
4 Other Permit Fee $
E
TOTAL $
Check#
3 07-2Building Inspector
NORTl�
Town of A
ONo. 44,3o 0
�o @ h ver, Mass, / 0 - a Y -
CO[NICHIWKK %,
41,9 p°R�rE° P•Pa,��(5
S fJ
BOARD OF HEALTH
Food/Kitchen
PERMIT . T LD Septic System
THIS CERTIFIES THAT ...5.c..R!' r......1! :Y45#.......000.......� .: (m......Rr-O !pcl-!s BUILDING INSPECTOR
�� ,... Foundation
has permission to erer b�.�............... buildings on ....43.. !.f.04.4.0.M.C.47.......A*.
W Rough
to be occupied as ........ .........t'�`s e r T �'I/�0;4.. �'r......................................... 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
UNLESS CONSTRUCT N STARTS Rough
Service
•
....... .. .............. ..... ... ......BUI.........LDIN.....G................INSPECTO..R.. Final
GAS INSPECTOR
Occupancy Permit Required to Occupy Building 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.
Smoke Det.
Invoice
Colonial Fireplace Date Invoice#
2261 Main Street 10/20/2016 2185
Tewksbury, MA 01876
978-447-5192
customerservice@colonialfp.com
Bill To Ship To
Jim Brown
43 W.Bradstreet Rep Terms
Road
No.Andover,MA
01845
Quantity Item Code Description Price Each Amount
1 HI305 Hampton H1300 Timberlane Brown Wood Insert 2,500.00 2,500.00
1 Labor Installation Labor 1,500.00 1,500.00
MA State Sales Tax 6.25% 0.00
Total $4,000.00
i
Payments/Credits $0.00
Balance Due $4,000.00
Wood InsertsHAMPTON
H1300 Wood Insert
H1300 Medium Wood Insert
Model H1300
Optimum Efficiency 77%
Emissions(grams/hr)EPA Certified 3.8 grams/hr
Maximum BTU* 75,000 BTU
Maximum Log Size 18"
Firebox Size 2.3 cu.H. •�
Flue Size 6"
Bum Time(typical)* up to 8 hrs. -
Length of bum time and BTU Range depends on type of wood,climate conditions and
installation. _ .
Unit With Cast Faceplate
23-3/4'
:. £
B C
30-713"
42-VT
_ ��---.� Q ♦ O
O M7�1 A D
%E
F} G
®0 T
40" Dimension Description 12400
41
Unit With Oversize Cast Faceplate A Adjacent side wall(to side) 11"(280mm)
-23-3/4"- B Mantle(to top)** 20"(508mm)
43-1/4" Mantle Depth(not shown)Maximum 10"(254mm)
C Top Facing(to top) 12"(305mm)
D Side Facing(to side) 8"(205mm)
11-118,
17-1/4 E Minimum Hearth Extension* 18"(455mm)
F Minumim Heath Thickness* 0.5"(13mm)
1-114" G Minimum Hearth Side Extension 8"(205mm)
iiiL�
Side and Top facing is a maximum of 1.5"thick.
31-1/4" Floor protection must be non-combustible,insulating material with an R value of
Sas/e 1.1 or greater.
51-3/4' � x
21-1/2"
Hearth thickness of 0.5"with k value=0.84",R value=6 or greater.
Q 0 Q 13iis ❑
— A non-combustible mantel may be installed at a lower height ifthe framing
is made of metal studs covered with a non-combustible board.
_Q Thermal floor protection is not required if the unit is raised 3.5"minimum(measured
® from the bottom of the stove).However,standard ember floor protection is required.
It will need to be a non-combustible material that covers 16"(406 mm)in the US and
18"(450 mm)in Canada to the front of the unit and 8"(200 mm)to the sides.
®0® If the unit is not raised,thermal floor protection required is 18"(450 mm)in the
48-1/8US and Canada.
48-7/8"
Minimum Fireplace Opening All floor protection must be non-combustible(i.e.,metals, brick,stone,mineral
Height 21-1/2"(546mm) fiber boards,etc.)Any organic materials(i.e.plastics,wood paper products,etc.)
are combustible and must not be used.The floor protection specified includes
Width 25"(635mm) some form of thermal designation such as R-value(thermal resistance)or k-factor
Depth 17-1/2"(445mm) (thermal conductivity).
June 2007 Hampton Product Specifications Book 83
°The Commonwealth of Massachusetts
x Department of IndustrialAccidents
- 1 Congress Sheet,Suite 100
d
Y Boston,MA.02114-2017
www massgov/dia
Workers,Compensation Insurance Affidavit:Buffders/Contractors/Electricians/Plnmbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
A • icant Information -.Please Print Le 'bl
Name(Business/Orgatiizationadividual): i a .rCi
dace
Address:
City/State/Zip: vl bb 019 �P Phone#: "I 1 '"T `-� �"--
Are you an employer?Check the appropriate box: Type of project( eclnired),
LQ I am a employer with employees(full and/or part-time).* 7, E]NdVdonsttvction
2.❑I am a sole proprietor or partnership andhave no employees working forme in $, R Remodelhig
any capacity.[No workers'comp.insurance required.]
3.Q I am ahom-owner doing all work myself[No workers'comp.insurancerequired.]f 9. Demolition
❑
[]
4.F1 am a homeowner and will be hiring contractors to conduct all work on my properly. I will 10 Building addition
ensure that all contractbis either have workers'compensation insuraaca or are sole 11.❑Electrical repairs or additiops
proprietors with no'emplbyeas.
12.OPIMnbing repairs or additions
5. I am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 13'.[!Roof repairs
These sub-contractors have employees and have workers'comp.insurance.:
6.Q We area corporatio14.n and lis,officers have exercised their right of exemption per MGL c. Q Other
152,§1(4),and We have no employees.[No workers'comp.insurance required]
*Any applicant that cheeks box#i must also fill.out the section below showing their workers'compensation policy information:
t Homeowners who submit."affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this liox must attached an additional sheet showing the name of the sub-contractors and state whg1her or not those entities have
employees. Ifthe sub-contractors have employees,they must provide their workers,comp.policy number-
I am an employer tliat is providing workers'compensation insurance fora my employees $e1ow is thepoftcy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lie.#:. t7� Expiration Date:
lob Site Address: "t {� 5 City/State/Zip:
Attach a copy of the workers'compepsation policy declaration page(showing the policy num er and expiration date).
Failure to secure coverage as required under MGL e.152,§25A is a criminal violation punishable by a foie 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.
Ido hereby cert undefthepains qndpenalties ofperjury that the information provided above is true an.correct
Si afore:
, _ '� Date:
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.City/Town Clerlr. 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
receivetbr trastde 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 Iocal 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 xegwed"
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 certiflcate(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. rf an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit maybe 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 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 Indusirial.Accidents
1 Congress Street, Suite 100
Boston,MA 02114-2017
Tel.#617-727-4900 ext.7406 or 1-877-A4ASSAFE
Fax#617-727-7749
Revised 02-23-15 vTffw.mass.gov/dia
Massachusetts Department of Public Safety cJle �mzmzoorruc�zl!/r.u!'��aveac<rr�clla
Board of Building Regulations and Standards Ofrise of Consumer Affairs&Business Regulation
License: CS-105920
ME IMPROVEMENT CONTRACTOR
-
Construction Supervisor egistrAtion 181414 TYpe
xplration 4/1!2017 Corporation '
SCOTT M HAYES COLONIAL FIREPL-AGE '
6 CANTERBURY AVEC
HAVERHILL MA 0183b
SCOTT HAYES
474 MAIN ST \,r• � _
WILMINGTON,MA 01887 Undersecretary
Expiration:
Commissioner 08/19/2018