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HomeMy WebLinkAboutBuilding Permit #732-2017 - 497 WOOD LANE 1/24/2017BUILDING PERMIT 14)1 +i � TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATI N Permit NO: d Date Received aJ p� Date Issu IMPORTANT: Applicant must complete all items on this LOCATION Print PROPERTY OWNER Rise Redevelopments LLC Print MAP NO: 22 PARCEL: 63 ZONING DISTRICT: Historic District yes _- Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building © One family ❑ Addition ❑ Two or more family ❑ Industrial V1 Alteration No. of units: ❑ Commercial V Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer Renovation and Dormer Addition Identification Please Type or Print Clearly) OWNER: Name: Rise Redevelopment. LLC (Justin Benster) Phone: (611) 922-4310 ►_1 Jdress: Boston MA CONTRACTOR Name: Tuan V Nguyen Phone. (617) 797-6637 Address: 1248 Randolph Avenue, Milton MA 02186 Supervisor's Construction License: Exp. Date: CS -081382 08/03/2011 Home Improvement License: Exp. Date: 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. Total Project Cost: $120,000.00 FEE: $1,440.00 Check No.: Receipt No.: 14 _ NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund __ _�. _ o oop—we D oop Ven ,e %r vij as 01/23/17 8:34PM EST Signature of Agent/Owne raR u`BuaYmv 01/E0123/177:52PM ESTG re Of Contractor ELGV-UMXR-KZYE E9DV ti ti, r ~ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE -01{ -SEWERAGE DISPOSAL Public Sewer ❑ TanningNassage/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 ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH COMMENTS Reviewed on Siqnature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submifted yes . Planning Board Decision: Comments Cons z ervation Decision: Comments Water & Seger COnnection/Signature &Date Driveway Permit DPW ToivvR2 Engineer: Signature: Located 384 Osgood Street FIRE ' EPARTM�=NT - Temp Dumpster on site yes no Located at 124 Mair.," Street Fire Departrnerit signature/date C0I lMLF;TS a - Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions_ Total land area, sq. ft.: ELECTRICAL: Movement of Dieter 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 Amy l tb ana UA 1 A- (For d B Notified for pickup - Date Doc.Building Permit Revised 2010 use - r Building Department Tree folowing 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 MOTE: 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 o 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 ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products 40TE: 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 Torun Clerks office must stamp the decision from the Board of Appeals that the apn•,-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must bt- submated with the building application Doc: Doc.Bui!dingpernnitRevised 2012 -1—H — 1. 1.r.,.r., a N. .v,ny,-111-1— Plans 11—. , Plans Submitted 6 - Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans CSI TYPE OF SEWERAGE DISPOSAL Public Sewer S/ 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 PLANNING & DEVELOPMENT ❑ COMENTS DATE APPROVED U' I E ♦ "' • 1 COONSERVATION ■ ■ COMMENTS HEALTH COMMENTS DATE REJECTED DATE APPROVED ❑ ❑ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Is .Conservation Decision: Comments iWater & Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street FIRE D EPA�R�TVE NT- Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Y, Location q97 WOOD L 14N No.?�? Date /r I ql O/ 7 Check # P53 3 1 411015 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $/41/0-40 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ � F 1 L/ Building Inspector tte�-�-, Plans Waived ed Plans ❑ Certified Plot Plan ❑ Stam Plans Submi p 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 COMENTS 111 DATE REJECTED DATE APPROVED CONSERVATION ■ ■ COMMENTS HEALTH COMMENTS DATE REJECTED DATE APPROVED ❑ ❑ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/Signature & Date Drivewav Permit Located at 384 Osgood Street FIRE DEPART ENT - Temp Dumpster on site yes no 411 W (. Located at 124 Main Street / Fire Department signature/date COMMENTS/E.�ii, �� �1�:•✓c s 3 0 H Q CG s w LL O0 O O m Y O LL N v7 U Q In p a Z z m c N 7 LL t tD K ? N C V @ LL cc O a fA Z z j a L m C _ m LL O a Z J U J t K V i N _ to L.L lL h Z Ln Q C7 t C to LL d' Q w 0 LU LCL N i CO O Z v � 0 a) CO E O t3 • � (Q 0 �w ctsy y- o N V r �• d N d w L 0 E O O ? 0cc .o V N vi CP* � 3 C; N t9 m • N N i O N �.O -a a 2U N Q 0 O `m r 4wZ N o 0 w 3 /- c o� Qaa� mss _-_tm F.; O r .c Q NcNa O .v m LO L -0 O LLumi •� N O I-- N 0=-:5 :EO Enr W 0 V Q O i� d N -Q O �*• C H OCL 0 U ti 5 0 w L: O V U) i 0 .: u mo O Q 0- cmQ C � cc J -0 O d Z CDU) r - i The Commonwealth of Massachusetts Department of IndustrialAccidents UMM a 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: BuilderslContractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Auplicant Information Please Print Legibl T 1/y Name (Business/Organization/Individual): Tuan Y Nguyen Address: 1248 Randolph Avenue City/State/Zip: Milton MA 02186 Phone #: (617) 797-6637 Are you an employer? Check the appropriate box: 1. I am a employer with employees (full and/or part-time).* 2. I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3.❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4. [-11 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5.0 I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.$ 6.n 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.] Type of project (required): 7.New construction 8. Remodeling 9. ❑ Demolition 10 [] Building addition 11. ❑ Electrical repairs or additions 12.0 Plumbing repairs or additions 13. Roof repairs 14. Other *Any applicant that checks box#1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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. Iain an employer that is providing lvorkers' coniperisation 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 MGL c. 152, §25A is a criminal violation punishable by a fine tip 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. I do hereby certify under thepains and penalties of petjuty that the informationprovided above is true and correct. 1 1e V°f EST 01/23/2017 Signature:%a"— AFRJ-ZKBW-BREK.wiNr Date: Phone #: (617) 797-6637 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 Cleric 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 1203000.00 m $ - $ 1,440.00 Plumbing Fee $ 180.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 180.00 Total fees collected $ 1,900.00 497 Wood Lane 732-2017 on 1/24/17 reno and dormer addition 4Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS -087382 Construction Supervisor TUAN V NGUYEN �' r 1248 PANDOLPWAVENUE -- ~; MILTON MA 02186 } •.�. Expiration: Commissioner 08/03/2017 L f onstruction Supervisor estricted to: nrestricted - Buildings of any use group which contain ss than 35,000 cubic feet (991 cubic meters) of enclosed ace. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. DPS Licensing information visit: WWW.MASS.GOV/DPS File number: 160922-6 UNREGISTERED LAND Attorne : MICHAEL R. PAOLINI Deed Book 14398 pa e 46 Lender: Plan Book 507 Pae Lots 69 & 70 Owner: NANCY ROCHELAN REGISTERED LAND Reg, Book Sheet Lot(s): Date: 9/2712016 Certi nate of Title Assessor's Map 22 Blk: Lot fi3 Census Tract MOR TGA GE INSPECTION PLAN Scale: V=3D' 497 WOOD LANE, NORTHANDOVER, HA LOT 71 LOT 0, LOT 67 SHED LpT69& 70 11203 ('U M _ Lr) o L17T 68 ;4971 C Q w a A. H,T, 100.48' WOOD LANE CERTIFICATION I CERTIFY TO THE ABOVE ATTORNEY, BANK,AND THEIR TITLE INSURANCE COMPANY THAT THE MAIN BUILDING, FOUNDATION OR DWELLING WAS IN COMPLIANCE WITH THE LOCAL ZONING BYLAWS IN EFFECT WHEN CONSTRUCTED (WITH RESPECT TO STRUCTURAL SETBACK REQUIREMENTS ONLY) OR IS EXEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER MASS. GENERAL LAW TITLE VII, CHAPTER 40A, SECTION 7. FLOOD DETERMINATION BY SCALE, THE DWELLING SHOWN HERE DOES NOT FALL WITHIN A SPECIAL FLOOD HAZARD ZONE AS DELINEATED ON A MAP OF COMMUNITY N 25009CO209F AS ZONE X DATED 7-3-2012 BY TI FE NATIONAL FLOOD INSURANCE PROGRAM. <, n� GARY ,g. N Olde Stone Plot Plan Service, LLC LABRIE P.O. Box 1166 N0.40039 Lakeville, MA 02347- Sl Tel: (800) 993-3302 Fax: (800) 993-3304 -7 I(� PLEASE NOTE: This inspection is not the result of an instrument survey. The structures as shown are approximate only. An instrument survey would be required for an accurate determination of building locations, encroachments, property line dimensions, fences and lot configuration and may reflect different information than shown here. The land as shown is based on client furnished information only or assessor's map & occupation and may be subject to further out-sales, takings, easements and rights of way. No responsibility is extended to the landowner or surveyor, or occupant. 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