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Home My WebLink AboutBuilding Permit #59 - 497 WOOD LANE 7/9/2010 $ORTH BUILDING PERMIT OFtt.�o TOWN OF NORTH ANDOVER �� '''- `- *' �0 APPLICATION FOR PLAN EXAMINATION q cxwcwew.c. � Permit NO: Date Received24 q°RAr.o �SSACH►1`�� Date Issued: (� IMPORTANT:Applicant must.complete all items on this page LOCATION N--�T ^`dein PROPERTY40INNER; L' � / 1 > Print 'MAPS - PARCEL°old - SZONING DISTRICT= Historic®�stnct ye no' - Machine Shop Village ye nq TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family o v/ Addition Two or more family Pond Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well, Floodplain,• . Wetlands ,, 1Natershed District,\ W6ter•%Sewer - - - ry . :.- DESCRIPTION OF WORK TO BE PREFORMED: �itrludS Identifica ' lease Type or Print Clearly) OWNER: Name: Ek ( q f n Phone: Address: /VO �-Ta/d d cy-tow /Y�q ' d 3 CONTRACTOR, Name ' U�-1 'tFs r Phone � � Supervisor's yCnnsYructionate a _ . . Horne Imp-6V ment�Licen`se � „__ : .� Exp ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.000 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ -2A�3 7 C1 FEE: $ i Check No.: 04 Receipt-No.: pso d NOTE: Persons contrac ng yih unretered ntractors do not have access to the guaranty fund Signature of Agent/Owner::_ - ignature 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 COMMENTS CONSERVATION Reviewed on i Signature ` COMMENTS cJ, , HEXLTH 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 F1REEPArR4 ,ME:NT Temp Dumpstero.n�site y s y Y A no` Located=at 124.tMa n}Street y F,ireDepartmentsignature/date COMMENTSw' _ �a 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 i Doc.Building Permit Revised 2010 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) I ❑ 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 2008 Location No. Date 13 - o „OR,h TOWN OF NORTH ANDOVER f � 2 ' certificate of Occupancy $ •i ; �'�J''•°• MUS t�� Building/Frame Permit Fee $ 4C Foundation Permit Fee $ r Other Permit Fee $ TOTAL $ Check # 231 u Building Inspector 'Sse�yv ' ��ir+z�3nvn ji linmar A?JN !IM., V®= a-B/L,-3n?InS SV 155VW ° a5AoaNIV MlaON NI QNV`l NV16 (30 . 1 O)M VI I m •°08��Z rm Vi1 1 m o � � n I sv��sa�sap �nvd c X o The Commonwealth of Massachusetts Department of jndusVial Accidents Office Of Lnvesiigations 600 Washington Street Boston, M4 02111 WWw-m.rzssg0r1&a Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Am licant Informafion Pleas t Legib zation/Indi idual):Name(Business/Organi � y ,C?'1 Q P Address: `--" City/State/Zip:_. AJO, 40&-eA A4(- Phone#: Are you an employer?Check the appropriate box: L❑ I am a employer with 4. ❑ I am a general contractor and Type of project(required): employees(full and/or part-time).* have hired I d• ❑Nev,construction the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet t 7• ❑Remodeling ship and have no employees These sub-contractors have working for me in any capaeit5, workers comp. g' ❑Demolition [No workers'comp. insurance 5 P insurance. ❑ We are a corporation and its 9' ❑Building��rion qurred.) officers have exercised their 10-e electrical repairs or additions 3• I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself [No workers'comp, c. 152,§1 4 in required.] t )Nand or have no 12. Roof q � employees. [No workers' ❑,, repairsrepairscomp.uzsurance required.] 13n�-Other `--s--_ *Any=-'";;?ics^t tit chi box.=i mss;`so Mow ecc seen=bc'oa• Homeown ers who submit this affidavit indicating the;,az_do;E all wOrk and FContmaon that chmic thea hire outside oont*acto rliur submr;anew affidavit indicating such. this bor.gust ached an additional sheet showing the name of the sub c ontxactors and their workers'comp.P-,.— information. I am an emp!<iyer that isproviding workers'compensation fo P insurance for my employees, Below is the policy and job site Insurance Company Name: C Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: Attach a copy of the workers' conrensafion policy declaration nae(showingCity/State/Zip; , A uot"� Failure to secure coverage as required under Section 25A ofMGL F 152can lto ththe e imposition expiration date). fine up to$1,500.00 and/or one-year imprisonment as well as civil criminal penalties of a of up to$250.00 a day against the violator. Be advised that a co Penalties m form of a STOP WORK ORDER and a fine Investigations of the DIA for insurance coverage verification PY of statement may be forwarded to the Office of I do hereby cerfify under the pains and paitatties o er fP lu►J that the information provided above is true and correct � Signature: _...._ Date.:.__ �l a Phone# Official use only. Do not write in this area, to be completed hj,com,or town o fJlciaL City or Town: Perwit'License# Issuing Authority(circle one): 1.Board of Health Z.Building Department 3. Citv/Town Clerk 4.Electrical Inspector 5.Plumbing b. Other b Inspector Contact Person: - Phone#: Information an_ d Instructions Massachusetts General Laws chapter 152 requires all employers to provide wort-rs'compensation for their employees. Pursuant to this statute,an employee is defined as"...every Peon in the service of another under any contract of hire express or implied,oral or written." An employer is defined as"an individual,partnership,associ,a tion,corporation or other legal entity,or any two or more of the foregoing engaged din a joint enterprise,and including the legal representatives of a deceased employer,or tk receiver or trustee of an individual,partnership, association om7 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 mainte—mance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not be cause of suchemployment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or lug 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 coAxplia.nce 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 ua-til 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 certificate(s)of insurance. Limited Liability Companies(I.LC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'comp easation 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 saute to sign and date the affidavit The affidavit should be rct-minti to the city or tovim that the application for'the p" t or license:S being rVS22CSt:d,not the Depar[Rrent.of Industrial Accidents. Should you have any questions regarding the law or if you aiv l--q rcd to obtain a workers' compensation policy,please.--all the Department at the aumb=r 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 cinr•ent 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 permiits 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 Office of Investigations would like to than you in advance for your cooperation and should you have any questions, please do not hesitate to give us a ca1L The Department7s address,telephone.and.fax number. .. T'he Commonwealth- cif Massachusetts. Department of Industrial Accidents Office of Invesfige,,ateons 640 Washington Street Boston,MA 0.2111 Tel. #617-727-4900 ea,-t 406 or 1-877-M4SSAFE Revised 5-26-05 Tax-r1r1 6.17-72.7-7749 T�rVirV',m2SS._g Ov�C1S a ORTH 0VMo 6 over �AK o dover, Mass., I� COCMICMEWICK �� 7d ADRATED S V BOARD OF HEALTH Food/Kitchen .PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........... .................... ........�!IL").. .......................................... ........................ Foundation has permission to erect........ .........A.6i"iArINAd .. buildings on ...4 4........06.104.............. �......... Rough to be occupied as...... ...... Chimney �.� ......... .....acoQ.L.......... �.—......... .... ... . . provided that the person accepting this permit s all in every respnform to the terms of the application i n file in Final 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 CONS UC S TS Rough ..... ........ .................. .......................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. Str. Str. Sls. C.A.T. DATE Acct. ' No. Phone# I No. No. No. P RODUCI' ORDER F®RIUI rP SPt`S�y HO GUSTOMEH55/NC�'e3 Ca F fel fl P.iB f?<17111j/ iHtl begins. '4 Ng MCO,LLC COMP SOLD TOS STREET S ^ CITY STATE. 1'� l�T HOME PHONE NO. ) - BUSINESS PHONE NO. ZIP QUAN. EDPk - � DEPT. MODELN/DESCRIPTION 3 N CL C qq . c� N , Lj Sub Total Tax ( tel Irl Total Less Deposit Balance Due BUYERS SIGNATURE: X OFFICE COMPLETE North Andover MIMAP 497 Wood Lane July 9,2010 K . t •. r :� 11.0-.. �� .o 0-00. ? " N In 1�( f 0- 2:o-oos `-`` it I 2• 09 09 2.0 111 6 �n k 2.' t+t YYI � � 1 0 �rYiiL. s 022rr . I Interstates Into rotate —Major Roods Hori—tal Datum:MA Stateplane Coordinate System,Datum NAD83, Roeda Meters Data Sources:The data for this map was produced by Merrimack �10RTM Valley Planning Commission(MVPC)using data provided by the Town of t Easements '9 North Andover.Additional data provided by the Executive Office of O` Environmenta C3 MVPC Boundary l AflalrslMassGIS.The IMorrnatlon depicted on this map is + e t]Parcels 3 L for planning purposes only.It may not be adequate for legal boundary FO- — " t deflnitlon or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING } ; THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY •"s ,^♦ OF THESE DATA,THE TOWN OF NORTH ANDOVER DOES NOT I ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF .� 'b±Argo.•�•`,�y THIS INFORMATION �SsACwuset V=129 ft `�' North Andover MIMAP 497 Wood Lane July 9, 2010 011.0-0057 0062 Greene Street 9 02 0-011', 022.0-0056 022.0-0059 I I 022.0-0062 022.0-0058 022.0-0063 o0 022.0-0088 022.0-0072 ,rte 022.0-0089 G� I v^ 022.0-0090 022.0-0079 -�Reil Line Interstates Horizontal Datum:MA Stateplane Coordinate System,Datum NAD831 Interetate Meters Date Sources:The data for this map was produced by Merrimack —Major Roads NORTH valley Planning Commission(MVPC)using data provided by the Town of Roads Of x`go ,a North Andover.Additional data provided by the Executive Office W C.Easements r eat ees OO Environmental Affairs/MassG15.The Information depicted on this map Is Trails •� L for planning purposes only.It may not be adequate for legal boundary O -• M definglon or regulatory Interpretation.THE TOWN OF NORTH ANDOVER C3 MVPC Boundary F A MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING ❑Municipal Boundary 41 +i THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY •i 'i OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT ❑Parcels ♦C'0 xr • ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF Hydrographic Features 71 o+.rso �eej THIS INFORMATION Streams ,SSA�MUg�S v Wetlands ":Exempt Lards 1"=49 ft w�' OORTM TOWN OF NORTH ANDOVER 3rOb OFFICE OF �' BUILDING DEPARTMENT ro d* 1600 Osgood Street Building 20, Suite 2-36 9 caw:rw.. • North Andover,Massachusetts 01845 SACNO Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please print DATE:_ �� /C) JOB LOCATION: �9� W tInd 14x<— Number Street Address Map/Lot HOMEOWNER e Name Home Phone Work Phone PRESENT MAILING ADDRESS 4G 1 C�and � �J 2 City Town St2te. Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) 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 structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the 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. HOMEOWNERS SIGNATURE na C, APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535