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HomeMy WebLinkAboutBuilding Permit #616-15 - 5 GREEN HILL AVENUE 1/20/2015BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received I /ZO Date Issued: ACHUC IMPORTANT: Applicant must complete all items on this page LOCATION 5 &0,1, N W -L AVS A (;AJ1.1 AN70v�K MA olSIf 5 Print PROPERTY OWNER 56()T-1 e -A 61,t l S Print MAP NO: q 015 PARCEL: ZONING DISTRICT: Historic District yes 49 210 htt- v - o 1 m9 OW -0 Machine Shop Village yes n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building V One family ❑ Addition ❑ Two or more family ❑ Industrial 6(Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer CArtTlALL�J FIwifIf1.4 17A3it MkN-( Identification Please Type or Print Clearly) OWNER: Name: 5co77 450,51(,A r-WA5 Phone:(4vI) 432-6139 ` Address: 5 4rLEEP 1LL- AvE Hort-TN pN70vErc A 61�4s CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: 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: $ 14J00-00 FEE: $ 116.00 Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner�, %i ` Signature of contractor Location No. U 6 � � — Date f I 2-Z1 I \e - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $- TOTAL $ Check 4t A—S 2 8 4 3 7 Building Inspector ■ BUILDING PERMIT i NORTF� w• �. •` OC, TOWN OF NORTH ANDOVER 02 APPLICATION FOR PLAN EXAMINATION"..'' ~ 1 Z y Permit No#: Date Received gpR�TEp rPp` (�% � Date Issued: SSACHUS�� IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER. Print 100 Year Sfructure _. , yes no AP PARCEL: ZONING DISTRICT:_ Historic District yes no - Machine Shop Village yes �no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Others: ❑ Repair, replacement ❑ Assessory Bldg ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District _ ❑ Water/Sewer UC0%.#M1r i 1UN Ur VVUKK I U t3E PERFORMED: Identification - Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name Phone: Address: Supervisor's Construction License:Exp. Date: II Home Improvement: License: Date: ARCHITECT/ENGINEER Phoria - Address: Reg I�Co FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED EOSTBASED ON $125.00 PER S.F. Total Project Cost: $ FEE:. Check No.: Receipt No. NOTE: Persons contracting with unregistered contractors do not have -access to tlreeguaranty fund Signature of Agent/Qwner _ Signature of con;tractbn �. 4 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 a 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 Doe: Building Permit Revised 2014 0 0 �{ D Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TypF 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 COMMENTS CONSERVATION COMMENTS e HEALTH COMMENTS Signature Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Planning Board Decision: Conservation Decision: Com Comments Zoning Decision/receipt submitted yes Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - TemP Dumpster pn site yes..r-'. Located at 124:Main Street Fire `DeparbneWb� -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 servicedroprequires approval of Electrical Inspector Yes DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine Doc.Building Permit Revised 2014 Enter construction cost for fee cal - North Andover Fee Cakulation Construction Cost $ 143700.00 m $ - $ 176.40 Plumbing Fee $ 22.05 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 22.05 Total fees collected $ 320.50 5 Green Hill Avenue 616-15 on 1/20/2015 Partially finishing basement c=: C O ,Z �i r L J W x O O mC N u jy O LL cu Ln N u Q0 Q)- (n O d z Z m .2 m o 7 LL s w Gni c U f0 C LL O d NN z C7 Z co J d s j w _ (0 C LL O d z a u J LN s j w 41 '� N (0 C LL cc Q F" u ui 0. Z auj C7 j O w f0 C LL WC G a a 5 LL j m Z N {% v Y C N m O f� z• V = c :.M L W Q.� O a. L N rel Y <vjj W ++ O o E ai Q0 O � L ** �• 3 J M J I- �+ as • dw: m U)4S.- m o -0a c 'o r — o -O > :cn � a t o ,a ' ,� -0 o a immim: CL Nz m - .�+• y O O o = c 2 3 = Q r mss m u = o cc•w 1 Q i i O-0 ,O ~C Q. m W = 'O - O O - LL N O N = O '= = O LLJF- H O a., yt, :0 Z 0 o O LU �L- 0 0 - L � co a 0 am N J ti N 0_ 2 ea LC = F- 0 t +�+ Q- 0 0 > CO 2 z G co Z U) w CL W H W a. o a Z aqz 0 m Z V CO LUJ M E z w i d 0 V a. .CL V w 0 O L- CL CL 0) Q t J O d Z CLN c C 4 � � J F � Y � I CA 0 H a h Y � 8 J O V onto z I CA 0 a h Y � 8 J O V I CA The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations kv 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Scott Ellis Address:5 Green Hill Ave. Andover, MA 01845 Phone #:(401) 932-6739 Are you an employer? Check the appropriate box: I . ❑ I am a employer with 4. Q I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors >.. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its i. ❑✓ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' insurance Type of project (required): 6. ❑ New construction 7. ❑✓ Remodeling 8. Q Demolition 9. Q Building addition 10. ❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12. ❑ Roof repairs 131-1 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. $Contractors 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. 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 insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. /20/2015 401) 932-6739 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 #: "ORTM TOWN OF NORTH ANDOVER O� r •`:"av �•` .�° OFFICE OF BUILDING DEPARTMENT • + 1600 Osgood Street Building 20, Suite 2-36 =� „t;;:«�•�# �Ss�cwus�� North Andover, Massachusetts 01845 Gerald A. Brown Telephone (978) 688-9545 Inspector of Buildings Fax (978) 688-9542 HOMEOWNER LICENSE EXEMPTION Please rint DATE: 1/20/2015 JOB LOCATION:5 Green Hill Ave. Number Street Address Map/Lot HOMEOWNERScott Ellis (401) 932-6739 (508) 458-0399 Name Home Phone Work Phone PRESENT MAILING ADDRESS 5 Green Hill Ave. North Andover MA 01845 City Town State 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. / X ©per HOMEOWNERS SIGNA APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Partial Basement Finishing Project Address: 5 Green Hill Ave. North Andover, MA Owner: Scott and Jessica Ellis Phone: (401) 632-6739 Narrative: The project consists of providing a finished basement for approximately 600 sf of the existing 1,400 sf basement space to create an additional living room / recreation room. The basement is currently constructed of 12" CMU block on an approximately 4" concrete slab on grade. The current basement is a full walkout on the backside of the house with a 2'-11" wide x 6'-6" door. There are a total of 4 existing windows approximately 32" W x 21" H with 2 of the windows located at the back of the house and 2 windows located on the side of the house. No modifications will be made to the existing windows or doors. The existing stair that leads up from the basement and onto the ground floor will be left as is. Proposed Work: Interior walls: In order to finish the space, separating walls will need to be built to separate the storage space and the current laundry room, boiler and furnace spaces. These walls will be built using 2x4 construction with a single top plate and single bottom plate. The bottom plate will be a pressure treated 2x4 fastened to the concrete slab on grade with 2-1/2' nails placed on foam sill sealer to create a thermal break. The walls will be enclosed using %:" drywall. Exterior walls (foundation): The walls that will be framed adjacent to the foundation will be built using 2x4 construction in the same manner as the interior walls. However, these walls will first be insulated using W rigid insulation with an R -value of R-4. Once these walls are framed an additional layer of R-15 Rock wool insulation will be used to create a total R -value of R-19 combined. These walls will also be finished with %:" drywall. Rim Joist Condition: The rim joist / sill plate condition where the foundation walls meet the floor framing above will be insulated using 2' rigid insulation which will then be spray foamed at the perimeters to seal any gaps. After this is completed fiberglass insulation with an R value of R-13 will be placed over this and stapled into place. Floors / Ceilings: The proposed ceiling will be 7'-0' from finished floor to the underside of the dropped 2x2 or 2x4 Acoustical Ceiling. The main support beam of the house also runs through the middle of the space and will be left exposed. The main support beam will be 6'-8" above the finished floor condition. The proposed flooring material will be carpet. Partial Basement Finishing Project Address: 5 Green Hill Ave. North Andover, MA Owner: Scott and Jessica Ellis Phone: (401) 632-6739 Heating and Electrical: Heating of the finished space will be accomplished by adding a 3rd zone onto the existing forced hot water gas furnace. Electrical work will be completed using a licensed electrical contractor that will provide lighting and electrical outlets per the required building code standards. Lighting will be reconfigured in the storage area and laundry space in order to provide adequate lighting. Electrical outlets will also be added into these same areas to provide enough electrical power as required per code. vu 41C W p%3,'