HomeMy WebLinkAboutBuilding Permit #187 - 55 COVENTRY LANE 9/15/2008 BUILDING PERMITof `'O RTH qti
TOWN OF NORTH ANDOVER 3? °`fit'- `,he,b oL
APPLICATION FOR PLAN EXAMINATION
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Permit N0:/ Date Received-919 0 .
��SSA :HUS
Date Issued:
IMPORTANT: Applicant must complete all items on this page
.LOCATION
PROPERTY OWNER. CA e- I I in r�ec ac rp W' ,
Print
MAP NO: X— f IV PARCEL: ONING DISTRICT: Historic District yes
Machine Shop Village yes *no
TYPE OF IMPROVEMENT PROPOSED USE
Reside Non- Residential
wilding One family
Addition S 1X ore family Industrial
Alteration No. of units: Commercial
Repair, replacement Assessory Bldg Others:
Demolition Other
Septic Well Floodplain Wetlands Watershed District
Water/Seger
,;DESCRIPTION OF WORK TO BE PREFORMED:
rJ
� tiriMR41 on Mse T e or P ' t Clear
OWNER: Named d- C Phone:
Address: �� U
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.
C (�
Total Project Cost: $ .��V FEE: $ �r_
Check No.: � � Receipt No.: �70 d'
NOTE: Persons contracting ith unregistered contractors do not have access to the guarantyfund
of Agent/Owner mature of contractor
Location 5!97 C o
No. Date 7D�
�aRTN TOWN OF NORTH ANDOVER
O
� 9
+ Certificate of Occupancy $ ,
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
21 5u8
Building Inspector
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
d /
CONSERVATION Reviewed on qhnInV Signature
COMMENTS /
HEALTH Reviewed on Signature
4
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
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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2008
pORTM TOWN OF NORTH ANDOVER
OFFICE OF
BUILDING DEPARTMENT
+ 1600 Osgood Street Building 20 Suite 2-36
�►'°�,..o '�+ North Andover'Massachusetts 01845
1sswcaus��
Gerald A.Brown Telephone(978)688-9545
Inspector of Buildings Fax (978)688-9542
HOMEOWNER LICENSE EXEMPTION
Please print
DATE: U
JOB LOCATION:
ll �
Number 1S}, Address Mapll,ot
HOMEOWNER
Name Home Phone Work Phone
PRESENT MAILING ADDRESS
h
hky�
1�
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 shuctums. 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 helshe understands the Town of North Andover Building Department
minimum inspection procedures and requirements and that helshe will comply with said procedures and
requirements.
HOMEOWNERS SIGNATURE . G
APPROVAL OF BUILDING OFFICIAL
Reid 10.2005
Form Homeoma s Exemption
ROARD OF WFAIS 6RR`)541 C0\SERV.1T'Ip\68R-9530 IIE.U,T116RR-9540 PL.L\\I\G 688-9535
XA®RTH
TONM of Andover ,
No.
Z' O dover, Mass., •• •
O LAK
co MIC ME WICK V
s OATED PY
1 BOARD OF HEALTH
PERM T D Food/Kitchen
Septic System
BUILDING .INSPECTOR
THIS CERTIFIES THATJ
v
........... ......�......... ... .....................................Q........ X..................................... Foundation
has permission to erect........................................ buildings on .....5.9 .....co.wftfo%W.4w-, ........js6m�: Rough
2wd
to be occupied as.............V..................... .. ......./0.x..�.Y�i-o-
........................................................................ Chimney
provided that the person accepting this permit shall in every respectrm to the terms of the application on 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
UNLESSC®NSTRI.JC STARTS
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.
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
Applicant Information
L Please Print Legibly
Name (Bussinneess/Organization/Individua): 0
Address:J
City/State/Zip: G
Phone #: q 2
-log.
Are you an employer?Check the appropriate box:
1.ElI am a employer with 4. ElI am a general contractor and 1 Type of project(required):
employees(full and/orart-time)
p .* have hired the sub-contractors 6. New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 1 7• ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance.
[No workers comp. insurance 5. 9. E] Building addition
' p ❑ We are a corporation and its
required.] officers have exercised their I O.❑ Electrical repairs or additions
3. 1 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions
myself. [No workers' comp. C. 152, §1(4), and we have no
insurance required.] t 12.❑ Roof repairs
Q ] employees. [No workers'
comp. insurance required.] 13.❑ Other
*Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.
+Homeowners who subniii.this aiidavii indicating they are duifig au work an&I 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.
/am an employer that is providing workers'compensation or insurance
information t employees. Below is the policy and job site
Insurance Company Name:
Policy#or Self-ins. Lie.#:
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 her by c fy under the a' a d e aloe erjury th t the information provided abo is the an4 correct
Si atur
Date:
Phone#:
--------------------
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/hcense 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 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. # 617-7274900 ext 406 or 1-8.77-MASSAFE
Revised 5-26=05
Fax# 617-727-7749
www.mass.gov/dia
Residential Property Record Card
PARCEL—ID-.210/064.0-0142-0000.0 MAP:064.0 BLOCK-.0142 LOT:0000.0 PARCEL ADDRESS.-55 COVENTRY LANE FY:2008
PARCEL INFORMATION Use-Code: 101 Sale Price: 584,000 Book: 06337 Road Type: T Inspect Date: 09/27/2007
Tax Class: T Sale Date: 08/28/01 Page: 0184 Rd Condition: P Meas Date: 09/27/2007
Owner: Tot Fin Area: 4032 Sale Type: P Cert/Doc: Traffic: M Entrance: C
POWELL, NICHOLAS IAN Tot Land Area: 1.01 Sale Valid: Y Water: Collect Id: SGC
Address: Grantor: DANIEL WONG Sewer: Inspect Reas: M.
55 COVENTRY LANE
NORTH ANDOVER MA 01845 Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% /
RESIDENCE INFORMATION LAND INFORMATION
Style: CL Tot Rooms: 10 Main Fn Area: 1956 Attic: NBHD CODE: 8 NBHD CLASS: 8 ZONE: R1
Story Height: 2.60 Bedrooms: 5 Up Fn Area: 2076 Bsmt Area: 1956 Seg Type Code Method Sq-Ft Acres lnflu-Y/N Value Class
Roof: G Full Baths: 3 Add Fn Area: Fn Bsmt Area: 600 1 P 101 S 44076 1.010 227,339
Ext Wall: FB Half Baths: 1 Unfin Area: Bsmt Grade: A VALUATION INFORMATION
Masonry Trim: Ext Bath Fix: 0 Tot Fin Area: 4032 Current Total: 702,700 Bldg: 475,400 Land: 227,300 MktLnd: 227,300
Foundation: CN Bath Qua[: T RCNLD: 475368 Prior Total: 776,200 Bldg: 537,100 Land: 239,100 MktLnd: 239,100
Kitch Qual: T Eff Yr Built: 1987 Mkt Adj:
Heat Type: FA Ext Kitch: Year Built: 1987 Sound Value:
Fuel Type: G Grade: GCost Bldg: 475,400
Fireplace: 1 Bsmt Gar Cap: 2 Condition: G Att Str Va11:
Central AC: Y Bsmt Gar SF: 530 Pct Complete: Att Str Val2:
Att Gar SF: %Good P/F/E/R: /100/100/91
Porch Type Porch Area Porch Grade Factor
E 170
W 330
SKETCH PHOTO
17
10 170 S 2a 330 Sq.Ft 101 F7 3342
� '
41
FM66 FU*1.60/FM/B FU*.5 1f 1/E
39 S .Ft 39 S .F� .:
1176 Sq.Ft
26 26
55 COVENTRY LANE
Parcel ID:210/064.0-0142-0000.0 as of 9/9/08 Page 1 Of 1
JUN-02-2006 15:19 I::''', & T GROUP INC. 506 752 6895 P.01i01
MORTGAGE INSF°F, `TION PLAN o
RENEY MORAN & 11NAME ROBERT MACINNIS tz
REGISTERED LAND SURVEYORS
75 HAMMOND STREET - FLOOR 2 zma
WORCESTER, MA 01610-1723 LOCATION 55 COVENTRY LANE O
- PHONE; 508-752-9885
FAX: 508-752-8895 NORTH ANDOVER
RMT®HSTGROUP.NET
A Olvislon of H. S. & T. Group, Inc. SCALE 1 „ = 60 DATE 06-02-OB
C.r
REGISTRY ESSEX NORTH DEED BOOK/PACE 6337/184 I
L?am um, DOCUNENTAnON Pnowom.REaumm MEASURE- Xs PLAN NO.10936 m
NENM WM MADE OF TME FRONTAM AND BU"I' c ro”" �„�H OF PLAN 000
TMI9 K/Pl w
ON YORTCJGE WgPOMN PLAN. IN OUR.IU ALL
ENI3
MSl&j EASENARE 5M�AND THERE ARE NO MA71ONS �� WE CERTIEy"T THE BUILDING(S)ARE NOT *MIN THE
OF ZONING REAUIgaIDM REGARDING STRUCTURES TO PROPEIRTY OANfSPECWL FLOOD NA?IAO AREA. SEI MUD MAP:
UNE OFFSETS NN1ES5 OTMUWM NOTED IN ORAWW BELOW).
tot NOT DEFINED ARE ABOVEGROUND POOLS DRIVEWAYS. J•
OR SHEDS WM NO FOUNDATIONS.THIS IS A iWGACE NAN ►1 10 8 um 06-15-83
IKKCNON pyw NOT AN UHSIRUNENT SURVEY. DO NOT USE TO
(QCT F£NCES iiSNER BOUNDARP SmuCnIRFS. oR TO PtMjt M 047
SHRUBS, tOfJh}pN E RIE I IU $TRUS) SHOWN HEREON IS EITHER .� i,•! iL000 ZONE IHIIS 6EFl! OEIERMINFD DV SCALE AND
IN COMPLIANCE WTN LACK JONIKO FOR PROPERTY UNE OFFSET IS NOT NECFSSAItlLY ACCURA�• UNTIL DEfkL111YE PWS ARE
REOUA04E14113.OR 13 DIEMPT FRow VIOLAnON ENFORCEMENT ISSUED BY HUD ANO/OR A VERTICAL CONTROL SURVEY IS
AACTTIION UNDER WM.cL TIRE NI. CHAP, 40A, SEC. 7 UNLESS
�p�� PEAFOR4ED, PRU.ISE ELEVATIONS GNN07 BE DETfRMurED.
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