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HomeMy WebLinkAboutBuilding Permit #281 - 57 OLYMPIC LANE 10/21/2008 BUILDING PERMIT of"°DT baa TOWN OF NORTH ANDOVER ,.. APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received '�q,T.o•ppy(� Date Issued: G b�d`� ACHUS IMPORTANT: Applicant must complete all items on this page LOCATION 5-7 d 1_n'/ ;c Lw e PROPERTY OWNER 9.0r--,I iwa ,Print ee-e ✓e Print MAP NOI- , PARCEL: ZONING DISTRICT: Historic District yesno 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 Repair, replacement Assessory Bldg -Sh ea Others: lition Other Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Idgntification Please Type or Print Clearly) OWNER: Name:_ o ar^ ve- Phone: 57ff 665-606uAv Address: 5-7 O rn - �c CONTRACTOR Name: Phone: Address: (tvD •-- 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: $ 1 2000 FEE: $ �^ Check No.:_ Receipt No.: a (466 NOTE: Persons contracts g Awithn g stere contractors do not have access to the guaranty fund Si gnature of Agent/Owner Signature of contractor Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL a 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 Signature #210 COMMENTS 1J C' HEALT Reviewed on Signature COMMENTS r 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 ,-,Tgmp Dumpster on site yes 00 Located at 924 Main$to6et-, *. Fire Department signature/date COMMENTS .t 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 Location �� O� !� No. Date MOA�M TOWN OF NORTH ANDOVER • �. Certificate of Occupancy $ Building/Frame Permit Fee $ -� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # Building Inspector 171 'iaf �w 4f,(IT,� •'5� ,'' y... x• "tr: t d I �i �►lc a Y-• �hi, l `� ,. ti *.•%�} °i. ,rn E Y. xEi Awl, 1 I 1 w,, VIA r r 3pAr "� far r Bag 4 r f +L .!' •;S� _�_ .4Y s r dam . � � I x �r4"ti r, ht's, ' _t .. .rte." r DeWfilrsh t A ` f'* 1.r.I �` t lY F +• a/ y �►rt 1 1 1 I 11 aR The Commonwealth of Massachusetts 1 Department of Industrial Accidents ` l i ��`",l• � Office of Investigations 600 Washington Street f Boston, MA 02111 \ tlMM I t iw www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): -o Address:_ �� C 1"7/ -1' City/State/Zip: Nol-ep4 dycr Phone #: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. $ 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised.their 10:0 Electrical repairs or additions 33 1 an a homeowner doing all work right of exemption per MGL 1 1.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12,0 Roof repair A; insurance required.] t employees. [No workers' `9 comp. insurance required.] l3�Qther +Any sppiicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit.ihis affidavit indicating they arc doing atl wort:and ihen 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. 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 u er th pains aan enalties of perjury that the information provided above is true and correct Sic-mature: ���--�, ,p Date: f U Phone#: oG v Official use only. Do not write in this area,lobe 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#: NORTH Town of 0 No. 2i 8 o �` dover, Mass., �c7•�/•Z> � CocmCKE WICK �� A�RATE D S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.... ......... e � �` :.....:'.:'. ........................................................... Foundation has permission to erecta... .......................`............ buildings on ....5. ...... L�.fKG..................................... Rough to be occupied as.........cF.,X� s n��• Chimney ....................................................................................................................................................... provided that the person accepting this permit shall in every respect conform 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 UNLESS CONSTRU Rough .............. ... .......................................................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place -on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Buildiing Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. YWI Z YF6,77- s: mn ri------------ w lit, 'o, 6WINjP; 1W, F % iAN �e t5 vliIl. F Y,74 I Ppinlle xii, 3 15, & X:p" 4 ......... 4 K. �...... ........ ............ ......... .......... -17 ir I ................ Residential Property Record Card PARCEL ID:210/106.B-0141-0000.0 MAP:106.13 BLOCK:0141 LOT:0000.0 PARCEL ADDRESS:57 OLYMPIC LANE FY:2008 PARCEL INFORMATION Use-Code: 101 Sale Price: 250,000 Book: 03756 Road Type: T Inspect Date: 05/14/2006 Tax Class: T Sale Date: 06/14193 Page: 0237 Rd Condition: P Meas Date: 09/10/2000 Owner: Tot Fin Area: 2028 Sale Type: P Cert/Doc: Traffic: M Entrance: X REEVE 111,HOWARD C Tot Land Area: 1.00 Sale Valid: Y Water: Collect Id: SGC BRENDA C REEVE Grantor: PERRY,MARTIN Sewer: Inspect Reas: M Address: 57 OLYMPIC LANE Exempt-B/L%a / Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% / NORTH ANDOVER MA 01845 RESIDENCE INFORMATION LAND INFORMATION Style: CL Tot Rooms: 9 Main Fn Area: 975 Attic: NBHD CODE: 7 NBHD CLASS: 7 ZONE: R1 Story Height: 2.00 Bedrooms: 4 Up Fn Area: 1053 Bsmt Area: 975 Seg Type Code Method Sq-Ft Acres Influ-Y/N Value Class Roof: G Full Baths: 2 Add Fn Area: Fn Bsmt Area: 250 1 P 101 S 43660 1.000 224,835 Ext Wall: FB Half Baths: 1 Unfin Area: Bsmt Grade: VALUATION INFORMATION Masonry Trim: Ext Bath Fix: 0 Tot Fin Area: 2028 Current Total: 517,500 Bldg: 292,700 Land: 224,800 MktLnd: 224,800 Foundation: CN Bath Qual: T RCNLD: 292692 Prior Total: 540,700 Bldg: 304,100 Land: 236,600 MktLnd: 236,600 Kitch Qual: T Eff Yr Built: 1983 Mkt Adj: Heat Type: HW Ext Kitch: Year Built: 1979 Sound Value: Fuel Type: G Grade: G Cost Bldg: 292,700 Fireplace: 1 Bsmt Gar Cap: Condition: A Att Str Vall: Central AC: N Bsmt Gar SF: Pct Complete: Att Str Val2: Att Gar SF: 528%Good P/F/E/R: /100/100/87 Porch Type Porch Area Porch Grade Factor E 126 P 230 W 126 SKETCH PHOTO � — Via • 14 14 S4 E 9 126 Sq. 126 Sq. 24 148 1 39 Sq.R G FA118 528 Sq.R 9BS4f¢fx !' 22 26 nt 74 23 Q P 10 230 Sq.R 10 23 �. � 57 L-36 OLYMPIC LANE w h;l Parcel ID:210/106.6-0141-0000.0 as of 9/9/08 Page 1 of 1 f 00RTIr TOWN OF NORTH ANDOVER opo•` �,1�ou� OFFICE OF p BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 North Andover,Massachusetts 01845 ,s3ACHirS<< Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION pleaselxiut DATE: zoos DI me/C JOB LOCATION: �- Number S A ss Map/Lot HOMEOWNER I rCeeVC 9�(� 66sC�aG �76 Z 7,� /60! Name Home Phone Work Phone PRESENT MAILING ADDRESS ©C /c 20fA kOrd do Ilei(— #0 Cil(1y.- 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 lure 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 helshe understands the Town of North Andover Building Department minimum inspection procedures and and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE ' APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homeowters Exemption 110ARD OF WE S 6,"-9541 CO.NSMr.VFION 688-9530 HEALTH 698-9540 PLANNING 688-9535