Loading...
HomeMy WebLinkAboutBuilding Permit #218-03 - 571 SHARPNERS POND ROAD 9/29/2003 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: � 7 Date Received Date Issued: / IMPORTANT: Applicant must complete all items on this page � Pnnt� PROPERTY�"OWNE_R�..�3C". Printf 1p:0�YedWid Structure yes; „ _ MAP'NO' PARCEL ZONINGtDISaTRICT Historic pistnct; yes nos _ - ti J Machine;Shop.V,illage� yes, o, TYPE OF IMPROVEMENT PROPOSED USE I Residential Non- Residential ❑ New BuildingOne family ❑Addition ❑Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ ❑ Septic, ❑slNellB ❑ Floodplami ElVVetlantls, ^(]�1Natershe:dQDistrict� . f ❑Water%Sewer, - DESCRIPTION OF WORK TO BE PERFORMED: I Identification Please Type or Print Clearly) OWNER: Name:/,e"d2.Cl 2 y Ph e:�� Address: CQNTACTORRName. L `u/ Lvfone _ - _ - - Add' }SupervisorrszCons.true#ionsLicense,: Expo 'Date: 1 _ Ii•. ;Hornelmproye_ment;Lcense: - Ezp; Q'ate ARCHITECT/ENGINEER Phone: Address: Reg. No. li FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ i Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ...f,r.««,y .fie w+. s SignatureF of Agent/O' rf , Si nafure'of contractor '. _ -r ��_:.� _ _ _ u ., 9 ._.___..��_._..____. v._ _ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans 0 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 DumP ster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM I DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on X') /3 Siqnature��", CO— COMMENTS 0�\ Lo (D-�S�03 e r dens �s Irz HEALTH Reviewed on `f 9 r Siqnatgre , COMMENTS �� x z D � �l� 11]r i Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments I Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit f DPW Towz., ]Engineer: Signature: Located 384 Osgood Street FIRE ®EPARTME'NT -,Temp Dumpster on site yes no Located at'124:Main Street - Fire Departinert-t* 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 I L3 Notified for pickup - Date Doc.Building Permit Revised 2010 i f 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 k ❑ Building Permit Application F ❑ 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 (VOTE: 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 i ❑ 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 (VOTE: 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 app:,al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording subm,. a must be ted with the building application Doc: Doc.Bui?ding Permit Revised 2012 µoerH TO"OF NORTH ANDOVER Q4,7teo a'Sy 02 0--'e k., 0 OFFICE OF fia p BUILDING DEPARTMENT ` '.1600 Osgood Street Building 20,-Suite 2-36 y "4r. � North.Andover,Massachusetts 01845 f_Gerald A.Browny Telephone(978)688-9545 Inspector'of Buildings Fax (978)688-9542 HOMEOWNER•LICENSE EXEMPTION BUIDING PER UT APPLICATION Please print `�✓ • DATE: • JOB LOCATION: Ap,Lb Number Street Address Map/Lot IJOMEOWNER Name Home Phone Work Phone PRESENT MAILING ADDRESS �' S 17 P A-12, Cit- Tom Stag• Zip Code The current exemption for`4homeownare,was extended to include owner-occupied dwellings to two units.or less and to allow such homeosfners to engage an iidividual.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 Persons)who gwns 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 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 Forth Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements, HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL, Revised 7.2009 Form Homeowners Exemption . BOARD OF APPEALS 688-9541 CONSERVATION 688-9530r HEALTH 688-9540 PUNNIIQG 688-9531 EXISTING DISTRIBUTION BOX tic�F �cy T cy TSF q�,y T� ,pF�cy icy Fti �y SWING TIES O 1 TO A 26.0' 2 TO A 15.8' 1 TO B 33.8' 2 TO B 15.5' 1500 GALLON SEPTIC TANK / 500 GALLON PUMP CHAMBER IV WD] INV IN 92.66, INV OUT 92.49 a _� - +6-- 2 10' O I EXISTING OF DWELLING I GLUED JOINT SCH 40 PV.. '� � S = 0.02Qi ' ®EkJ,4Mlb C. FOUNDATION INVERT 93.25 OSGOOD,JR. CIVIL NEW ADDITION NOTE: MAL THIS AS BUILT PLAN IS FOR THE RELOCATED SEP NLY. FOR LOCATION INFORMATION REGARDING THE LEACH TRENCHES, SEE PLAN ON _ FILE WITH NORTH ANDOVER BOARD OF HEALTH PREPARED BY JOSEPH BARBAGALLO DATED 10/7/1994. 20' 0 20' 40 60' This is to certify that New England Engineering Services Inc. has inspected the septic tank SEPTIC TANK RELOCATION relocation installed at 571 Sharpners Pond Road, AS BUILT PLAN North Andover, MA. The system has been constructed in compliance with 310 CMR 15.00, 571 SHARPNERS POND ROAD the approved design plans dated 9/19/2003, and NORTH ANDOVER, MA local requirements, except as noted herein. SCALE: 1" = 20' v DATE: SEPTEMBER 27, 2004 RECEIVED NEW ENGLAND ENGINEERING SERVICES 60 BEECHWOOD DRIVE OCT 0 2004 NORTH ANDOVER, MA (978) 686-1768 TORE�TwjI� F'AI�TMa°T~R PLAN #: DRAWN CHECKED BY: 56P BY: P,C,O,fir, 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 Anmlicant Information Please Print Legibly Name(Business/organization/Individual): erw t',""t�2 Address:�7� City/State/Zip: �e' . �?'�'�j 01/A- Phone#: i Lre you an employer?Check the appropriate box: Type of project(required): ❑ 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 El am a sole proprietor or partner- listed on the attached sheet.# ? 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 i required.] 4_ officers have exercised their 10.0 Electrical repairs or additions I am a homeowner doing all work - right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers comp. N ., c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t � employees.[No workers' 13 ther �comp.iinsurance required.] �`��'/� ty applicant that checks box#1 must also fill out the section Below showing their workers'compensation policy,information. omeowners who submit this affidavit indicating theyare doing all work and then hire outside contractors must submit a new affidavit indicating such. ntractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. W itn employer that is providing workers'compensation insurance for my employees. Below is the policy anti job site grmation. urance Company Name: icy#or Self-ins.Lic.#: Expiration Date: Site Address: City/State/Zip: ach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). lure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a 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 tp to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of ,stigations of the DIA for insurance coverage verification. t hereby certunder thepains andpenalti ofperjctry that the information provided above is true and correct. iature: Date: ?� ne#: official use only. Do not write in this area,to be completed by city or town official. ;ity or Town: Permit/License# ssuing Authority(circle one): .Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector Other '-nnfarf P.-Ven". Ph nn,-.i#- 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/license 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, ilease do not hesitate to give us a call. he Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA.021.11 Tel..#617-727-4900 ext 406 or 1-877-MASSAFE Fay:f(17-7?7-.774.9 or—) 102.7' 102.7' EX/ST.FND. LOT 4 �o 0 •o. 53.3' 12p 0. iy f 1 0 0 a I SEP z 199N', SND RD. FOUNDATION LOCATION PLAN THE PRIMARY STRUCTURE HE HORIZONTAL SETBACK REOUIREMENTS OFSHOWN THE LOTO LOCAL APPLICABLE ZONING BY-LAWS IN EFFECT WHEN CONSTRUCTED. (THIS CERTIFICATION DOES NOT CONSIDER ANY OTHER J.BA RBA GA L L O RESTRICRONS SUCH AS COVENANTS WETLANDS,EASEMENTS, CLIENT. ORDERS OF CONDITIONSETC) • HIS DRAWING SHALL NOT BE USED BY HE CLIENT FOR ANY THIS CERTIFICATION IS MADE AND LIMITED PURPOSE OTHER THAN THAT OUTLINED ABOVE,EXCEPT WITH HE WRITTEN PERMISSION OF CHRISTIANSEN & SERGI INC. TO THE.ABOVE CLIENT. FURTHERMORE THIS DRAWING IS THE COPYRIGHTED PROPERTY OF CHRISTIANSEN & SERGI INC. AND ANY UNAUTHORIZED USE IS PROH/BITED.CHR/STlANSEN & SERGI TAKES NO RESPONSIBILITY FOR THE UNAUTHORIZED USE OF THIS DRAWING OR ANY INFOR- MATION CONTAINED HEREON. i LOCATION:SHARPNERS POND RD. ti NO.ANDOVER OF " g MICH � SCALE:1"=60' DA TE.8/31/94 z J. " No 91 0 CHR/S TIA NSE/V SERGI PROFESSIONAL ENGINEERS �}�_ LAND SURVEYORS 150 SUMMER ST. HAVERHILL,MA. OIBJO TEL 508-37J-0510 ©1994 BY CHRISTIANSEN & SERGI INC. DWG.NO.:94057002