HomeMy WebLinkAboutBuilding Permit #531 - 573 JOHNSON STREET 4/10/2009BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: 6`3 Date Received
Date Issued:410-ofC,
IMPORTANT: Applicant must complete all items on this naize
LOCATION .�c , � �ISt N ST A Dovi&-
Print
PROPERTY OWNER C % A0 t0 0 4C
Print
MAP NO: PARCEL:_* ZONING DISTRICT: Historic District yes
�Machine Shoo Villaae ves
no
no
TYPE OF IMPROVEMENT
rot
Residential
Non- Residential
New Building
One family
Addition
Two or more family
no
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
Others:
Demolition
Other
Septic Well
Floodplain Wetlands
Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address:
CONTRACTOR Name: Phone:
Address:
Superuisor's Construction Licens 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: $ �� 3 FEE: $ �"t ---
Check No.: ��i - Receipt No.: 01
NOTE: Persons contractingwit a eyed contractors do not have access to the guaranty fund
signature of Agent/Owner Signature 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
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed on
DATE REJECTED DATE APPROVED
. Fr -
HEALTH Reviewed on Signature
a
COMMENTS
Zoning
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Com
Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Usgood 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 DEPARTMENTMFORM07
Revised 2.2008
Location ,� I -� To(A S o r, C, } -
No. 531 Date
�oRTM TOWN OF NORTH ANDOVER
� 9
Certificate of Occupancy $
Jwc„us•`� Building/Frame Permit Fee $ 3� Q
Foundation Permit Fee $
Other Permit Fee $
�TOTAL $
Check # % T`
2 i J:Jc.
Ka -
Building Inspector
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
t Boston, MA 02111
4 s� www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): �JL, S-�/��DavC
Address: S? 3 7t l ivsoa( S r
City/State/Zip: uo-,Lm4 4v .rL /(-A otNl Phone #:
q7�j-�S 7•1v3,�
Are you an employer? Check the appropriate box:
❑ I am a employer with 4. [:11 am a general contractor and I
employees (full and/or part-time).*
2. ❑ 1 am a sole proprietor or partner-
ship and have no employees
working for me in any capacity.
[No workers' comp. insurance
required.]
3PI am a homeowner doing all work
myself. [No workers' comp.
insurance required.] T
have hired the sub -contractors
listed on the attached sheet. I
These sub -contractors have
workers' comp. insurance.
5. ❑ We are a corporation and its
officers have exercised their
right of exemption per MGL
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.0 Electrical repairs or additions
1 l .❑ Plumbing repairs or additions
12.❑ Roof repairs
13.❑ Other
*Any applicant that checks box #I must also till out the section below showing their workers' compensation policy information.
f 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 their workers' comp. policy information.
I am an emplover 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. #:
Job Site Address:
Expiration Date:
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 certind trains and penalties of perjury that the information provided above is true and correct.
i
rhro• L//�o wS
Phone #: 9 7�- SS 7 - /035
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 #:
Town of North Andover
❑Base Map IF—Zoning 2005 Aerials Watershed Zone Utilities Size 00El
I ❑� Help Scale 1" ft
http://maps.mvpc.org/NorthAndovennimapNiewer.aspx
Page 1 of 1
Selection 11 L
FSelect
(show all)
Owner
SCIAUDONE, P.
1 selected Tc
Property
Ownerl
Owner2
Address
Map/Lot
Lot Size
Fiscal Year
Land Use
Code
Last Sale
3/26/2009
MODEL #:
❑ PINE VINYL ❑ CEDAR
SIZE: $
Q Gray Q Green Q Brown Q Burgundy
Ramps 4x3 Single Door -------------------------------------------------------------------------------
QTY
x $
60.00 ea. $
4x5 Double Door -----------------
-_---_------_-.-------QTY
x $
85.00 ea. $
4x6 Double Door----------------------------------........................................... QTY.
x $
110.00 ea. $
4x7 For Roll -Up Door-----------------------------------------------------------------------
QTY.
—x $
.135.00 ea. $
Pressure Treated % Plywood Flooring Per Sq. Ft. of Floor -------------- NO. OF SQ. FT
x $
2.00 ea. $
Pool Filter Hole------------------------------------------------------------------------------------------------ QTY
—x $
75.00 ea. $
Plywood Partitions -8 -------------------------- -------------------------------------------------------------
Plywood Partitions-10--------------------------------------------------------------------------------------
QTY
QTY
x $
x $
100.00 ea $
125.00 ea. $
Plywood Partitions-12'-----------------------------------------------------------------------------------
QTY.—x
$
150.00 ea. $
No Floor—Per Sq. Ft.-----------------------------------------------------------------------NO.OF SO. FT.
x.$
-(1.00) ea. $
Additional Wall HT Pine Per Lin. Ft --------------------------------------------
Additional Wall HT Vinyl/Cedar Per Lin. Ft ---------------------------------
NO. OF LINEAR FT.
NO. OF LINEAR FT.
z $
x $
5.00 ea. $
6.00 ea. $
Additional Std. Window(s-----------------------------------------------------------------------
----------- QTY
x $
80.00 ea. $
Additional Large Window(sr-------------------- ------------------------ - --- ___------- _---- - --- QTY.
To Change Standard Window to Large --- _---- ------- QTY.
Standard Window Box ----------------- _---------- _-------- __ -QTY.
------------------------------------------
x $
'2- x $
x $
135.00 ea. $
65.00 ea. $
25.00 ea. $
Large Window Box __- --- ------- __ ------------------------------------------------------------
_QTY
x $
35.00 ea. $
Additional 3' Finishshield Door ----------------------------------------------- --------------------------- QTY.
Additional 5' Finishshield Door -------------------------------------------------------------------------- QTY
x $
x $
200.00 ea. $
,250.00 ea. $
Additional 6' Finishshield Door-------------------------------------------------------------------------QTY.
x $
300.00 ea. $
Change 5' Door to 6' Door ---------------------------------------------------------------------------------
QTY.
x $
50.00 ea. $
Additional 5' Steel Roll -Up Door-----------------------------------------------------------------------QTY
Additional 7' Steel Roll -Up Door ------------------------------------------------------------------------
QTY._x
x $
$
350.00 ea. $
400.00 ea. $
To Change 5' Finishshield Door to 5' Roll -Up Door -------------------------------------------
QTY.—x
$
200.00 ea. $
To Change 5' Finishshield Door to 7' Roll -Up Door -------------------------------------------
QTY
x $
250.00 ea. $
Loft 4'x 8 --------------- -------------------------------------------------------------------------------------------QTY.
x $
60.00 ea. $
Loft 4'x 10'-------------------------------------------------------------------------------------------------------
QTY.
—x $
80.00 ea. $
Loft 4'x 12'-----------------------------•-------------------------------------------------------------------------
QTY
—x $
100.00 ea. $
Solar Shed'Light Kit ---------------------------------------------------------------------------
'---------------- QTY.
x $
135.00 ea. $
Architectural Roof Shingles (Not Available on Gambrel Style) ---------
NO. OF SQ. FT
x $
1.00 ea. $
*Shutters included on all Windows
SUBTOTAL $
ROOF COLOR Standard
SHUTTER COLOR Q Almond
`lack Q Blue Q Clay Q White
Q Red
Q Gray Q Green Q Brown Q Burgundy
VINYL COLOR Q Frost White
Q Wicker Beige Q Victorian Siate Q Sunny Maize Q Adobe Clay
Q Warm Sandlewood Q Vintage Sage Q Classic Sand Harbor Stone Q Charcoal Grey
Q New Linen
PLACEMENT OF DOOR(S) AND WINDOW(S)
BACK
Z
LEFT Lada P S ` r
SIDE ItA111 or-*' 1 e
SKETCH IN THE APPROPRIATE SYMBOLS
F=======I—
DEALER
SALESPERSON nak-
AMOUNT RECEIVED $
% lt� STAX $�/ tI,
TOTAL $ 30
y
TOTAL AMOUNT DUE cyfl
UPON DEUVERY $ Z 3$. as
Q CREDIT CARD ❑ CHECK ❑ CASH O TYPE
NO.
MORrM TOWN OF NORTH ANDOVER
o•'"�� `1�° OFFICE OF
BUILDING DEPARTMENT
1600 Osgood Street Building 20, Suite 2-36
�:.,5 •�••� •':tom North Andover, Massachusetts 01845
Gerald A. Brown Al Telephone (978) 688-9545
Inspector of Buildings Fax (978) 688-9542
HOMEOWNER LICENSE EXEMPTION
lease pbt
DATE: 31126 26 0
JOB LOCATION: S 7 3 � tA&/Sb)q SV
Number Street Address
HOMEOWNERT>�„L &,CN .; 976-SS7-)o3S 761-795- (,Z3
Name Home Phone Work Phone
PRESENT MAILING ADDRESS 5-7-,? as N 50ty ST
No�,r,a fyNW,/C /1I A of bq!
City Town State Zip Code
The mient exemption for homeowners” was extended to include owner -occupied dwellings to two units or less
and to ailaw such homeowners to engage an individual for hire who does not possess a license, prodded that the
owner acts as supervisor). State Building (Code Section 108.3.5.1)
DEFDJTI'ION 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 mquircip is and that he/she will comply with said procedures and
requirements. �� )J �, 2
HOMEOWNERS
APPROVAL OF BUILDING OFFICIAL
xmised 10.2005
Foam Horaeo "m Em mw ion
BOARD OF \PPE:\1.S 6R9-9541 CONSERV.\'I'IQN 688-9530 NEAL'Ili 6x8-9540 PL.-NNING (88-9535
ants VIV VVI JJJV iNvAir=rUN t1.00M
191UUziUUZ
MORTGAGE INSPECTION FLAN
NORTHERN ASSOCIATES, INC.
401 SOUTH BROADWAY, LAWRENCE MA. 01843-3522 TEL:(978) 837--3335 FAX:(978) 837-3336
MORTGAGOR= PAUL L 4 5HERYL A SCIAUDONE
LOCATION: 573 JOHN50N 5TREfT
CITY,5TATE: NORTH ANDOVER, MA
DATA=: 1/ 1 1/09
I
•
CERTIMED T : WACNOVIA MORTGAGF, F515
Flood hw s has been determtned by scale
and is ri;y accurate.lhdU aej�ir hive plans
are g D and/or a vertioaZ contra! survey
is per d~iorra canrtnt be determined.
0
LOT 4
43,5GO 51=4,
150.00,
JOHN50N 5TREET
�vor� ZY.sa re
rnspm i9n waa prepared
6prtosfrCall¢� jb
l purpose only and
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v JXaddeetermination
FIMSELL
only and
be used to estabMah p►vpeniy
7
lingo. The
hereon are baaod art
CiiQnE-
and may be svb7eot
to further
takiimm emome►da amd s$ohts
of wasfi
of "ward and prawrptive
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it g
to land owner or odoup%w4,
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ils proposed nr+art8age jtinaneino to Wd owrteagor.
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DEED REF: ,
PLAN Rfr- 12 123
5CALff: I "=G0'
JOB #: 209.00072
�I
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h
This maltggaappee i:aa !on was psepared in aaaar�deewe
with the 9� n SYaadarrls j9r YosY9d8o I-qTM
In apsetiona az adopted by the Aftasmhn,utes Board of
Regtstratton of Amis—&-fil Efti— -ad Iamd
SM"AMPU v 050 C" 605.
I further state that 4n my projosaionor opmiara that
/the sfriochrQa shown cenjb m with the raaar as ing horizontal
di:ner+aianal setback nequi�nents at the ;tare of don0ruct{on, or
aro exempt wider prevtaione of K&1_ CS I0 -A Sec. V.
401. /House is net ua Aged l3avand.
M I Fre to ix a Plead Ab awd Asea.
O 8 I tion {s tns+;/j 1009 to atmeRr vA w Rood hazard.
Mood Hawed determined roan latex! Fedarel Flood
'r,""M lento lf"p Fw g
Date - e7 3.- San v