HomeMy WebLinkAboutBuilding Permit #237-2017 - 58 GLENWOOD STREET 9/6/2016 BUILDING PERMIT NORTFr w.
O��SLED /6 ALO li
TOWN OF NORTH ANDOVER 3� y
o
APPLICATION FOR PLAN EXAMINATION
— Date Received '� a� o,Pa`g5
Permit No#: re
�SsgCHus�c
Date Issued:
I ORTANT: Applicant must complete all items on this page 4
LOCATION � 6y*,07 Gt,�D
PROPERTY OWNE Print��1�/r9
Print 100 Year Structure yes no
MAPPARCEL: `b ZONING DISTRICT: Historic District ye no
Machine Shop Village y no
TYPE OF IMPROVEMENT PROPOSED USE
Res i ntial Non- Residential
❑ New Building ne family
0 Addition El Two or more family El Industrial
❑Alteration No. of units: 0 Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition _ ❑ Other
❑ Septic [I Well ❑ Floodplain. ❑Wetlands ❑ Watershed District
0 Water/Sewer '
DESCRIPTION OF WORK TO BE PERFORMED:
Identification- Please Type or Print Clearly
OWNER: Name:a16,4-11%A,,V ��i�9c�' Phone:s/7-/- l°x2,q11rrz1
Address: G Dc/ --� �v O�/)
Contractor Name: Phone:
Email:
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASEDON$125.00 PER S.F.
Total Project Cost: $ 1,91, (Jr� 0. FEE: $
Check No.: lb 7b Receipt No.:
NOTE: Persons contracting`wa4h registered contractors do not have access to the guaranty fund
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 Dumnpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS N
a
ONSERVATION Reviewed onR (e Si nature 1
7"
COMMENTS A)"
HEALTH Reviewed on Siqnature
COMMENTS Q,w�
t
ZoningBoard of Appeals:ppeals: Variance, Petition No: Zoning Decision/receipt submitted yes
�r
Planning Board Decision: Comments
Conservation Decision: Comments
Water& Sewer Connection/signature & Date Driveway Permit
DPW Town Engineer: Signature:
FIREDEPARdTMENT Te t Located 384 Osgood Street
i mpDumpstergntsite �es,�� Oro
;Locate�at'�124tMainiStreet - -_ 1
-e4De artment,s` - ,
p :gnature/date;
-.- .
COMMLNTS
- s
Plans Submitted
Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE O SSEWERAGE DISPOSAL
Public Sewer
Tanning/Massage/Body Art ❑ Swhnming Pools ❑
Well ❑ ❑
Tobacco Sales Food Packaging/Sales ❑
Private(septic tank, etc. ❑ Permanent Dwnpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF m U FORM
\�/PLANNING & DEVELOPMENT Reviewed On
lLI zolo Signature
COMMENTS
ONSERVATION Reviewed on R
Signature 1-4
COMMENTS
HEALTH Reviewed on
Signature
COMMENTS
I
Zoning Board of Appeals: Variance, Petition No:
Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
i
Conservation Decision: Comments
Wafter& Sewer Connection'si nature&Date
Driveway Permit
DPW Town Engineer: Signature:
FIRE DEPAR�TtMENT,.g;;Te p o Located 84 Osgood Street
x 3 rnp um ster 3
a., �tlaat4124 Main:St�eet '. r : p� n ,S�tC��ye5
.,Fire�Dep
..,, -r, a _ signature/date• r w �, , �` ,� t
i
h
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.$Ioo-$1odo fine
NOTES and DATA— (For department use)
LI Notified for pickup Call Email
Date
Time Contact Name
Doc.Building Pennit Revised 2014
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
OTE: 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
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
Building Permit Application
i
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
2012 IECC Energy code
Engineering Affidavits for Engineered products
OTE: 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:Building Permit Revised 2014
t4O R T11
Town of 6Andover
No. a 31_ 2b y
7z
h ver, Mass ?-hip
coc«Ic«EwIcw
x,95 RATED �'PP,`'�5
U BOARD OF HEALTH
LDFood/Kitchen
PER T Septic System
- % T I N e BUILDING INSPECTOR
THIS CERTIFIES THAT ................ ...... ..:.lr�.AA....... ..... ................... ........................ ..... ................
Foundation
has permission to erect .... ................. .. build' gs on .. ...... .. .... ......
.� Rough
tobe occupied as ....... .. .... ....... ...... .... ........................................... Chimney
provided that the person accepting this permit shall in a ry respect c nform to the terms of the application Final
on file in 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 CONS TI Rough
Service
... .. ... .. ... ........ ...... Final
BUIL INSPE TOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building 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.
Smoke Det.
51 9
CIA CDS v)"5
laooj
4
g� �sA
el
,FF 9F
D
\ / 41
7 _ 713
7 LEGEND: 7
CONC. WAL 14 S85°15'00"W150.00' �3 RET. EOP EDGE OF PAVEMENT v1
� n
I C.L.F. X
{ LOT AREA { I L WETLAND RESOURE AREA
A—.1
15,000 S.F.
--- M i,
_ o j �'A-5 WETLAND FLAG
7 1 31.4' PROP. STAKED SILT FENCE ,31,8( { T�
{ 24x9 I { EXAREA DEN b C.L.F CHAIN LINK FENCE vj
TAX MAP
LOT #
43'' DECK 52.31-2 p P '�
25x8 12.3 %25x0 240 m p 99X55 EXISTING SPOT GRADE
p 1 SET DECK ` 12r3x4 po o �? FFE FIRST FLOOR ELEVATION `y
1 AT EL=33.50 { X n
O O Rem veEx. Ste s� F=; N
Step _ G� o 'T' Z3A VARIANCE GRANTED. t
��
56 6.6 �"'� 4 8 t 91 -Ti
, THE TOWN OF NORTH ANDOVER ZBA GRANTED
I EX. 2. STORY 1 r A VARIANCE PER DECISION 2007-015 FOR THE
1 WD. FR. STRUCTURE 2 x8 �1 BUILDING HEIGHT FOR THIS PROPERTY. SEE
1 ,1111 hl BOOK 10908 PAGE 232 AT THE ESSEX NORTH
FFE=34.05' A—3 REGISTRY OF DEEDS FOR THE RECORDED DECISION. lJ
7 / 2 CAR I 0 1
#58 GARAGE 36" °O
2x4 \ FLOODPLAIN NOTE:
26x2 PLATFORM LATFORM Bit. Conc.. Prop. 48of 64 PVC\Fence w/.Gate ):h.. THE ENTIRE PROPERTY FALLS WITHIN A DESIGNATED
Driveway ,` A-4 ZONE AE FLOODPLAIN AS SHOWN ON THE LATEST F.I.R.M.\
COMPOSITE - 19. `\ MAP (PANEL 25009CO209F DATED 7/3/2012)
PLATFORM W ZONE AE FLOOD ELEVATION = 34'
1, , 7 STEPS J� i Q II
N m DHSS°15'00"E m�, J ,�, 150.00'
oco Ah- 0 � �1
co
Z - I �,,]� n �
hyo H ;3 '�.4 i J .
24x5 EOP 23x2 JUL v
GLENWOOD STREET
BENCHMARK: 58 GLA'"00D S7WEET
PK NAIL IN PAVEMENT ZONING INFORMA TION:
ELEVATION = 23.12' ZONING DISTRICT : R4 PLOT ''LAN OF LANDLOCATED IN
NORTH A100VER, MASSA CHUS TTS
(ESSEX COUNTY)
ASSESSOR INFORMATION: ' ` ` , _ PREPARED FOR
x 4A, ?
MAP 7 LOTS 10-12 r 1 �� �% MAR.[NA STNA CI
DEED REFERENCE: z �xxr � � ,t; p SCALE: I "=- 20' DAVE: JUNE 24, 2016
BOOK: 14421 PAGE: 40 � -? a±= n a
_ PREPARED BY
F :5, , �� r
OWNER INFORMATION: GRAPHIC SCALE `;' _ "�� ''r`
A. g °a° u SULLIVAN ENGINEERING GROUP, LLC
P.O. BOX 2009
MARINA S1NAC1 FEET SCALE. 1"--20'
58 GLENWOOD STREET 20 0 10 20 40 WOBURN, WA 01888
Lar�. �,„;:,
NORTH ANDOVER, MA 01845 '"`” ``a'� (781) 854-8644
TOWN OF NORTH ANDOVERas
�
_s_ _ OFFICE OF
_ BUILDING DEPARTMENT
*� 1600 Osgood Street,Building 20, Suite 2035
North Andover,Massachusetts 01845
Gerald A. Brown Telephone(9 78)688-9545
Inspector of Buildings, Fax (978)688-9542
HOMEOWNER LICENSE EXEMPTION
DIJIDING PERMIT A'PPLICA`1,0N
Please print
DATE:
JOB LOCATION:
Nur ber Street Address p Map/Lot GP
HOMEOWNER—C/
Name Home Phone �J Work Phone
PRESENT MAILING ADDRESS J
City Town State Zip Code
The current exemption for"homeowners"was extended to include owner occupied dwellings of one or two family
dwellings and to allow such homeowners to engage an individual for hire who does not possess a license,provided
that the owner acts as supervisor.
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 dwelling,attached or detached structures accessory to such use and/or farm structures.A
person who constructs more than one home in a two-year period shall not be considered a homeowner.(780 CMR
Section 110.R5.1.2)
The undersigned"homeowner"assumes responsibility for compliance with 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 requireme that he/sh will comply with said procedures and
requirements. -
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Revised 8.2015
Form Homeowners Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
The Common-wealth of lMXas'�s,,�,'chusetts
:.z DepaptMeng ofindusMalAcctclents
1 Congress Street,Suite 100
Boston,MA 02114.2017
•J'•,"•,^tV4� WWW ma�ss.govfalza
5Y a kers'Compeaisationlnsuranee.Afidavzt:Builders/ContractorslEleetdeiamTlian.bens.
TO BE FffL 0 WITff TBE RERARTUNG AUTHORITY'.
Applicant InfolmatiOn Please Print Tlea1
Name (B-asmess/Or emationllndividual):p /q R4.4,19
Address: S� (1—/eAl L-00
cztyltatelzip: Phone
Areyou an employer? checicf&ap,ropriaie box: Type ox project(I'eClu7Sed):
1.I l am a employerv&h employees(iirll audlorparf-time).* 'J.• New construction
2.0 I am a sole ptoprietozorparfnership andhave no employees working forme in 8. 0 Remodeling
any capacity.[No wo±ers'comp.insurance requited.] 9, El Demolition
3.)ZI am a homeownerdoiagall workmyseLr ENo workers'comp.insurance regrrized.] 10 Building addition
4.n I am a homeownerand vM be hiring contmeLors w conduct all-Work on my property I will
ensure that.all contractors either have workers'compensation insurance or are sole 11: Electrical repairs or.additions
proprietors-withno employees. 12: Plumbing repairs or additions
5.❑IamageneralconfraaforzndIhavehiredthesab-contractorslistadontheattachedsheet 13: Roafrep af-s
These sab-canfractorshave employees andhave workers'comp_fi mm=T
' ' • 14.El Offer
6.Q We area corporatia¢pad#f pfcershaveegercised e righto�egemptionperMGLc.
152,§1(4),andwehaveno,employe. jNoworkers'comp.insuraneezequired.]
`AnyappHcaotthatchecksb&41mustalsozIMouttheseeiionbelowshowingthenworkers'compensaaonpnIicyi onnauon
T Homeowners'S ED Mi )Eitt�ff afAdadth-hCatingthey are doing all workaadthenhire outside canlractorsmnstsit-it anew affidaviLindicating such
?Contractors_haat checktb3s b�mus 4a ached an addit onal sheet showing the name of the sub-cont ractoss and state whether ornotrliose enfides have
employees. if the sub-cozifracbn have employees,liey must pro-vidaf ieir workers'comnu
p.policy mber.
I amore an erriployer t1z at zs.piovidingworkers'compensation insunmeefor my ezRTloyees:'13eloiv is thepolicy acid jog site
infoi7nadon.
Insurance Company 3lyame:
Policy,#or Self-zns.lic.#: ExpirationDate:
lob Site Address: � P�Z f/Q oG! S� //h" Q/l to//Zip -
Attach a copy oftheyFoykers' coxapeWationpolicy declaradonpage(showingtAepolicynumber and expixatzoa date).
Failure to secure coverage as required under MGL o. 152, §25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprlonmc4,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$25'0.00 a
day against the violator.A,copy of this statement may b e forwarded to the Office of Investigations of the DTA for insurance
coverage verifiGation-
Z do hereby c c_ sins and penalties ofpetja�y Haat the infornaifon provided aboae is�zie and comer eft
Si afore:
Date:
Phone#
D fficzal use only. JI o not7vrite in this area,to be completed by city or toYwn o iicfaX.
City or Town: PermitlLicense#
Issuing Authority'(circle one): 1
1.)Board of ffealtli.2.BuildiugDepartment 3.CRy/T'own Clerk 4.Electrical;inspector 5_Plumbing Inspector
6.Other
Co)atact Person: Phone Ah
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation fortbeir employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract bf hire,
express or implied,oral or written."
Au.employer is defined as"an individual,partnership,ass ciation,corporation or other legal entity,or any two or more
Of the foregoing engaged in a joint enfi6rprise,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 beau 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 coramonwealtht for any
applicant who Lias not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states`Neither the commonwealth nor any ofits 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 dompletely,by checking he boxes that apply to your situation and,if
necessary, supply sub contractoi(s)name(s),address(es)and•phonenumber(s)along with their certificates)of
insurance. LimitedLiability Companies(LLC)or Limited Liability Partnerships(LLP)withno employees'otherthan the
members or p attn.ers,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees, a policy is required. lie advised that this affidavit maybe submitted to the Department of•Industrial
.Accidents foi confixi ation ofinsurance coverage. Also be sure to sign and date the affidavit. Thaaffildavitshould
be retained 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 regardingthe law or if you'are xequired to obtain a workers'
compensation policy,please call the Deportment at the number listed below. Self-iissi red.companies should'enter their'
self-insurance license number on the appropriate line.
City or'I'own Officials
Please be sure that the affidavit is complete and printed legibly. The De artment has xovided a space ace at the bottom
P P
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 areference number. In.addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit i=ndicating current
policy information(if necessary)and under`fob 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 Erle for future permits or licenses. A newaffidavit 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 bum leaves etc.)said poison is NOT required to complete this affidavit.
The Department's address,telephone and fax number:
The Commonwealth of MassacEusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston,MA 02114-2017
Tel.# 617.727-4900 ext. 7406 or 1-877-MAS-SAFE
Fax#617-7277749
Revised 02-23-15 wwwmass.gov/dia