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Home My WebLink AboutBuilding Permit #332 - 58 MAY STREET 10/26/2009 TOWN OF NORTH ANDOVER 2 APPLICATION FOR PLAN EXAMINATION Permit NO: J Date Received Date Issued: l6 "� I IMPORTANT:Applicant must complete all items on this page LOCATION AV V& ,,,erint I PROPERTY OWNER ` Print MAP NO: di—PARCEL:, ZONING DISTRICT: Historic District yes -no Machine Shop Village yet; no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building "eP 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 PERFORMED: off J,Z7 Identification Please Type or Print Clearly) OWNER: Name: aAa a Phone: • r��8 /,,:5.-a Address: CONTRACTOR Name: Phone: r� =c Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp, ;Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$1200 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ w FEE: $ �— Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner +ay, nature of contractor Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGEJDI�POSAL Public Sewer Tanning/MassageBody 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 t Si nature r COMMENTS HEALTH Reviewed on Signature i 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 I Doc: Doc.Building Permit Revised 2008 Location �� -S- q No. Z-- Date MORTH TOWN OF NORTH ANDOVER 0 �. • O� F i Certificate of Occupancy $ _ �ss+cMustBuilding/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �g 2GJV;j Building Inspector NORTH Town of 2 : Andover o z= LAKE dover, Mass., to 24 COCMICMEWICK 0RATE D APS\ cb BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System 1 BUILDING INSPECTOR THIS CERTIFIES THAT I . . ........ . Foundati on has permission to erect........................................ buildings on ....... ............ ... ......... ....... .............. Rough CIA a tobe occupied as......S.K.8........... .. .. AL............................................................................................................to 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 36 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU TARTS Rough ............. ..................................... Service BUI TOR 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. I Residential Property Record Card PARCEL_ID:210/018.0-0008-0000.0 MAP:018.0 BLOCK:0008 LOT:0000.0 PARCEL ADDRESS:58 MAY STREET FY:2009 PARCEL INFORMATION Use-Code: 101 Sale Price: 0 Book: 01059 Road Type: T Inspect Date: 10/02/2006 Tax Class: T Sale Date: 12/31/65 Page: 0054 Rd Condition: P Meas Date: 06/16/2000 Owner: Tot Fin Area: 3191 Sale Type: Cert/Doc: Traffic: M Entrance: X FONTAINE, RAYMOND Tot Land Area: 0.15 Sale Valid: N Water: Collect Id: SGC MADELINE FONTAINE Grantor: Sewer: Inspect Reas: M Address: 58 MAY STREETExempt-B/L% / 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: CO Tot Rooms: 9 Main Fn Area: 1685 Attic: Y NBHD CODE: 4 NBHD CLASS: 4 ZONE: R4 Story Height: 3.00 Bedrooms: 5 Up Fn Area: 1506 Bsmt Area: 1185 Seg Type Code Method Sq-Ft Acres Influ-Y/N Value Class Roof: G Full Baths: 2 Add Fn Area: Fn Bsmt Area: 1 P 101 S 6400 0.150 156,306 Ext Wall: WS Half Baths: Unfin Area: 395 Bsmt Grade: VALUATION INFORMATION Masonry Trim: Ext Bath Fix: 0 Tot Fin Area: 3191 Current Total: 376,700 Bldg: 220,400 Land: 156,300 MktLnd: 156,300 Foundation: BK Bath Qual: T RCNLD: 220370 Prior Total: 376,700 Bldg: 220,400 Land: 156,300 MktLnd: 156,300 Kitch Qual: T Eff Yr Built: 1962 Mkt Adj: Heat Type: FA Ext Kitch: 1 Year Built: 1920 Sound Value: Fuel Type: G Grade: A Cost Bldg: 220,400 Fireplace: 0 Bsmt Gar Cap: Condition: FA Aft Str Vail: Central AC: N Bsmt Gar SF: Pct Complete: Aft Str Va12: Aft Gar SF: %Good P/F/E/R: //100/72 Porch Type Porch Area Porch Grade Factor E 119 P 240 SKETCH PHOTO P FU"0.75 P 120 q.R 500 Sq.R 120 q.R 20 20 20 20 FM 1685 Sq.R 1 UIN35 29 29 If 9 17 E 58-60 MAY STREET 119 Sq.R 17 Parcel ID:210/018.0-0008-0000.0 as of 10/16/09 Page 1 of 1 i North Andover MIMAP 58 May Street October 16, 2009 00 . 0 0 0 00 .• 00 018.0-0004 00 00 0 � 06 00 00 .0 018.0-0005 eet 018.0-0010 rya i 018.0-0009 0 8.0-00117 018.0-0008 li? 018.0-0018 018.0-000 018.0-0019 018.0-0006 018.0-0020 S� 018.0-0021 `moo ale 1..0-0006 018.0-0024 Rall Line Interstates Interstate Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, —Major Roads - Meters Data Sources:The data for this map was produced by Merrimack Roads f pORTry, Valley Planning Commission(MVPC)using data provided by the Town of O ",to 7• North Andover.Additional data provided by the Executive Office of Ci Easements 'fit �e�y OO Environmental Affairs/MassGIS.The Information depicted on this map Is Tralls _ for planning purposes only.It may not be adequate for legal boundary Streams f -� e definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING O MVPC Boundary • ; THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY w^ # OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT O Municipal Boundary �► no �� 1 ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF ❑Parcels �"o�� ",fig THIS INFORMATION Hydrographic Features �'�$ CH Wetlands $A�NUSE Exempt Lands 1^=39 ft '"�` North Andover Pictometry Viewer Page 1 of 1 : .: Town of North Andover Massachusetts Municipal Information Mapping Access Program (MIMAP) View from the South ❑ t Fri,Nov 23, 2007 .> ..... 11:03 AM '• " View from the North Frl,Nov 23, 2007 10:16 AM I ,® View from the East Fri,Nov 23, 2007 Size 10:09 AM ❑ N ❑ View from the West s Fri,Nov 23, Google Maps Go v2.)(beta 11 r Layers r Labels er mud NYar NemaF('aneerim des notnLLn eywmh.ezPteued ofemptied nnarne env kpiliel>iliryarrw}ewsd>fliN for thn awncy.rxnFdetsea.aruMutrcn,o1'de('.eogrehYic.bf aion Svsera X015}4Voaov advden psmWedMmn.Thc OlS dre is iihwnhreanly mlenddshuld Mlnamrdadfn rY eOapu.pue.ThedeY donna mle lye Fian otep�af slmel surrey ndhu rrokpl beerire(t e the rna Jspe,m,bcaYm,aeXulwse alepessEvphn lrture,waprnylme.wpdifiod npr�ennou.Akmeeak alley Pl�sq,Camaisraa squats Wt oy use of Ols nlamnlevn bs eeoenpesed Eyerekrtnm n aces dtheM —k Wley Plemag Creumsdnn'surntthn is net mwemnuesnnpremntntrnssnrye aunty afeddafmriulNn.Any—Ab,aG .hoes M rhes ,.A ran rich. http://maps.mvpc.org/GPVPictoNorthAndover/viewer.aspx?lon=-71.13 55907&lat=42.70... 10/16/2009 4 This* Plait'do r snot "quire the :��,�� of Ih6 � � �'�an�?'i�•�-;� o�r� o� siva Town of tl h. e r 7 Aw 7T _.. .. _ _��.._.. ...._.:��...... can E-,r �o :b L+ A N L. ,d NLS /N NORr" "ASSACAZln� TT,% As I?AYIWOAID. A r 4s' 7- R ,E K n 80.00 r - eor. oc�ges o J ( 57 lei ( 2 SAY W"/'e., I o u ( �ewC .ro w 7 498 • 'a� Q CO 01 CUkTOK- N FOSTER e-,5 /d.3 //7q/0/7 .50uare Nig rhi c�Suryeyor t , The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Naive Business/Or anization/Individual ' P Address: v�y /1144 City/State/Zip: �Co r ,'�N �rq, / i Q I�'� -Phone#: ` 2`� - 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. t 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for in any capacity. workers' comp. insurance. 9. Building addition o workers' comp. insurance 5. ❑ We are a co ❑ g [N p. corporation and its Electrical re required.] officers have exercised their 10.❑ pairs or additions 3. I 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 12.❑ Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13.❑ Other '.^.r.y uyplicant that checks box#1 m••µ..so F.11 out the section below showing their workers'compensation policy information. LLJ.WOV l t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors 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 thepolicy and job site information. Insurance Company Name: Policy#or Self4ris. 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 certift under the pains andpenalties ofperjury that the information provided above is true and correct 1 Si afore: Date: as 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' " P P P p insurance coverage required." g � 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 c workers' compensation insurance. If an LLC or LLP does have q �' p . . 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 thepermit 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-inured 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 Investigation 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 bum 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 4 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,021.11. Tel. # 617-7274900 ext 4,06 or 1-877-1MASSAFE Revised 5-26-05 Fax# 617-727-7749 www-mass.gov/dia .* µORT#+ TOWN OF NORTH ANDOVER o�,i OFFICE OF p BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 " , �y North Andover,Massachusetts 01845 �SSgC►+uSE� Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please print DATE: JOB LOCATION: ✓� j` —.T?' Number Street Address Map/Lot HOMEOWNERo — ame Home Phone �e PRESENT MAILING ADDRESS L!57- 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 familystructures. A person who cont _ p constructs more that one home in a two-year period shall not be Y 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 requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE_A�r�_j e�;F� APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535