HomeMy WebLinkAboutBuilding Permit #120-12 - 614 FOREST STREET 8/10/2011 i
/d a, 1d -- TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit N0: Date Received /
Date Issued: IRV
IMPORTANT: Applicant must com lete all items on this page
LOCATION STRL E7:
Print
PROPERTY OWNER M tU4e LC 4 30 C-nQC-f;r Unit#
Print
MAP NO: 10 5 PARCEL: ZONING DISTRICT: Historic District yes G
Machine Shop Village yes no
100 year-old structure 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 ❑ Others:
❑ Demolition ❑ Other _
®;Septic (] Well t `C Fl oo d lain Wtlar�d s ,�h ❑ Uatershedist_iiet
[jWaterl$ewer-
DESCRIPTION OF WORK TO BE PERFORMED:
(Identification Please Type olrPrint Clearly)
OWNER: Name: M l C 6UF_ ki_. p Phone: U l-4-953--+2.(o i.
Address: lol FOR_E--_Yr- STpiEiET
CONTRACTOR'Name: cL°" v +T' °Phoria: `a LI Si-l'-�S 1
01'1 q-
Address: _1S0 t'l 1.CJD Le q--q-&-eT Ww,-E .... 1_mffy 0 lci_, ->Z-
, Supervisor's Construction License: Exp. Date: ZZ Zbl�
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Q\uLk A-r--i UouT Phone: q`)8- Z.1E>_4 -4ST-7C0
Address: 3 W� t�tA-�t�1 S�. t'1 e-17_ ZArnpv� Reg. No. 3G1cp�Y_�')
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ 101 ! vacs . FEE: $ P3 q
Check No.: 1225 Receipt No.: oZ
NOTE: Persons contracting with unregistered,contractors do not have access to the aranty fund
Signature ofiAaerit/Qwner= '
r y
Sianat� "re nf eintartnl5( 'z1' `l�r�
Location
No. —1 Date j
NORTH TOWN OF NORTH ANDOVER
F
° Certificate of Occupancy $
bis'•"°';�� Building/Frame Permit Fee $
s�CHus
Foundation Permit Fee $
Other Permit Fee $
n TOTAL $
Check # L
24463
Building Inspector
{
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools1
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
ges 6RIQAT ON Reviewed on Si nate ZG
r
COMMENTS
HEALTH Reviewed on / Si nature
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
I
❑ Notified for pickup - Date
Doc:.Building Permit Revised 2011 June/mi
r _
Building Department
The followingis a list of the required forms to be filled out for the appropriate permit to be
obtained.
q
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
o Photo Copy of H.I.C. And C.S.L. Licenses
a 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
b 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: Doc.Building Permit Revised 2008mi
NORT#q
own of �� dover .: .
TIM0r
�( 0 o , dover, Mass., O ' �•
T 0 -- LAKE
2 COCHICHEWICK
SRATED p �C2
U BOARD OF HEALTH
PERMIT -T D
Food/Kitchen
Septic System
•
BUILDING INSPECTOR
THISCERTIFIES THAT...........................G........:....................... .............................................................. ...................... Foundation
has permission to erect........................................ buildings on r........... Rough
�.�C. ........ .. ...............T.............
to be occupied as.... ..�... :. . 1M �
4L -..................................... Chimney
provided that the pelson accepting this permitla !nry respect ?&niiorm to the terms of the application on file in
Final-
this
inalthis 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
f PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTIO T Rough
........................ .................................
...................................................... Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Ocatpy Building GAS INSPECTOR
Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done
Until Inspected and Approved by the Building Inspector. Burner.
Street
Street No.
SEE REVERSE SIDE smoke Det.
2011/03/291 15 :20:08 2 /2
CcKI
RTI F1C 1 c OF INABILITY !NSURA i�Cc r 29/2 01 lYYYYI�
��- � 3 2R/2C11
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT'S UPQN•THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED '
I REPRESENTA MVE OR PRODUCER,AND THE CERTIFICATE HOLDER. I
IMPORTANT: If the cartltfcate holder is ars ADDITIONAL INSURED,the rA
—111 ries)rreta be moor so&.I€SUBROGATION IS VMWED,subject to
the terms and conditions of the policy,certain policies may roofs an endorsement.A statement on this certificate does not confer rights to the
certificate holder In Ileu of suttrendorsement(S). CONTACT
PRODUCER NAME FAX
astern Insurance Group LLC -Main PHONE
( :508-651-770 :508-653-8089
233 West Central Street ADDRESS:CSR24CLCeasterninsurance.coin
Tatick Wilk 01760
IPSUREIR(M AFFORDING COVERAGE NAIC II
INSURERA:Continental Casualty Company _ 0443
I INSURED 38615 NSUIRERBValley ForcTe Insurance Co 05C8
Rogers Pool Patio Tay Inc INSURERcTransportation Insurance Co 20494
1150 Middle Street INSURERD:
Lowell MA 01853
i INSURERE:
i
- INSURER F -_-
j COVERAGES CERTIFICATE NUMBER:609532800 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIESOF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
HD(CATED. NOTVJi THSTANDNG ANY REQUIREMENT,TERM OR CONDITION OF AN,(CONTRACT OR OTHER DOCUMENT WITH RESPECT IO WijCH.`IHIS I .
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN;THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.'LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS:
LTRS (MIVJODNYMPOLICY EFF. POLICY EXP. LITS
OF INSURANCE POLICY NU 48ER
jA Gl3+fERALLIABILITY I 3011046601 (L/17/2011 - '/17/2012 EACH OCCURRENCE $1,000,000
II-- 1 COMMERCIAL GENERAL LIABILITY I ( I PREMISES occurrence), $300,000 1
CLAIMS-MADE �OCCUR ` I ( MED EXP(Any one person) $10,000
iI I PERSONAL&ADV INJURY" $1,000,000
GENERAL AGGREGATE $2,000,000
I �GEN'LAGGREGATE LIMIT APPLIESPER: ( I I 1PRODUCTS-COMPIOPAGG '$2,000,000
$
POLICY PROE. LOC
LJ
GLE
5 I AUTOMOBILE LIABILITY I 12094361533 /21/2010 /21/2011 (aeBcadent N - MI $1000000
ANY AUTO- 1 I BODILYANJURY(Per person) Is
1 ALL CNVNED X AUTOS
BODILY INJURY(Peraoadent} $
I I AUTOS u AUTOS I I I
NON-OWNED I I 1 PROPERTY DAMAGE, $
HIRED AUTOS AUTOS Peracciden
is
i
IUMBRELLA UAB OCCiR I I !EACH OCCURRENCE s
EXCESS LAB ! !CLAIMShIADE! I I AGGREGATE $
DEC) RETENTION$ Is
C IWORKERSCOMPENSATION I 3011046646 /17/2011 /17/2012 X WT STATIC 1 OIH-
AND EMPLOYERS'LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVEN1A
( I E.L.EACH ACCIDENT $100000
1 OrRCERWEMa�EXCLUDEE0 I�
i I(Mandatary in NHS I ( E.L.DISEASE-EA EMPLOY $100000
DFSCRIRTIONOFOPERATIONS below EL.DISEASE-POUCYLIMIT $500000
I
I
1 DESCRIPTION O F OPERATIONS f LOCATIONS I VEHICLES(Attach ACORO 101,AOGihonal Remarks Sch%We,IF more spme is requaei*
I � `
it
I
CERTIFICATE HOLDER CANCELLATION
i
SHMILD AVY OF TME ABOVE DESCRIBEO P�"-- BE CANOE 'M BEFORE
Rogers Pool Patio & Toy Inc. THE EXIMAt1ON DATE THEIIIJEOF, NOTICE WILL BE DELyERM IN
150 Middle Street I ACGORDANCEVOTH THE POLICY PROMS N&
M24 01853
AUTHORIZED REPRES84TATWE
i
1 t I
Ce i9864Dr1011W14. Ali rights reserved.
ACORD 25(2010105) —ine ACORD name and logo Bre registered marks of ACORD
!
CERTIFIED PLOT PLAN
JL' ILIL IL ILMAP 105D LOT
Tg11A M'�S
'�" IL N/f L 00N 8c 2273
,1L PIAN
,..,._.,......,.....,.,........ 178.09'
'"..,.,........ I.PIPE
W 180.00' (FND)
I.PIPE I
V (FND) I
I
i SII i
�I
PARCEL „g,.
10o' BUFFER I, II 43,610 S.F.± j
70 B.V.W.
PROPOSED II
FENS I I i APPROX.
WELL LOC,
z
17.3'* CD
PROPOSEDco
a I.G. POOL EXIST-
WD. DECK 9
ScI = o
a rn 17.0'* - �.... c 31.11 f - N
GARAGE EXISTING S.F• y -�
_
0046 Sa s' :,p ;j� W.F. DWELL►NG I � x u
h'rt......, {814 30_8'* c
I I
I I �
461 S.A.S. LOC•
L, -,—,—,—,—,-,—,—,—,—'—
' I
150.00'
(NOT FND) ..' ,t',;:,,.,�;';'�' ' :�'• ,;:,; ,.,..
ZONING DISTRICT: R1
REQUIRED: PROVIDED: # EXIST (EXEMPT)
MIN. AREA: 87,120 S.F: MIN. AREA: 43,610 S.F.
MIN: FRONTAGE: 175' MIN. FRONTAGE: 150'
CALL MIN. YARDS: MIN. YARDS:
TOLL FREE FRONT: 30' FRONT: 116.4'
1-888—DIG—SAFE ASSESSOR MAP: 105 D SIDE: 30' SIDE: 30.6'
(1-888-344-7233) PARCEL: 127 REAR: 30' REAR: 109.2'
72 HOURS IN ADVANCE POOLS: POOLS:
10' SIDE AND REAR 17' SIDE AND 101.5' REAR
LOCATION : 614 FOREST STREET
REVISED: 9-AUG-11 BY: WCH LOCATION: NORTH ANDOVER MASSACHUSETTS
CITY/TOWN STATE
29—JULY-201140
DATE: SCALE: 1 INCH = FEET.
DEED AND PLAN REFERNECE:
o� ESSEX NORTH REGISTRY OF DEEDS.
WILLIAM G. DEED BOOK: 11 ,297 PAGE: 313 PL. BK.: PLAN
HOLT
No 39688 CERTIFICATE OF TITLE NUMBER: PLAN No. #10133
SNA CERTIFICATION IS HEREBY MADE TO: TOWN OF NORTH ANDOVER
OWNER: GREGORY E. & MICHELE J. STEIN
THAT THE EXISTING STRUCTURES AS SHOWN ARE SITUATED ON THE LOT DESIGNATED, IN COMPLIANCE WITH
P.L.S. DATE THE APPLICABLE ZONING BY-LAWS, FOR SETBACK, AREA AND FRONTAGE REQUIREMENTS OF THE
G.
MUNICIPALITY WHEN CONSTRUCTED, EXCEPT WHERE OHTERWISE NOTED, OR ARE EXEMPTED FROM
GWILLIAM . HOLT ENFORCEMENT.
CERTIFICATION IS HEREBY MADE THAT THE STRUCTURE(S) SHOWN ON THIS IS NOT LOCATED WITHIN A
LAND SURVEYOR, DESIGNER SPECIAL FLOOD HAZARD AREA (100 YEAR) AS DELINEATED ON THE FLOOD INSURANCE RATE MAP FOR:
83 WEST MAIN STREET COMMUNITY No. 250098 PANEL No. 0009C DATED: 6-24-93
MERRIMAC, MA 01860 THIS PLAN WAS PREPARED USING EXISTING RECORDED INFORMATION, EXISTING MONUMENTATION, AND
ASSESSOR'S DATA, AND DOES NOT REPRESENT AN INSTRUMENT SURVEY OF THE PREMISES. THIS PLAN
MAKES NO DETERMINATION
AS TO THE EXISTENCE OF SUBSURFACE STRUCTURES, UTILITIES, OR PRESENCE
TEL: (978) 257-4576 OF HAZARDOUS MATERIALS.
E—MAIL: billgholt@aol.com JOB NUMBER: 11-004—CPP
Office of Consumer Affairs and Efusiness Regulation
10 Park Plaza -
Surte 5170
Boston, Massac_4wetts 02116
Home Improvement10)
otrator Registration
Registration: 113956'
f.+ Type: Private Corporation
,4,_ Expiration: 7/2 /2013 Tr# 213573
..^ r r to
ROGERS POOL PATIO & TOY Cd�'V
GARY ROGERS -
150 MIDDLE ST
LOWELL, MA 01852
4
Update Address and return card.Mark reason for change.
DPS-CA1 iv Address Renewal D Employment E] Lost Card
SOM-04/04-G�1T01216p
✓fie TDG/72G�eCLGGli oy`/l�Gp�dC�c�LtCQe6 ..
Office of Consumer Affairs&B siness Regulation License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: ;0,13956 Type, Office of Consumer Affairs and Business Regulation
Expiration X922/2013 Private Corporation
10 Park Plaza-Suite 5170
Boston,MA 02116
RO ERS POOL PATI()&�fOX CO( 1C
i � c
GARY ROGERS ,�,,
150 MIDDLE ST - g o
LOWELL,MA 01852 ,.' ;=" Undersecretary of va ' ithout signature
CERTIFIED PLOT PLAN
mon tAT�wd+s
I." #12273 ,
176.00• /
t.PRE
160.00 (FIN)
GD m wtrw+�vs
r. •T
I
W t { 1
i PARCEL "B"
; ,
li i 43,610 S.F.t 4
i 1 �
(001' "�"OOLioc
17
,c
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g ��S .'� a••t.r"i;Tt: oARAOE ��at6 - �,i
w IANC +� I 3a6't
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L-------------I_._•-._._.-.J
Vis' I'
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(NOTY..: �,:•�.._77
ZONING DISTRICT: R1
REQUIRED: PROVIDED: •EXIST(EXEMPT)
MIN. AREA: 87,120 SF. MIN. AREA: 43,610 S.F. •
MIN. FRONTAGE:175' MIN. FRONTAGE: 150' •
CALL MIN. YARDS: MIN. YARDS:
1-888 FREE FRONT:30' FRONT:116.4'
DIcSAFE ASSESSOR MAP: 105 D SIDE:30' SIDE:30.6'
0-888-344-7233) PARCEL: 127 REAR:30' REAR:109.2'
@72 HOURS IN ADVANCE POOLS: POOLS:
10' SIDE AND REAR 17' SIDE AND 93.5' REAR
LOCATION: 614 FOREST STREET
REVISED: BY: LOCATION: NORTH ANDOVER MASSACHUSETTS
CITY/TOWN - STATE
DATE: 29—JULY-2011 SCALE: 1 INCH- 40 FEET.
_q1 DEED AND PLAN REFERNECE:
ESSEX NORTH
� REGISTRY OF DEEDS.
WI,aLTLuAm DEED BOOK: 11,297 PACE: 313 PL.BK.: PIAN
No CERTIFICATE OF TITLE NUMBER: PLAN No. #10133
CERTIFICATION IS HEREBY MADE to- TOWN OF NORTH ANDOVER
OWNER: GREGORY E. & MICHELE J. STEIN
Z 3o'H�
THAT THE EXISTING STRUCTURES AS SHOWN ARE SITUATED ON THE LOT DESIGNATED,IN COMPLIANCE Wlni
P.L.S. DATE THE APPLICABLE ZONING BY-LAWS, FOR SETBACK, AREA AND FRONTAGE REQUIREMENTS OF THE
MUNICIPALITY WHEN CONSTRUCTED.EXCEPT WHERE 04MRWISE NOTED.OR ARE EXEMPTED FROM
ENFORCEMENT.
WILLIAM G. HOLT
CERTIFICATION IS HEREBY MADE THAT THE STRUCTURE(S)SHOWN ON THIS IS NOT LOCATED WITHIN A
LAND SURVEYOR, DESIGNER SPECIAL FLOOD HAZARD AREA(100 YEAR)AS DELINEATED ON THE FLOOD INSURANCE RATE MAP FOR:
83 WEST MAIN STREET COMMUNITY No. 250098 PANEL No. 0009C DATED: 6-24-93
MERRIMAC, MA 01860 THIS PLAN WAS PREPARED USING EXISTING RECORDED INFORMATION, EXISTING MONUMENTATION, AND
ASSESSOR'S DATA, AND DOES NOT REPRESENT AN INSTRUMENT SURVEY OF THE PREMISES. THIS PLAN
MAKES NO DET NATATION AS TO THE EXISTENCE OF SUBSURFACE STRUCTURES.UnUT1E% OR PRESENCE
TEL: (978) 257-4576
E—MAIL: billgholt@aol.com JOB NUMBER:11-004—CPP.,
Hughes, Jennifer
From: Michele Stein [mstein@tewksbury-ma.gov]
Sent: Friday, August 05, 2011 8:17 AM
To: Hughes, Jennifer
Cc: Greg Stein
Subject: 614 Forest Street
Attachments: KM BT20020110805075828.pdf
Hi Jennifer,
I measured the rock wall with Greg this morning. The 100 ft mark is exactly where we spray
painted it before. However, with your concerns about grading and the fence, I shifted the
pool so that it is 10 ft off from the house not 17 ft. I added in the fence line so that it
shows it is 5 ft off the 100 ft buffer. I am having the contractor put up a construction
fence for the 100 ft buffer line to make sure that soil does not get pushed in that area at
all.
I know you mentioned how contractors are but please keep in mind that I also am a inspector
for a town and will be watching/riding these guys like a hawk because I do not want any
issues with conservation. My goal is to have a successful project and great standing with the
town. My husband losing part of the driveway, well I will have to deal with that separately.
Please let me know if this is acceptable. If so, please have Brian look at it. I can get the
certified plot plan revised and bring it in. I'm hoping to only have to come in one more time
if possible to drop off plan, and pay for permit.
Thank you for your time and consideration.
Michele Jodar Stein, PE
Town Engineer
Town of Tewksbury
978-640-4370 Ext 239
978-640-4365 FAX
-----Original Message-----
From: community-development(@town.tewksbury.ma.us fmailto:community-
development0town.tewksbury.ma.us1
Sent: Friday, August 05, 2011 7:59 AM
To: Michele Stein
Subject: [Image File] Michelle,KMBT200, #586
FROM:
Image data has been attached to
the E-Mail.
Please note the Massachusetts Secretary of State's office has determined that most emails to
and from municipal offices and officials are public records. For more information please
refer to: http://www.sec.state.ma.us/pre/preidx.htm.
Please consider the environment before printing this email.
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