HomeMy WebLinkAboutBuilding Permit #273-2017 - 64 WAVERLY ROAD 9/14/2016 / NORTH
r1,, BUILDING PERMIT ttt!!! oLEp
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TOWN OF NORTH ANDOVER o ,
APPLICATION FOR PLAN EXAMINATION T _
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Date Received /• � � "°R�TEo�
Permit No#: P"•c5
iJ J� 9SSACHUS
Date Issued:
ORTANT: Applicant must complete all items on this page
LOCATION
Pri
PROPERTY OWI I daM r'� "
Print 100 Year Structure yes no
MAP _PARCEL: ZONING DISTRICT: Historic District yes n
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition '�4qwo or more famil. ❑ Industrial
[Iteration No. of units: ❑ Commercial
VRepair, replacement WAssessory Bldg S r-G f ❑ Others:
❑ Demolition ❑ Other
l Septic'. U 1LUe11 r ❑a Flo_o�p�lain� Wetlands; D1N'atershed District
p Vllaterlsewexs
DESCRIP ON OF WORK TO BE PERFORMED, I a
' lam✓ �� Clf Gh i'J����y-G � S''�.V 1'L ICS,
—� p � � s,✓,�c�Lam.
Identification- Please Type or Print Clearly
OWNER: Name: rPhone:
Address:
Contractor Name: r � M �-.�� �`J Phone:
Email:
Address:
License:Li
ti
t
'
Su ervisors Construction ceC D S Exp. Date.
p -v �0aV-A-,'
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 25.00 PER S.F.
Total Project Cost: $ �JC)0 FEE: $
Check No.: Receipt No.: � 3
NOTE: Persons contracting with nr is ered contractors do not have access to the guaranty fund
_. _ n
■
P
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOS
Public Sewer Swimmin Pools ❑
Tanning/Massage/Body Art El Swimming
Well ❑ Tobacco Sales ❑
Food Packaging/Sales ❑
Private(septic tank, etc. ❑ Permanent Dumpster on Site ❑
ti
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
I
CONSERVATION Reviewed on Signature
COMMENTS
i
i
HEALTH Reviewed on Signature
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
FIR�DEPARdTMERIT ,Tem on es, �►
t ,Dumpster o f Y'
` xYt' r 7-71. �, r a T t�' 4 = h' r . r, y 3 .Ii:t t�nC)l" k 3.�tt K
Located at�124�IVIaintStreet a �� �ti� 'r, »}
71,
re rim �
EirejDe artment signature/date
t9 .�
••< .♦ � r.._ . �+ .. _. _. a :��:� eq r"i�:.e .�,4r,.i.
1
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Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
i
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)
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® Notified for pickup Call Email
Date Time Contact Name
Doc.Building Pennit Revised 2014
r
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
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 I ECC 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
Yv%ErI ui rvvnn Hiiuuve,
ayment mite Wednesday,September 14,2016
eposit Number 1709141
1perator Counter pc 1
ICR(BUILDING INSPECTION) $120.00
4
otal Paid $120.00
ash $120.00
hange $0.00
eeeipt Number gov00005000
X14/20161:40:25 PM
ashier Id. treascoll-17
v
own of North Andover
payment Date Wednesday,September 14,2016
eposit Number 1709141
perator Counter pc 1
CR(BUILDING INSPECTION) $120.00
0
otatPaid $120.00
ash $120.00
hangs $0.00
ecelpt Number gov00005000
!1412016 1:40:25 PM
ashler Id. treascoll-17
E Location
4 No. "' Datej,
• - REdElf MVMTH ANDOVER
.K SEP -l.4 2016
Certificate.of'OWupancy $
DO �t Fee $ ""
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#
BuiYing Inspector/
Locaton � �A
No. > Date
�, � • - TOWN OF NORTH ANDOVER
V � 4
-. Certificate of Occupancy $
Building/Frame Permit Fee $ j
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check# l
i
�► Buildin Ins ecto�rf
50t� a3 9 p Y
NORTH
own of sAndover
O - 0
No. 3- 61 -
h ver, Mass,
A_ coc.41CHEWW" �'►•
7.Q A�RgTEO '•Pa,`�5
S
BOARD OF HEALTH
PER
Food/Kitchen
T
Septic System
THIS CERTIFIES THAT .......... ..... L. ..... . ... ...... .. . .. .... .................. .........
...................... BUILDING INSPECTOR
has permission to erect . .... buildings on .... 1�� ...................... Foundation
.......... ..•j. ........... ............
�. Rough
tobe occupied as ............. .. . .... .....Afe�. ..................................................................... Chimney
provided that the person accepting tH1s permit shall in every respect conform 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
..... . ....... ..... .........
Fina
BUILDIN SPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Buildinz 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.
TOW, N OF NORTH ANDOVER
OFFICE OF
_ BUILDMG DEPARTMENT
s 1600 Osgood Street,Building 20, Suite 2035
'�. North Andover,Massachusetts 01845
Gerald A. Brown Telephone(978)688-9545
Inspector of Buildings• Fax (978)688-9542
HOMEOWNER LICENSE EXEMPTION
DUIDING PERMIT APPLICATION
Please print
DATE: Lee 16
JOB LOCATION: Lj C�U,C r- e—) �7
NumbStreet AAdess Map/Lot
HOMEOWNER ')j '
wr- ��J
Name orae Phone Worlc Phone
PRESENT MAILING ADDRESS �h 0-rp.�-3
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 su ervisor.
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 requir ments and t he/she will comply with said procedures and
requirements.
HOMEOWNERS SIGNATURE .
APPROVAL OF BUILDING OFFIC
Revised 8.2015
Form Homeowners Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
The Common-wealth of Mass ch efts
z . .Depayftneyzi of IndusMal.Acctclents
a _ I Coxigress sft'eet,suite 100
`t Roston,.]iyY�/��.T�02114J/y(2/017
s�+ workers'CompensationTnsnranceAff:Ldavit:Builders/Contractors)Electricians/Plmnbers.
TO IM Yff-"WSJ TM 1IlARTT'1NG AUTHORITY
Applicant oxmation Please Print imgAh
Name pusiness/D ganiza(ionadividnal)^�G�
Address: 66 (j c e-t-41 �`A
Gty/State%zip: /Ua14" avo{r.1101r- A4k Phone#. �1Y -KO`f^S ( 3
Areyou an employer? L7aeeise appxopriaie hox: Type of project,(Te4&ed):
1.�I am a employer�ithh s employees(fall andlarpatt gime). ], NeV,l coIlsfCtlettoIl
21]I am a sole proprleb:rorpaftimship andhaveno employees working forme in $, ❑Rem odeag
f _
yap
caciiy.[No woers'comp.insurance required.]
9. El Demolition
3 Ianiahomeawnerdoingallworkmyseli[No workers'comp__;nsnrancezaquired.]�
10❑Building addition
4.0 I am a homeownerandwRl behirmg contractors to conduct all work onmypropmty. I-WM
ensure that.all contactors either have-mrk rs'compensation ir+s ce or are sole 11.0 Electticai repairs or.additions
proprietors wffino employees. 12:[[Plumbing repairs or additions
5.QIamageneralcontractor and Ihave hiredthesab-coni<aetorsEstedontheaitachedsheet 13. oQIrepairs
Y� a snb-contraetnrsl ave employees and have comp.iasm=a.; n
- ' 14.F1 Other
6.R We are aco orate audits ofcershave eaereisedeii right of'eaempiionperMGL c.
e na eni to ees. o workers .insraance req�ed]
152,§I(4),andw_have , ..�..p y_, IN comp
o�Iloutthesectionbelowsho-i& then-workers'compensanonpoHryiniomiaiiom
Any applicas Jit checlosbox..l mus;,als g
T hoshb it'- • affdavatindicatingtheymedomgallvmTkaadthenhueouisidecontractorsmustsamitanewaffidavi<mdicafingsuch-
eowners w
mom
cordmGton;�atcbeckTILhboxmus-aitachoclEnadditionalsheetshowingtlpnameofr7lesabco�racinzsandstatewhetEerornot-ffi entifesh- o
employees.Ifthe sub ctaororsliave employees,ilieymustprovidetheir workers'comp.policy number.
lain ar2 erriployer tfzatYS-Provi g�vorkers9 compensation insunmcefor W eprzplayees.'Bdoiv is the policy andjob siva
infa��zaYior2. .
Insurance Company Name:
Policy,#or Self-ins.lir.#: ( RxpirationDate:
lob Site Address: (> 6 U Ve r-"� �� City/,State/ydp: /" ►TI�Co�r; N� G 4�Y 5
Attach a copy of the7'orkers' coangeMationpolicy declaration.page(Showing the poRcynunbex and expiration daze).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500-00
and/or one year imprdsoarnent;as well as cz9il penalties iia the form of a STOP WORK ORDM and a zme of up to$250-00 a
day against the-violator_A,copy of this statement may be forwarded to tha Office ofInvestigations of the DIA.for insurance,
coverage vezxdcatio
I do bexeby certify er e and ena&es ofperj�� that the ifgormeonprovidedlaabov-is tie amu'cow�ect
Si afore: Data:
Phone# 5 ' ;7�0 Ll—�-( 3
o ffzciaz use o,7zzy. .Do not-write zn this area to be completed by city or town officzaZ
City or Town: Permit[License#
Issuing AnthoritF(circle one): i
1.Board of)BCealtfa Z.BuRdbagDepaxtment 3.C'R7fTown Clerk 4.Electrical Inspector 5.Plunbinglaspector
6.Other
Contact Person: Phone 9:
i
Information and Instructions
Massachusetts CxeneralLaws chapter X52 requires all employers to provide workers'compensation forthet employees.
Pursuantto this s�iatute,an employee is defined as"...every person.in the service of another under any contract bfhire,
express or implied,oral or-mitten."
An,employer is defined as"an individual,partnership,ass o ciafion,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 employex,or the
receiver-or trustee ofan 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, r 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 buildingappurtenant thereto shall not because of such employment b6 deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or to cal licensing agency shalt withhold the issuance or
renewal of a license or permit to op orate a business or to construct buildings in tine commonwealth for any
applicant wbLo lias not pro duced acceptable evidence of compliance with the insuxance 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 beenpros entedto the contracting authority."
Applicants
Please fill-out-the workers' compensation affidavit completely,by checking lo-boxes that apply to your situation and,if
necessary, supply sub=contractors)name(s),address(es)and•phonenumber(s)along with theircerfifcate(s)of
insurance. LimtedLiability Comp anies(LLC)or Limited Liability Partnerships(LLP)withnoemployees'otb.erthan the
members orpartners,are notrequiredto carryworkers' compensationinsurance. If an LLC brLLP doeshave
employees, a policy is required. Be advised that this affidavitmay be submittedto the Depattment of-Industrial
Accidents fo=conf�m�.ation oft=ance coverage_ Also be suxe to sign and date the affidavit. The offzdavlt should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
IndustrialAccidenis. Should you have any questions regarding the law ox ifyoiz'are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-iiisured companies sfiould '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 Tn.vesfigations 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 indicating current
policy information(if necessary)and under`Uob Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been ofCxcialty stamped or marked by the city or town maybe provided to the
applicant as proof that a valid affidavit is on fife for future permits or licenses. A new affidavit mast be fitted out each
year.Where a home miner 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 Department's address,telephone and fax number:
The Commonwealfh of Massachusetts
Department of 7ndustrialAccidants
1 Congress Street, Suite 100
Boston,MA 02114--201.7
Tel.# 617.727-4900 ext.7406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 02--23-15 www.mass.gov/iia
North Andover MIMAP September 13, 2016
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0 MVPC Bo Zoning Overlay Zoning
Municipal Boundary 0 Adult Entertainment Distric :1 Busine s 1 District
0 Machine Shop Village Ove 0 Busine s 2 District Horizontal Datum:MA Slateplane Coordinate System,Datum NA083,
Rail Line 0 Watershed Protection Dist O Busine 3 District Meters Data Sources:The data for this map was produced by Merrimack
Interstates 0 Historic Mill Area 0 Busine s 4 District gORT14 Valley Planning Commission(MVPC)using data provided by the Town of
—1 0 Medical Marijuana O Gene Business District Ot au. !qNorth Andover.Additional data provided by the Executive Office of
—SR 0 Downtown Overlay District O Planne Commercial Dev <t • O
�� • O Environmental Affairs/MassGIS.The information depicted on this map is
Q Historic District 0 Corido Development Dist ,� L for planning Roads 0 Osgood Smart Growth 40 0 Corrido Development Dist _ 9 Purposes only. r may not H adequate for legal Hboundary
9 ( P O — - A definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER
%r Easements n Hydrographic Features 0 Corrido Development Dist 'A MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING
Industri 11 District
❑Parcels Streams THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY
Q Industri 12 District n^ OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT
Wetlands 0 Industri 13 District p no - �,• x ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
4 Exempt Lands 0 Industri 1 S District 9 a+""""' .,� THIS INFORMATION
Reside ce 1 District X1,9 •.�o. t
6 Reside ce 2 District SSA�NUSE
93 Reside ce 3 District
de ce 4 District
1"=30 ftde ce 5 District
ode ce 6 District
e esidential District
North Andover MIMAP September 13, 2016
OrY
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60 WA•VERLY RD � �� . 018.0-0045 -� .
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❑MVPC Bo
Int Irstates Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83,
SR Meters Data Sources:The data for this map was produced by Merrimack
RoadsNORTH Valley Planning Commission(MVPC)using data provided by the Town of
North Andover.Additional data provided by the Executive Office of
Easements = pOt ��a 00 Environmental Affairs/MassGIS.The information depicted on this map is
Parcels _ G for planning purposes only.It may not be adequate for legal boundary
•—•' - A definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER
MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING
♦ 'JJWIWNTHE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY
At It OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT
ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
THIS INFORMATION
�,SSA�MUS�t
1"=30 ft ^��
Date.Aon iek...
TOWN OF NORTH ANDOVER
0
PERMIT FOR WIRING
CHU
AR r1l"
Thiscertifies that ........;................................... ................................
has permission to perform ....?�eq�...........5�A.j
wiring in the building of............fakil. a,-.7 ...............................................
at..... . .......... North Andover,Mass.
......... .................
Fee..F N... Lic. ... .......... ........P ..............
ELECTRICAL
Check # 3sy sP7
Commonwealth of Massachusetts Official Use
Only
�� G
t Department of Fire Services Permit No.
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/051 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INF RMATION) Date: I cP-046e
City or Town of: �M�, Kl eve To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perfo , the electrical work described below.
Location(Street& tuber) cP Wt
Owner or Tenant Telephone No.
Owner's Address
Is this permit in conjunction with a b ilding permit? Yes No ❑ (Check Appropriate Box)
Purpose of Building �,-M Utility Authorization No.
Existing Service LO Amps / Volts Overhead Undgrd❑ No.of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
j Completion of the following table may be waived by the Inspector of Wires.
No. of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.o Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
I No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o mergency Lighting
rnd. rnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges f No.of Air Cond. Total Tons No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons1.KW No.o Self-Contained
p Totals: Detection/Alerting Devices
No.of Dishwashers ! Space/Area Heating KW `02 Local❑ Municipal ❑ Other
Connection
No.of Dryers Heating Appliances KW Security Systems:
No.of Devices or Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
:
No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wir
No.of Devices or E uivainglent
i
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: LIC. NO.:
Licensee: 4&ZZ f/& 6%, G071-11/l Signature O.: J::�
(If applicable, enter "exempt"in the license number line.) Bus.Tel.No.:
Address: Alt.Tel. No.:
*Security System Contractor License required for this work; if applicable,enter the license number here:
OWNER'S INSURANCE W IVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by;w.4�y �, e elow, I hereby waive this requirement. I am the(check one)❑ owner —1 owner's agent.
Owner/Ag v`t -5131Signature Telephone No. �? PERMIT FEE: $
� a