HomeMy WebLinkAboutBuilding Permit #323-16 - 674 SALEM STREET 5/1/2018 ` NORTI/
BUILDING PERMIT oF�zLeD ,61'0
TOWN OF NORTH ANDOVER Fa/
APPLICATION FOR PLAN EXAMINATION
� JR4 ,.
Permit No#. Date Received �s9s RATED"P��(5
SACHUS
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION 607
Zit S� ,a
PROPERTY OWNER LL t C(►'1� -`
'Pant 100 Year Structure yes
MAP � -, PARCEL° ZONING DISTRICT Histone District yes no--a. - - w _ Mach"§hop Village ?yes �.,
r o.
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
[I Addition El Two or more family [I Industrial
N Alteration No. of units: ❑ Commercial
o,Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
Septic:- ❑1N.ell 4'` ❑ Floodplainb.Wetlands ; ❑ 1Natershed Di_stnctu
DESCRIPTION OF WORK TO BE PERFORMED:
511Z .�
9CM0y*_0_ Wal ct� MSI L# L � �Cr�-r�.�+e.� GCl1�
(lroom ([Y' ,eo
Identifi ation- Please Type or Print Clearly
OWNER: Name: rffamsc^ Phone: `t70- A - 7
Address:
.4 • '
Contractor Name Y _
Email: -.
Address._
s
#Supervisor's Construction'License 'L ExpR ®ate
r u - o- rt t
µ
HomeImprovement License <Exp Date: _ .
ARCHITECT/ENGINEER Phone:
Y
Address: Reg. No.
FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED 9X$125.00 PER S.F.
Total Project Cost: $ � FEE: $ � Z,)
Check No.: Receipt No. 13�
NOTE: Persons contracting witfl unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner / Signature of contractor .
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
Li Building Permit Application
Li Workers Comp Affidavit
Li Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o Copy of Contract
u Floor Plan Or Proposed Interior Work
Li Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
u Building Permit Application
L, Certified Surveyed Plot Plan
L, Workers Comp Affidavit
i u Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
' u Floor/Cross Section/Elevation Plan Of Proposed_Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Li Mass check Energy Compliance Report (If Applicable)
o 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)
L, Building Permit Application
Li Certified Proposed Plot Plan
u Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
a Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
a Copy of Contract
o Mass check Energy Compliance Report
a Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit
In allcases 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
1
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL `
Public SewerR \
❑ Tanning/Massage/Body Art ❑ Swmmning 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 Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Siqnature
COMMENTS
4
HEALTH Reviewed on Siqnature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
a
} Conservation Decision: Comments
Water& Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signatere: ._
_ _ oa O
,FIRE DEPARTtMENT� en)Dumpstertion site, yesz
t _ T x S
roes
Located of=124Main Sfteet Street
c e sgoo eet
Fii`re�Departmentsignature/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
i
I
I
® Notified for pickup Call Email
Date Time Contact Name
Doc.Building Pennit Revised 2014
I
Location _
No.52 3_��,yU Date
. - TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee
Foundation Permit Fee $
Other Permit Fee $
SUM
TOTAL $
Check.#f .?' 41
•
.9-34 8 Building Inspector
r
NORTH
own Of
. � E 1j Andover
o : - .:.. o
No. A?J_-00
ver, Mass
COC NIC Nl WI[It V
A°RATEo
s U
BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
THIS CERTIFIES THAT ................. . ..(e...... kn............................................................ BUILDING INSPECTOR
has permission to erect buildings on ........ Foundation
.......................... ...... �c. -.- ...............
Rough
11
to be occupied as . ...... ..�:�r..... �.). ........�...........�... ........ VL......................................... Chimney
provided that the person ccepting this 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
D PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION Rough
Service
......................... ....... ..... ..................................
"" Final
BUILDING INSPECTOR
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.
Eric Hanson 940-15
Andover st 10:36am
Xey egl I of 1
CS Beam 4.11.26.1
tanocannE*rc.4.k126.1
MaterialsMiabase 1516,
Member Data
Description: Top
Type: Beam Application: Floor
Top Lateral Bracing: Continuous
Bottom Lateral Bracing:Continuous
Standard Load: Moisture Condition. Dry Building Code: IBC/IRC.
Live Load: 40 PLF Deflection Criteria: 0360 live, 0240 total 1.000"max.LL
Dead Load: 10 PLF Deck Connection: Nailed. Member Weight: 12.6 PLF
Filename: Beam.1
Other Loads
Trib. Other Dead
(p ription) Side Begin End YVidth Start End Sta30 g e=nd CaEego g
Additional Uniform PS TOP,
0.0:06 14' 0.00 14' Oc0.0"
1400
m
14:0 0
Bearings and Reactions input min Gravity Gravity
Location Type Werial Length Required. Reaction uplift
Ta 0.0w, Wall SPF Plate(425psi) 5:500" 1845" 41181E
2 14' 0.0 Wall SPF Plate 425 si 5.500 1.84V' 4118#
Maximum Load Case Reactions
llsed tot applying point Weds Wine leads]to em_rying.m mt-Ois
Live Dead
1 3043# 1075#
2 3043#_ .. 1075111
Design spans
13' 2.75W
Product: 2.0 Rigidl-am LVj_ 1-3/419-1/2, 3 ply PASSES DESIGN CHECKS,
Connect members with 2 rows of 16d common nails at 12.0"oc
NOTE:Flails must be applied from both sides
Design assumes continuous lateral bracing along the top chord.
Design assumes continuous lateral bracing along the bottom chord.
Allowcabie Stress Design Location Loading
Actual Allowable CapaLoc
city T Total_Load,D+L
Positive'Moment 13618.# 21845.# 62°10 0 4, Total Load D+L,
Shear 35420 37.% total Load{>}L
Max.Reaction 4118:# 12272:x` 0 Total Load D+L
TL Deftection 0.5718" 0.6615" U277 7' Total Load L
LL Deflection 0.4226' 0.4410 " 1_/375 7
CoRtlol: LL Deflection
DOLS: LN&1000% Snw--115%' 11001=125% Wind-1677/
Design asst,ntes a repetitive rnernbef use increase in bending striess: 4'/
Ali p(odactnamosare hadema+ksottheir respective ovmors _
CopydgM(o)2013 by Simpson Strong 10 company Inc.ALL R161ft RESERVED. n����-
Pat& l3danned oewlie0 fire tltetnper,goarfold,beam orglide[shown on tmsdmadng meotnapptioablp doggo cdloda toi oot daLoa4imjaco�0lo the mei ufaclureP3
MM design mad be tWowed by a goalhlt{d dosignet ordeslgn prdfeadonal its mquired to Op+ovaL'hds design emano-a pros
Jackson
Quote
deafer o 'the.Year:
LUMBER & MILLWORK :2014'* Transaction #
2'i 6422
215 Market Street 101ndu real Orire 67 Haverhill Rd Price Date
Lawrence,MA 01843 Raymond,NH 03077 Amesbury,MA01913 09/. 0/2015
Phone: (978)6864141 Phone: (603)895-5151 Phone; (978)-388-0366 Location
i rng ax: 8- 41 LAVVRENCE
MAIL TO: Jackson Lumber 4 Millwork Co.Inc.
Sales Re resentative
PO Box 449, Lawrence,MA 01842 P TER LEBLANC
Bili To: Ship To:
ED. SAME —CASH ACCOUNT
ERIC FiANSON
IC D. ACCOUNT 12 SPRING GROVE ROAD
12 SPRING GROVE ROAD (978)470-3735 ANDOVER, MA 01810
ANDOVER, MA 01810
Customer# Quote# Quote Date 0per
Purchase.Order Terms Ship,Via
4
57531 216422 09!10/2015 047 CASH OUST PIU
t?escti tion. tJM, priceiunit Extension
LN# Item Number Ordered, p
1 LVL914
3 1 374 X 9 tit X 14`LV.L EA 53.46 160.38
Amount:
160:38
Tax: 10.024
This Quotation is valid thru 9/17/201 S. After that it subject to review Total: 170.40*
by Jackson Lumber and Millwork. Special ,-r ancl'Manufactured Paid: A.00'
merchandise is Non-Returnable. Due: 170.40
Page1 of 1 9110/201511:50:58AM
NORTH TOWN OF NORTH ANDOVER
pE i�eo Y 1
OFFICE OF
n BUILDING DEPARTMENT
* 1600 Osgood Street, Building 20, Suite 2035
North Andover,Massachusetts 01845
,SSACHUSE�
Gerald A. Brown Telephone(978)688-9545
Inspector of Buildings Fax (978)688-9542
HOMEOWNER LICENSE EXEMPTION
BUIDING PERMIT APPLICATION
Please print
DATE: Cr y Cls -
JOB LOCATION: 677 5A I-e
Number Street Address // Map/Lot
HOMEOWNER CfI L Pkjs� �'��1 I`(7�� 6f ib- 278
Name nHome Phone Work Phone
PRESENT MAILING ADDRESS Sal
/lam Ayjp,,,rr MAM a rAIPS _
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 requirements and that he/she will comply with said procedures and
requirements.
HOMEOWNERS SIGNATURE
__7e
APPROVAL OF BUILDING OFFICIAL
Revised 8.2015
Form Homeowners o eowners Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
The Commonwealth ofMasscachusetts
Department of IndlustrialAccidents
X Congress Street,Suite 100
Boston,MA 02X14 2017
_ v www mass.go-v/dia
umbers.
ec 'cians/PI
Affidavit:Buildexs/Contractors/EI, tri
Insurance
Workers
compensation
TO BE FILED WITH THE PERAUTTING AUTHOPJTY-
Aplilicaut Information
Please Print Legibly
Name(Business/Organization/Tndividual): (`
Address: Ch 4 - 643Y5
City/State/Zip: vc Phone#: q786l -27�
Areyou an employer?Chec'U&appropriate box: Type of project )Vequired):
am a employer with : employees(full and/orpart time).* 7. ❑New construction
2.❑1 am a sole proprietor or partnership and have no employees working for me in 8. X Remo deliAg
any capacity.[No workers'comp.insurance required.]
• 9. El Demolition
3_b4 I am a homeowner doing all work myself[No workers'comp.insurance required.]t
10 [(Building addition
4.❑I am a homeowner and will be hiring contractors to 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 with no employees. 12.0 Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs
These sub-contractors have employees and have workers'comp.insurance.;
' 14.[]Other
6.❑We are a corporation and its of gers have exercised their right of exemption per MGL c.
152,§1(4),and we have no,employees.[No workers'comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
i Homeowners who submit this affidavit indicating they are doing all work andthen hire outside contractors must siibmit a new affidavit indicating such.
?Contractors that check this box must-attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-coni actors fiave employees,they most provide their workeis'comp.policy number.
I am an employer th a t isp iov iding workerscompensation insuran cefor my employees.'Below is thepalicy all djob site
information.
Insurance Company Name:
Policy#or Self-ins,Lie.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compepsation policy declaration page(showing the policy number and exp ation date).
Failure to secure coverage as required under MGL G.152,§25A is a criminal violation punishable by 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.A.copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certi under thepains andpenalties ofperjury that the information provided above is true and correct.
Si nature: Date: c w i f
Phone# r66 18-Z M
Offrcial 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 lyre,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,ox 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 comm onwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance 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 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 carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit maybe 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 the permit 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-insured 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 Investigations 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 ciuxent
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 proofthat 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 burn leaves etc.)said person is NOT required to complete this affidavit.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston,MA.02114-2017
Tel.# 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 02-23-15 www.mass.gov/dia