HomeMy WebLinkAboutBuilding Permit #318-2017 - 69 UNION STREET 9/23/2016 ` N
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1 04�D lel' BUILDING PERMIT O� ({`ED 6q�•O
TOWN OF NORTH ANDOVER °
APPLICATION FOR PLAN EXAMINATION
1 .^
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Permit No#: Date Received OArED
s s
ACH�1
Date Issued:4iq1ORWTANT:Applicant must complete all items on this page
LOCATION
o Pr
PROPERTY OWNER
Print 100 Year Structure yes no
MAP Q>t� PARCEL��ZONING DISTRICT:-Historic District yes
Machine Shop Village yes
TYPE OF IMPROVEMENT PROPOSED USE '
Residential Non- Residential ,
❑ New Building ❑ One family
11 Addition ❑Two or more family [I Industrial
11 Alteration
No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed,District
❑Water/Sewer
DESC PTION OF WORK TO BE PERFORMED: (-PA1
�,�,y�o �'
I O
C ® 1--)
Identification- Please Type or Print Clearly
OWNER: Name: i Y�rr� G1L1 Phone[
Address:
Contractor Name: Phone:
Email: ,
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone:
r
Addres�: Reg. No.
FEE SCHEDULE:BULDING PERMIT-'$1Z00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ L-�-o o FEE: $ (0b
Check No.: Receipt No.:
NOTE: Persons con 7J�
' g with unregistered contractors do not have access to the guaranty fund
°�- " T tin Si nature of contractor
Signatof A O ►�( I __g___-.
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL,
Public Sewer/ Tanning/Massage/Body Art ❑ Swimming Pools El
Well ❑ Tobacco Sales ❑
Food Packaging/Sales ❑
Private(septic tank,etc. 11 Permanent Dumpster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
� LANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on 3 fo Signature
COMMENTS \Liz)
HEALTH Reviewed on Siqnature
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
*Planning Board Decision: Comments
f, Conservation Decision: Comments
Water & Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
RE DEPARTMENT TempDumpster ona site yes
rio
Located of 124 Main Sfreet
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 "f
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA— (For department use)
I
I
❑ 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
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/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
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
Doc:Building Permit Revised 2014
i
-Location 57"" f
No.-J% NT Dated J �i
RECEIVED PAYME
EP 2 3 2016 TNORTHSTOWN ANDOVER
• , ORTH ANDOVER
URE R-COLLECTOR
Certificate of Occupancy $
Building/Frame Permit Fee $�-�' �-
Foundation Permit Fee $ '
Other Permit Fee $
TOTAL $
V
Check#
F "
G Building Inspector
v
-own of North Andover
layment Date Friday,September 23,2016
)eposit Number 1709261
)perator Counter pc 1
ACR(BUILDING INSPECTION) $60.00
'otal Paid $60.00
:ash $60.00 �r
:hange $0.00
teceipt Number gov00005024 '
1/23/2018 8:48:19 AM
Jame 69 UNION STREET-318-2017
:ashier Id, treascoll-17
NH
ORT
Town of
I, s ndover
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No.
a7
soh ver, Mass, 3 O
C OCHICHOWICK y1'
�d A�p�TED NPa,�'�5
S U
BOARD OF HEALTH
Food/Kitchen
P-ERMIT .T D Septic System
�THIS CERTIFIES THAT ... ...... ......... ........... . ..�..... . .. ......................................... BUILDING INSPECTOR
Foundation
has permission to er ...........Ai
ldings on .... ......�t.H...I. .✓.... irk .....................
Rough
tobe occupied a .. .�. ........................................................................................... Chimney
provided that a pe son accepti 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
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit.
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONST 10S Rough
Service
4N�1�1
. Final
BUR
GAS INSPECTOR
Occupancy Permit Required to Occupy Buildinje 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.
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Pub67
lic Sewer T Swimming Pools ❑
anrung/MassageBody Art ❑ g
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'FO:RM
1
� LANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on 3 r� Si nature, '
COMMENTS
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/siignature& Date Driveway Permit
DPW Town Engineer: Signature:
FIRE ._
DEPAR-TtME- N. .
m
.. _. Located 3on8Osgood
o sgotree
t
T TernpDu mps_er onsye
t
L•oeafed ate 124�Main„Street r " "` �°` ��
-Fire De : arfinent si
nature/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 equires 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 Call Email
Date Time Contact Name
Doc.Building Permit Revised 2014
The Commonwealth of Hassachusetts
_ Department of IndustrialAccidefits
1 Congress Street,Suite 100
02114 2017
- Boston,MA.
^ �r` www mass.gov/dia
a�M SJ�v
Warke&,Compensation Insurance Affidavit:Builders/Contxactors/Electritcians/Plum ers.
TO BE FILED WITH THE PERMITTING AUT"OR'Ty- 'Blease Print Le 'bl
i
A �licant Information
Name(Business/Oigauization/Individual):
i Address: 6
City/State/Zip: 0, 4 (2(c)r J-e e� Phone#:
Are you an empIoyer?Check the appropriate box:
Type of project(required);
if[�I am a employer with__employees(fell and/or Parttime).*
7. []N6Vdonstr6ction
2,❑I am a sole proprietor or partnership and have no employees Working£or me in 8. Rem o deluig
any capacity.[No workers'comp.insurance required.] 9. O Demolition
3.�]I am:homeowner doing all work myself[No workers'comp.insurance required-]t 10❑Building addition
4, homeowner and will be hiring contractors to conduct all work on my property. I will
11.❑Electrical repairs or additions
ensure that all contractors either have workers'compensation insurance or are sole � []Pluinbirig repairs or additions
proprietors with no employees.
a�
54-11 am a general contractor and Ipave hizedthesub-contractors listed onthe attached sheet. 3-. - Rb6f airs
J
These sub-contractors have employees and have workers'comp.insurance./ 14 Odle
6.QWe are a corporation and its,officers have exercised their right o£exemption pez MGL c. _
152,§1(4),and we Have no employees.[No workers'comp.insurance required.] Q�J
enationPolicyinformation.
'compensation
their workers
o th P
*Any applicant that checks box#1_must also fill out the section below showing
dicating such
T Homeowners who submit•this aifi av lied an additional shdicating they are eet the all-work andname of the sub-contractors and state wen hire outside contractors must hether or,spot fhoseentih have
tContractors that check ibis must
emps. If sub-contractors have employees,they must provide their workers'
loyeecomp.policy number.
To workers'compensation insurancefor my employees. -below is the policy and job site
X am ee employer that is p
information.
Insurance Company Name:
Expiration Date'
Policy#or Self-ins.Lie.#:. _
Job Site Address:
U I� City/State/Zip: moi'�U Dye�' � �� 7—�
Attach a copy of the workers' comipeusation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under M0.152,§25A is
form of a STOP WORK ORDER a criminal violation and a tine of up to $200.00 a
and/or one-year imprisonment,as well as civil penalties
be forwarded to the Office of Investigations of the DTA-for insurance
day against the violator.A copy of this statement may
coverage verification.
I ertify under'tliepains andpenaldes o
do Hereby cf perjury that the information provided move is true and correct.
r ,,/1Q� Date: Z b
Si ature:
01' C
Phone#: _
Official use only. Do not write in this area,to he completed by city or town offzciaL
Permit/License#
City or Town:
Issuing Authority(circle one): '
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Phone#:
Contact Person:
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 enferprise,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 insurance coverage xequired."
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=contractors)name(s),address(es)and phone number(s)along with their certificates)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 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 the permit or license is being requested,not the Department of
IndustrialAccidents. 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 current
policy information(if necessary)and under"fob Site Address"the applicant should write•"a11 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 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 fmdustrial Accidents
1 Congress Street, Suite 100
Boston,MA 02114-2017
Tel. #617-727-4900 ext. 7406 or 1-877-NUSSAYE
Fax#617.727-7749
Revised 02-23-15 www.mass.gov/dia
f NORT#j 1 TOWN OF NORTH ANDOVER
3a
10 LID
�" OFFICE OF
A BUILDING DEPARTMENT
10 * 1600 Osgood Street,Building 20, Suite 2035
North Andover, Massachusetts 01845
cmus��
Donald Belanger Telephone(978)688-9545
Inspector of Buildings Fax (978)688-9542
HOMEOWNER LICENSE EXEMPTION
BUIDING PERMIT APPLICATION
Please print
DATE: ,. ��
JOB LOCATION:
Number Street Address Map/Lot
CP
HOMEOWNER �
Name Home Phone Work Phone
PRESENT MAILING ADDRESS Or (-)4 ('On �S
dL M 9 CSS lapz�
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, rop vided
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 I IO.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 SIGNATURE4—z-AL"
`
APPROVAL OF BUILDING OFFI
Revised 8.2015
Form Homeowners Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688=9535
Residential Property Record Card
Parcel ID: 210/009.0-0007-0000.0 MAP: 009.0 BLOCK: 0007 LOT: 0000.0 Parcel Address: 69 UNION STREET FY: 2016
PARCEL INFORMATION Use-Code: 101 Sale Price: 1 Book: 10685 Road Type: T Inspect Date: 01/03/2011
Owner: Tax Class: T Sale Date: 03/27/2007 Page: 330 Rd Condition: P Meas Date: 01/03/2011
BANDLE,JANET Tot Fin Area: 1777 Sale Type: P Cert/Doc: Traffic: M Entrance: C
Address: Tot Land Area: 0.290 Sale Valid: A Water: Collect Id: RRC
1401 GREAT POND ROAD U:12 Sewer: Grantor: TURCO,KATHRYN Sewer: Inspect Reas: C
NORTH ANDOVER MA 01845 Exempt-B/L% 0/0 Resid-B/L% 100/100 Comm-B/L°/u 0/0 Indust-B/L% 0/0 Open Sp-B/L% 0/0
RESIDENCE INFORMATION LAND INFORMATION
Style: CP Tot Rooms: 6 Main Fn Area: 1309 Attic: NBHD CODE: 4 NBHD CLASS: 4 ZONE: R4
Story Height: 1.50 Bedrooms: 3 Up Fn Area: 468 Bsmt Area: 1247 Seg Type Code Method Sq-Ft Acres Influ-YIN Value Class
Roof: G Full Baths: 2 Add Fn Area: Fn Bsmt Area: 773 1 P 101 S 12596 0.290 N 151,000
Ext Wall: Ws Half Baths: 1 Unfin Area: Bsmt Grade: DETACHED STRUCTURE INFORMATION
Masonry Trim: Ext Bath Fix: 1 Tot Fin Area: 1777 Foundation: ST Str Unit Msr-1 Msr-2 E-YR-Blt Grade Cond %Good P/F/E/R Cost Class
Bath Qual: M RCNLD: 224966 Kitch Qual: T Eff Yr Built: 1970 PV S 648 1988 A A /50//42 12,800 1
Mkt Adj: Heat Type: HW Ext Kitch: Year Built: 1940 SE S 96 2000 A A ///91 1,600
Sound Value: Fuel Type: G Grade: AG Cost Bldg: 225,000 VALUATION INFORMATION
Fireplace: 1 Bsmt Gar Cap: Condition: A Att Str Val 1: Current Total: 390,400 Bldg: 239,400 Land: 151,000 MktLnd: 151,000
Central AC: N Bsmt Gar SF: Pct Complete: Att Str Va12: Prior Total: 378,800 Bldg: 224,000 Land: 154,800 MktLnd: 154,800
Att Gar SF: 312 %Good P/F/E/R: /100/100/75
Porch Type Porch Area Porch Grade Factor
E 20
Sketch Photo
13
13 rfi
n a.
33 12 G 24
312 Sq.F
E 5r FM/13
20 FUT-/FM/B 18216 N Ft13936 Sq.Ft
19 19 r
12 I�
95 S .
Ft
23
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69 UNION STREET