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HomeMy WebLinkAboutBuilding Permit #852 - 70 SALEM STREET 5/15/2012BUILDING PERMIT °' ``° '°•'No\ TOWN OF NORTH ANDOVER to APPLICATION FOR PLAN EXAMINATION %2 Date Received Permit NO:T�� I DgATtD Pa`�g �SSauuS�/ TYPE OF IMPROVEMENT PROPOSED USE Resi ntial Non- Residential ew Building ebrie family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Commercial ❑ teratio No. of units: Repair replacement � Assessory Bldg�9�. 11 Others: ❑ D mo ion etatiCe�-s""' X'+r ��,�r� ❑ Other �+... 1 �11/atersh�edDistnct �, a e�.. c �v �";.� y., >t „„•c.�� , �, ��.,�r ..r�� �� , �.'� +k��❑�WaferlSewers xF �. n�crci�T�nN nF WC)RK TO BE PREFORMED: 801 ICL � �,/.,) c?" eat J- �� �c, c2 (,cf�� d �c,Js ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BOLDING PERMIY12,00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ra jC�d FEE: $b� J� Check No.: 9 9e Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund r J/1 ILI f �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 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 Deport (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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Private Tobacco Sales ❑ Food Packaging/Sales ❑ (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 DATE REJECTED DATEPPROVED CONSERVATION El El S a �y?/J COMMENTS a C 0z, EALTH DATE REJECTED DATE ROVED ❑ �-IEl COMMENTS i Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/ S9nature Date Drivewav Permit Located at 384 Osgood Street Z 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 X' DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine Doc -Building Permit Revised 2007 Location 70 K1- �PS�- p'�f-" Check # 25346 Date TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee $- TOTAL 71 Building Inspector CA m X m CA m mm _v, y C � S COD Cl) 'v O _ 0 Z y CL � � o CZ y O CO -i CD O p CD O CL cr� =r CD CD o CD 00 w C CDCD y CL. O y >> I �CD S v CO) O 1 Z O O O CD O CCD cn cn n cn cn cn C O O O CD O to O C_ n tC CD cc0 Cl. C O CS N N c=mac: w S CN cr N d.CD y CO 0 m C) yoan S'p y r'C •* d go p 7I ' C a •r Mn N N C y -1 S Z' m m I a 'O C ♦ „nr �"1 . CACDn Z<, :•` : CD O ti. C.) Ca S =,a: CSN) C2 CD m CO) O Ca CL CD m � N d y a 00 a - �c�_ G m N �r C, CD 9Ni - CD um =r CD clcoc CD CD =CO) 'K 0 m �0 W m m C) ICU) c =� CD. 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Z O y 0 9 0 c REBAR SET 125.00' S88'Oi35"E — REBAR SET I I I I I 70 SALEM STREET I I MAP 96 BLOCK 41 LOT 0 AREA = 25,000 S.F. 0.574 ACRES 3 e IN I IN PROP. 24' X 24' GARAGE of 1 �j N 22.2' _/Ji!,', � 4 ZI 21.8' r;�HOFss o i TIMOTHY �SG r GGJ --AME c si. 44WININGS, zr%�1�r1%�,1r No. 45099 .6 A v i i PROP. 4' X 8' I �FES_��� PROPOSED00 LANDING (©` 5'X15' �- ADDITION ( IRON PIPE � _ _ 125.00'i FOUND sas�r35'E ----- EBAR SET --- ---- --- – - SALEM STREET -___----_=-------- GRAPHIC SCALE 40 0 20 40 so ( IN FEET ) 1 inch = 30 ft PROPOSED PLOT PLAN 70 SALEM STREET (Annoni PENNONI ASSOCIATES INC. 100 Burtt Road, Suite 120 93 Stlles Road, Sutte 201 Andover, MA 01810 Salem, NH 03079 PREPARED FOR: BART F. WEITZ 70 SALEM STREET APRIL 9, 2012 REaSEO MAY 16, 2012 PL -1 —_' FUMNi ASMA s iNG (p) 978-749.9M (p) 603.226-1950 (1)978-749-M www.ponnoni.com (0 603-226,1235PROJ NORTH ANDOVER, MA 01845 SMSN1001 CONSULTING BNGNAiiM TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT • �- �o� P^ � ...'1600 Osgood Street Building 2p, -Suite 2-36 fy�ssA�H�sc�5 North Andover, Massachusetts 01845 Gerald A. Brown Inspector of Buildings Telephone (978) 688-9545 HOMEOWNERLICENSE EXEMPTION Fax (978) 688-9542 BUIDING PERMIT APPLICATION Please print DATE: S ^' 020 / JOB LOCATION: ® Q •1�M �, Number Street Address Map/Lot HOMEOWNER Sar -f- Name Home Phone Work Phone PRESENT MAILING ADDRESS 20 c�- l ,��� City Town Styatre, . Zip Code The current exemption for "•homeowners" was extended to include owner -occupied dwellings to two units er less and to allow such ho neon=. ers to engage un iidividual 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 Qwns a parcel of land on which he/she resides or intends to considered a homeowner. reside, on which there is, or is intended to be, a one or two family structures. A person who constructs more that one home in a two-year period shall not e be The undersigned "homeowner" assumes responsibility for compliances with the State Building Code and other Applicable codes, by-Iaws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building De artment minimum inspection procedures and requirements and that be/she will comply with said procedures and p requirements, � - HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL, Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLA, NING-68�-9535 The Commonwealth of Massachusetts Department of IndustriqlAccidints Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Address: 20 aq I R^ �' . City/State/Zip: /UJf / ✓. Phone#• 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 (fall and/or part-time).* have lured the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet.1 ?• ❑ Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9, ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.0 1 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 '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 ale doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors 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 the policy and job site information. Insurance Company Policy # or Self -ins. Lic. Job Site Expiration 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 requiredunder 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certto under the pains and p.,enaldes ofperjury that the information provided above is true and correct. S—i,--nature: _41:;V4 U& f Date: 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. PIumbing Inspector 6. Other - - Contact Pers 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 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 ofpublic 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 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 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 a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department ofladustriat Accidents Office ofInvestigat ions 600 Wa.shiagtou Street Boston, MA, 02111 Tel, # 617-727,4900 ext 406 or 1-8,777MASS.AFE Revised 5-26-05 Fax # 617^727-7749 www.mass,gov/dia REBAR SET 22.2' 21.8' 44.6' PROPOSED 5' X 15' Azvawo on MAP 96 BLOCK 41 LOT 0 AREA — 25.000 S.F. 0.574 ACRES PROP. 24' X 24' GARAGE r PROP. 4' X 8' LANDING IRON PIPE FOUND o TIMOTHY tiG J. m $ WININGS y 0. 45099 v �. t9��ESS% /l EBAR - SALEM STREET GRAPHIC SCALE +0 0 20 40 so ( IN FEET ) 1 1wh = 30 & `I PROPOSED PLOT PLAN 70 SALEM STREET PENNONI ASSOCIATES INC. PREPARED FOR: Pennon► 100 Burtt Road, Suite 120 93 Stiles Road, Suite 201 BART F. WOTZ Andover, MA 01810 Salem, NH 03079 70 SALEM STREET n ( �M NONI ASSOC ES INC. x)97&749-'9420 f) ��'= 6032263745 NORTH ANDOVER. 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