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HomeMy WebLinkAboutBuilding Permit #444 - 85 MILK STREET 12/21/2007 BUILDING PERMIT NORTIi -� cf �2 �' "t- -� .6 OL TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION • '° Permit NO: Date Received /� ���7 °' ' ,y °44Teo 9SSACHUS�� Date Issued: / 2 1/ b IMPORTANT: Applicant must complete all items on this page LOCATION PJInt $ m ;RbPER Y OWNER` 4 L � MAP NO; PARCEI_ �Ol1NG DISTRICT His#oricDastrict yes rao 1Vlachme Ship Villagek -yes rao " �s TYPE OF IMPROVEMENT PROPOSED USE Reside Non- Residential ew Builth One famil Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Sep#ic;yiNell 4 ~ Floodplain iNetlands laterslaedDistr�ct. WatelSewer DESCRIPTION OF WORK TO BE PREFORMED: v Identification Please Type or Print Clearly) OWNER: Name: Phone: (4t 7- d©►- 1®;�-( Address: 39 W4ut1,-( (Lo,-4) IJ6/f-k i JO-I-e� CO.NTRAGTOFt Narne � � U 1?honbi z Address =t }a Supervisor's Construction Lice�ase ' � s Expate is HomE lmproveent License ° " ,.Exp Date ` x ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$1200 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ � 0()0 FEE: $ �- Check No.: (� 1 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have acc ss to the guaranty fund 5igrureof 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 ❑ 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 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) a Building Permit Application x Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses v Workers Comp Affidavit �e, Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) (�e, Copy of Contract ❑ Mass check Energy Compliance Report x 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 4 Plans Submitted' Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS DATE REJECTED DATE APPROVED -"CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS C Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/si nature & Date Drivewav Permit Located at 384 Osgood Street 07 FIREPDEPAI2TMENT "ernprf�ump # ,r yes sl#e a no r�"7 ,Located,-at 124° Str1z Ox, eetf t''' Fire Department signat" f0da#e GOMIVIEN. TS r 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 ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 I Location S No. Date TOWN OF NORTH ANDOVER C�� � e � 1ti0O e. ~ F ` Certificate of Occupancy $ + 04 ' . Building/Frame�'�s' •'<� /Frame Permit Fee $ ,`.. sncMuse 9 Foundation Permit Fee $ / 00 , Other Permit Fee $ TOTAL $ .r Check # / 20875 Building Inspector FORM - U - LOT RELEASE FORM INSTRiXTIONS: This form is used.to verify that an-necessary approval'/�Irmits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements- �sa■s■aa.aaaaa■s asaaaaatasa•asasas aaa.Aasssass�rss■a■aas■ raasasfs.sassss■a• APPLICANT r G� f` �y� PHONE ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISION LOT NUMBER ¢j Z STREET /moi STEET NUMBER I■•a* ■ .■ ;■a■■saaaaaa•s■■a■ssaaara.a.•aaasasaas.—.-AT■REET` saas■as■rs aasssr�sa■ OFFICIAL USE ONLY iamemo a■saa,asaaaaaa•■aauaaaaa'a.aasaaa:as�aaaaaaaaa.aamammas anaman RECOMNDATIONS OF TOWN AGENT'S �■l�sa r ■aa � Bassa■aaa. ■ ■s�asiaaaaasaaasaaaassaaasaaas■saaasassasaaaa.on DATE APPROVED ��Ji CO ERVATION AD TOR DATE REJECTED CON MENTS 4V (� 1 DATE APPROVED f O & 0 J*-- TO PLANNER DATE REJECTED CONRVIENTS DATE APPROVED FOOD IN PEC OR-HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPEC R-HEALTH - DATE REJECTED COMMENTS PUBLIC WORKS-SEWER!WATER CONNEC ONS %- DRIVE Y P BJ F DATE APPROVED EPAR DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE_ 1 The Commonwealth of Massachusetts Department of Industrial Accidents " Office of Investigations d 600 Washington Street t Boston,MA 02111 M www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): P,, � Address: Ll City/State/Zip: 4w_Pk 4c 9 ol8gK _Phone.#: 6 l 7 - 01-0 1 - i 0 rcl Areyou an employer?Check the appropriate box: Type of project(required)°, 1.El am a employer with 4. E] I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in an capacity. employees and have workers' Y P t3'• $ . 9. ❑Building.addition [No workers' comp. insurance comp insurance. ] ❑ e are a corporation req 5. Woration and its 10.❑Electrical repairs or additions u - 3. I am a homeowner doing all work officers have exercised their 11.E]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowner;who subrit this affidavit indicating they are doing all work and then hire outside contractors must submit 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-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: 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 required under 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. Sipnatur`e: Date: _ Phone#: Offccial•.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 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"ever 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 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 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 may 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 burn 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 of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #6.17-7274900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-.22-06 vruw.mass.gov/dia M°RTM TOWN OF NORTH ANDOVER ° ° '•�" OFFICE OF . BUILDING DEPARTMENT s* 1600 Osgood Street Building 20, Suite 2-36 ;..::r North Andover,Massachusetts 01845 c�nrstt Gerald A Brown Telephone,(978)688-9545 Fax (978)688-9542 Inspector of Buildings HOMEOWNER LICENSE EXEMPTION Please mint DATE: f), (Q(2007 JOB LOCATION: gJ I l S i�reet Number Street Address M*Lot HOMEOWNER 11-90/ -/0 6 Name Home Phone Work Phone PRESENT MAILING ADDRESS 4 3G c eK ver I c RCS City Town State Zip Code The current exemption for"homeowners"was extended to include owner-oocupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code$eCtion 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which halshe resides or intends to 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 be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undersigned"homeowner"certif'iies 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 c i�4 APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homeownms Exemption BOARD OF \PPEALS 6RR-9511 CO SER\ANON 6RR-9530 ITE.\1:111 698-9540 PL.L\KING 6RR-9535 N CN Appendix I Manual Trade-Off Works eel Permit# Builder NamefZ .Lu- I� (I P- Y _Date Builder Address 4-3cr U)/3 Vf)LLY Ad,i ' Checked 8y .� Site Address a5 M r I(, SZone[J12 []13 []14 Subrriftt®d By 1q= 12(�_ Phone.. :g 7 Date Ceilings:Skytiahts, and Floors Quer outside Air .77 Required . Insulation . x,Ne U44'e Description R=Value U-Value Area _ l!A Ceiling (fable$2.2h x Area UA able.J6.2.2a) 30 C033 1:7 3 -'� �•��j� c ��� i' ��Z 14 D,fra Floor Over Outside Air (rable J6.2.2a) ---�- Total Area wall w1h nw§, @nd Qoors Insulation x :.,., _ _ .. Required tion R-Value U-Value, Area = - UA U-V lue x Area - UA walls - - ebie 'D�1 =--- :Z44-. 13455 =�,° .Windows: - . _ ---- � _ • _: NFRC dr Table Ji.5.3a)'' u • Doors ..._ ` ... NFRC or Table Jt! 5.3b �o. Slldlnq!t [att Doors ft2 NFRC d"nable J1.5.3a) 34— 49.: --�-�► . . �o% Total Area F1 _ s nd Foundations: insulatlon insulation -Ar Area or: - »equtl'etl Descrlptlon depth R-Value U-Value : perimeter '=UA U-Vali ze.. . ' x Area =UA Floor Over unconditioned (fable Spate J6:2.2e) : . - easement Walt (Table - - e;' Unhc sted Slab A (Table 46.2.2 Irl: Heated:Slab . ft _ able J8;2,2 in. total Proposed UA trust be lessTotal- than or-equal to Total(orAdjustecp Required UA PropR osed UA Totalf�`� p 9I A u d U Statement of Compliance:The.proposed building design represented in Ad1v-sted- these documents Is consistent with the building plans, specifications, and other calculations submitted with the permit application NgOred UA SuilderlDeslgner Company Name - . Date r�vi5ea cQui-jau, Restret r-lw- ipe-slaks rz S3V-07 NORTH ANDOVER BUILDING DEPARTMENT • Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: 1� is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL C 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: r L k �o (Location of Facilit Signature of Pe it Applicant Fire Department Sign off: �� JAL-- Dumpster Permit ell�1/ Date ' 1473 APPLICATION FOR WATER SERVICE CONNECTION North Andover, Mass. 16 19 ZqL Application by the undersigned is hereby made to connect with the town water main in �'( 1 Street, subject to the rules and regulations of the Division of Public Works. The premises are known as No. bC2 �4f�[�^ Street or subdivisi n lot no. `�O— 6 Z� 0,51" 3d4f I. 1/)�e1.t� 4v IVJ Owner Address Contractor Address ppli nt's Signature << ,n� Zt 0"00 PERMIT TO CONNECT WITH WATER MAIN The Board of Public Works hereby grants permission to to make a connection with the water main at ( � Street subject to the rules and regulations of the Division of Public Works. Board of Public Works By Inspected by Date See back for rules and regulations RULES AND REGULATIONS GOVERNING THE INSTALLATION Of WATER SERVICES 1. No persons shall tap or in any way tamper with water mains which are part of the distribution system of the Town of North Andover without a valid permit from the Division of Public Works. 2. All water services shall be installed a minimum of five feet below the finish grade. 3. No water services shall be backfilled without inspection by a representative of the D.P.W.—Telephone 687-7964. 4. Service connections shall be 1" type k copper tubing. 5. All fittings shall be brass flange type Mueller or equal H 15202 Corporations H 15212 Curb stops H 15402 Three part unions H 8185 stop and waste valves 6. Curb boxes shall be installed at the property line and shall be of the Erie Type with 4�/z foot rod and brass plug type cover. LOT #40-1A 120.00, LOT #40- 2A AREA=25,556 S.F. =0.5867 AC. CBA=25,556 S.F. =100.00% r N ,. J 'tom, PROP. DECK PROP. LOT #40-3 CHIMNEY 3p 65 2 21.13 1p, 1 2© p P N OUSE 20 �. 21.88' �a s coh' o. • /g. `A Nk NO TES P LAN 0 F LAND 0 1. PROPERTY LINES FROM EXISTING PLANS AND RECORDS. 086 TOWN OF NORTH ANDOVER ASSESSORS MAP #59 LOT #40 IN N AND DEED BOOK #559 PAGE #32 E.N.D.R.D. NORTH ANDOVER, MASSACHUSETTS 2. ZONE DISTRICT IS R3 DRAWN FOR 3 BEVERLY MURPHY o #85 MILK STREET NORTH ANDOVER, MASSACHUSETTS 01845 O Lo SCALE: 1"=40' DATE: DECEMBER 20, 2007 M O Lo 0 20 40 80 .120 .k th MERRIMACK ENGINEERING SERVICES u , 12-20 07 66 PARK STREET STEPHEN E. ST I, R.L.S. DATE ANDOVER, MASSACHUSETTS 01810 LOT X40-1A 2o.001 1 LOT X40- 2A AREA=25,556 S.F. =0.5867 AC. r' CBA=25,556 S.F. =100.00% 00 J c� PROP. DECK PROP. LOT #40-3 CHIMNEY 4p.56' 65' 21'13 30. 2 Zp'10 P pR p N� N olo 20.10 �. 21.88' v' tp�• O , Ivo* M 1lTO TESP LAN OF L � 0 1. PROPERTY LINES FROM EXISTING PLANS AND RECORDS. NSEE TOWN OF NORTH ANDOVER ASSESSORS MAP #59 LOT #40 IN N AND DEED BOOK #559 PAGE 032 E.N.D.R.D. NORTH ANDOVER, MASSACHUSETTS � 2. ZONE DISTRICT IS R3 DRAWN FOR BEVERLY MURPHY o #85 MILK STREET NORTH ANDOVER, MASSACHUSETTS 01845 --� SCALE: 1"=40' DATE: DECEMBER 20, 2007 OFLoo 0 20 40 80 120 I Q n z-zo/07 MERRIMACK ENGINEERING SERVICES ' 68 PARK STREET STEPHEN E. ST 1, R.L.S. DATE ANDOVER, MASSACHUSETTS 01810 ORTH T 01" 0 4� dover f No. 4 t f _ 00 dover, Mass., 0 LA COCHICHEWICK 0RATED P'f C IT % BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System 0 BUILDING INSPECTOR THISCERTIFIES THAT..... M .............................................................................................. Foundation has permission to erect........................................ buildings on . ............................... Rough to be occupied as.......3 . ..... .... . ... .. . Chimney... .................. W ............................................................... provided that the person acct ting this permit shall in every respect conform to the terms of the application on file in Final 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 3 �r Final fo PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough doom t�U, ........... Service Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det.