HomeMy WebLinkAboutBuilding Permit #1217-16 - 87 BUCKINGHAM ROAD 5/25/2016 J �J
BUILDING PERMIT r10RTyq
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION '' =
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Permit No#: /7 Date Received T
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Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION : .
a ' 'Print
-PROPERTY OWNER
,Pant 100 Year St�uctureh yes no .
R a
Y
MAP - PARCEL ZONING DISTRICT Historic D1stnct r ., .yes--'yno
Machine Shop Village yes; no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
XRepair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
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:4 x,�eptic ®.Welly r Fl:o d Rein 5 RL
FRT ®e�1Nater�hetl 'istrlct, r
DESCRIPTION OF WORK TO BE PERFORMED:
Identification- Please T�Pri t Clearly
OWNER: Name:k Phone: 5ba-9�2_-Z 6 9'�
Address
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Contractor Name .` v5 [� Phone S Z'-
Email
Address:
Supervisor's Gonstruc ion`License CS I'O� i `� .JExp ` Date4-fi 0
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Horne lmprovernent 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$125.00 PER S.F.
:y
Total Project Cost: $ =Ty`t 30,t" tJ FEE: $ Q�G�
Check No.: 0� O Receipt No.: �6 Lf o(
NOTE: Persons contracting with unregi red contractors do not have access to he guaranty unci
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Location y
No.
Date i
i
I J
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TOWN OF NORTH ANDOVER '
I
Certificate of Occupancy $
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I Building/Frame Permit Fee
- Foundation Permit Fee '
Other Permit Fee
TOTAL $
Check
Building Inspector
. I
I
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
F ❑TYPE OF SEWERAGE DISPOSAL `.
Public Sewer Tanning/Massage/Body Art E] 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 e U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on
Signature
COMMENTS
HEALTH Reviewed on Si nature
COMMENTS -
Zoning
OMMENTS -Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
fanning Board Decision: Comments ----
'< nservation Decision: Comments
Water& Sewer Connection/Siqnature & Date
Driveway Permit _
DPW Town]Engineer: Signature:
Located 384 Osgood Street
FIRE DEPgRTMENT �-
Located at 1►24 Main S reet
Fire Departmen signature/date
- ... +.... -i-..++iA�-`:x'.sasliii„�a'•- ,.w..�'i�a.� �-.+x?�baRM.+,d?� r €�,`--' � �' .Td�'w" }F�Cn��,�`�,� ,���
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 Call Email
Date Time Contact Name --------------
I
Doc.Building Permit 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
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
4. 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)
4. Mass check Energy Compliance Report (If Applicable)
Engineering Affidavits for Engineered products
IS 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 IECC 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
CS Beam Calculation
07/12/16
05:48:28
4 of 4
S Beam 4.11.26.1 Martino 621-1
1BeannEngine 4.11.26.1 87 Buckingham,Rd..N.Andover, 7:52am
aterials Database 1516 Seal:Massachuse
Member Data
Description: Member 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: L/360 live, L/240 total 1.000"max. LL
Dead Load: 10 PLF Deck Connection: Nailed Member Weight: 12.5 PLF
Filename: Beam1
Other Loads
Type Trib. Other Dead
(Description) Side Begin End Width Start End Start End Category
Additional Uniform(PSF) Top 0' 0.00" 12' 6.00" 12' 6.00" 30 10 Live
Additional Uniform(PLF) Top 0' 0.00" 12' 6.00" 0 65 Live
Additional Uniform(PSF) Top 0' 0.00" 12' 6.00" 12' 6.00" 10 10 Live
12 6 0
Q
r �
12 6 0
Bearings and Reactions
Input Min Gravity Gravity
Location Type Material Length Required Reaction Uplift
1 0' 0.000" Wall SPF Plate(425psi) 5.500" 2.306" 5146# -
2 12' 6.000" Wall SPF Plate(425psi) 5.500" 2.306" 5146# -
Maximum Load Case Reactions
Used for applying point loads(or line loads)to canying members
Live Dead
1 3167# 1979#
2 3167# 1979#
Design spans
11' 8.750"
Product: 2.0 RigidLam LVL 1-3/4 x 9-1/2 3 ply PASSES DESIGN CHECKS
Connect members with 2 rows of 16d common nails at 12.0"oc
NOTE: Nails must be applied from both sides
Design assumes continuous lateral bracing along the top chord.
Design assumes continuous lateral bracing along the bottom chord.
Allowable Stress Design /�
Actual Allowable Capacity Location Loading 11 r�
Positive Moment 15090.# 21845.# 69% 6.25' Total Load D+L (/"�l t�
Shear 4451.# 9642.# 46% 11.53' Total Load D+L
Max.Reaction 5146.# 12272.# 41% 0' Total Load D+Ly � /lIV
TL Deflection 0.4981" 0.5865" L/282 6.25' Total Load D+L
LL Deflection 0.3065" 0.3910" L/459 6.25' Total Load L t �H of
Control: TL Deflection \ �P� ASSgOy
DOLS: Live=100% Snow=115% Roof=125% Wind=160% (�
Design assumes a repetitive member use increase in bending stress: 4% V DARREN R. N
CONRAD m
O
U CIVIL
NO.51679
AN product names are trademarks of theh respectNe owners. � Q�^-
Copyright O 2013 by Shnpson Strong-Tia Company,Inc. ALL RIGHTS RESERVED. .\ -T�
This drawing is an Integral part of a floor joist component document as defined In theattached General Notes. Th's drawings NAL
ENG
not complete without the accompanying General Notes.The Engheees Seal on this drawing hdicates only that the floorpist
component shomonth's draymg meets'a ppficable design criteria for Loads,Load Ing Cond'sions,and Spa nsbsted on this sheet.
Th is
design assumes product installation accordhg to themanufacturofs specifications.
07/12/2016
NORT#�
Town of
O
C, h ver, Massy
COC LAK a
NICNEWIC« y�•
x.95 Rpt TE 0 #14f �,(5
U BOARD OF HEALTH
Food/Kitchen
P- ERMI.'T T LD Septic System
THIS CERTIFIES THAT ......:� ."�`�C `':s�af�. .�.,, �<; / sBUILDING INSPECTOR
fZ..&C Ar"/v���ltryl, { Foundation
has permission to erect .......................... buildings on .. .............. ............................
Rough
to be occupied as , L �
/7 g
.......... ....... ............i.... ............................ ............Ys-of
.t..I...Ji:!.`�.,lti.......... Chimney
provided that the person accepting this permit sfiail in every respect conform to the terthe 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 CONSTRUCTION STARTS 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.
The Commonwealth of Massqehusetts
F Department oflndustrialAccidents
f d 1 Congress Street,Suite 100
`< Boston,MA 02114-2017
www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
NaMe(Business/OrganizatioiAndividual):
Address: `a3 t Sax wcr
City/State/Zip: Phone
Are you an employer?Check tfie appropriate box:
Type of project(required):
1.❑I am.a.employer with employees(full and/or part-time).* 7. ❑New construction
IN 1 am a sole proprietor or partnership and have no employees working for me in 8. Remodeling
any capacity.[No workers'comp.insurance required.]
3..F1m I aa homeowner doing all work myself.[No workers'comp.Jusurance required.]t 9. El Demolition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 E]Building addition
ensure that all contractors either have workers'compensation insurance or are sole I L❑Electrical repairs or additions
proprietors with no employees.
12.[]Plumbing repairs or additions
5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet.
❑ 13-E]Roof repairs
These sub-contractors have employees and have workers'comp.instuance.$
6.❑We are a corporation and ifs offiers have exercised their right of exemption per MGL c. 14.❑Other
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box 4l must also fill out the section below showing their workers'compensation policy information.
Homeowners who subir it#his affidavit indicating they are doing all work and then hire outside contractors must siibmita new affidavit indicating such.
TContractors 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. lfthe sub-contractors have employees, lieu must promde their workers'comp.policy number.'
Iain an employer that is pr ovid6ig workers'compensation insurance for my employees.'.Below is thepolley and job site
information.
Insurance Company Name:
Policy#or Self-ins,Lie.#: 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 MGL c. 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 DTA for insurance
coverage verification
I do hereby cerci u/ er theepp�ains and n . s ofperjury that the information provided above is true and correct.
Si nature: ,thy' 7/` Date: c
h-?h
Phone#:
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.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 ofhire,
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 b6 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 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 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
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 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
Regulation
Office of Consumer Affairs and Business Re ula
O g
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Co�r Registration
Registration: 185227
Type: LLC
" f X Expiration: 5/12/2018 Tr# -288600
FZ
SAINT CHRISTOPHER PROPERTIES, =LC _ ;
PATRICK RUSSELL a
231 BROADWAY
METHUEN, MA 01844
Com, Update Address and return card.Mark reason for than
P e.g
Address 0 Renewal F] Employment Lost Card
SCA 1 0 20M-05/11 '
��,e`{po�nUr�zoryacuuc�G�a�-� /�a�aac�cu�eC(iy
Office of Consumer Affairs&Business Regulation License or registration valid for individual use only
OME IMPROVEMENT CONTRACTOR before the expiration dgte. If found return to:
Registration:,.,185227 Type: Office of Consumer Affairs and Business Regulation
Expiration=5%12.01^8 LLC 10 Park Plaza-Suite 5170
Boston,MA 02116
SAINT CHRISTOPHER;=RROP,RTJ'ES, LLC
PATRICK RUSSELL
231 BROADWAY
METHUEN, MA 01844 Undersecretary Not valid without signature
Massachusetts Department of public Safety
Board of Building Regulations and Standards
License: CS-109119
Construction Supervisor
PATRICK RUSSELL {
80 SAILE WAY __
NORTH ANDOVER MA 01846• "
l� Expiration_:
C�nmmiccinnor tr:.u7MM0