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Home My WebLink AboutBuilding Permit #637-13 - 89 BLUEBERRY HILL LANE 4/2/2013TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION l Permit NO: Date Received Z ` 3 Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION PROPERTY OWNER flS)Am & jKlA2inl-At �c UM� - Print 100 Year Old Structure yes no; MAP NO: PARCEL: ZONING DISTRICT: Historic District- yesno Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building , One family ❑ Addition ❑ Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District- ElWater/Sewer DESCRIPTION OF WORK TO BE PERFORmEU: OWNER: Name: Address: R� 1_� �v>__ 6 m HI l Please Type or Print Clearly) X_ tike I CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp.. Date: Home Improvement L ARCHITECT/ENGINEE Date: Phone: Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. l Total Project Cost: $' `/,X9FEE: $ Check No.: i Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund SLgnatureof Adent/Owner nature of contractor Plans Submitted ❑ Pans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Location No.&,?*'+' Date Check 4AA 26244 14� TOWN OF NORTH ANDOVER Certificate of Occupancy $- Building/Frame Permit Fee $-4-CiA Foundation Permit Fee $- Other Permit Fee $- TOTAL Lv Building Inspector 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 PLANNING & DEVELOPMENT ❑ COMMENTS CONSERVATION COMMENTS HEALTH t COMMENTS Reviewed on DATE APPROVED (, L '_—)I;e\ r(2,C) Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Seeger Connection/Signature & Date Driveway Permit DPW Towp_ ]Engineer: Signature: Located 384 FIRE -DEPARTMENT - Temp Dumpster on site yes no Located at'124 Main'`Street Fire Department-signature/date COMMENTS ;�5.. 04._ 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 — (Foie department use 0 Notified for pickup - Date E � Doc.Building Permit Revised 2010 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 o Building Permit Application o Workers Comp Affidavit a Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o 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 o Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o 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) Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses La Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract Li Mass check Energy Compliance Report o 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 appi�al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Bui!ding Permit Revised 2012 \ 3 ■ § ■ 2` « « y « e e a ■ r O N Ut = D CA C31 C7 i � � Z N W � W A J N J Ul (b � o 0 m D D m n v rt w D 7 m K o ui -o r o G ^ j. N. m m E5 25 N2 N N N 2 N a � i A m m 00 i c 00CZ m Z O N Ut = D CA C31 C7 i � � Z N W � W A J N J Ul (b � v N D D m m D 0 o � �p N N a i p 00 I f o N n D Z N u O r W J N w I i m m a 0 0 0 m D r a 3 0 3 m 3 W m m m J J r w w w r V Z co A O W OD A N A A = � � r O W W ri r w w Z A Azt A_ A O 1 A A A A O m O N � r O A N m N N r A O 3 3� 3� 3 w 3 oao n m m � r � � r O W W ri r w w Z A Azt A_ A O 1 A A O m W N C N m N N r O A A tl� W W i eD CA w � it o r u l7o r ll -1 qp (9 STRESS' ANALYSIS FOR LEVEL 1. CUSTOMER: DATE: 03/30/13 DESIGN: DECK13089 REF; 13089082<ZP1 SALESMAN # RKDECKDAY ------------------------------------------------------- MEMBER STRESS FACTOR COMPOSITE TYPE ------------------------------------------------------- SIZE FACTOR LOAD LOAD JOISTS 2X10 DEFLECTION 426 PSF 16" BENDING 273 PSF SHEAR 204 PSF COMPRESSION 374 PSF 204 PSF BEAMS 3-2X12LM DEFLECTION 209 PSF BENDING 139 PSF SHEAR 147 PSF COMPRESSION 371 PSF 139 PSF POSTS 6X6 STABILITY 843 PSF BEARING 587 PSF 587 PSF ----------------------------------- TOTAL LOAD 139 PSF DEAD LOAD 10 PSF -------------------------------------------------------- LIVE LOAD 129 PSF STRESS' ANALYSIS FOR LEVEL 2 CUSTOMER: DATE: 03/30/13 DESIGN: DECK13089 REF: 13089082.ZP1 SALESMAN # RKDECKDAY --------------------------------------------------------- MEMBER STRESS FACTOR COMPOSITE TYPE SIZE FACTOR LOAD LOAD ------------------------------------------------------- JOISTS 2X10 DEFLECTION 5151 PSF 16" BENDING 1457 PSF SHEAR 705 PSF COMPRESSION 863 PSF 705 PSF BEAMS 3-2X12LM DEFLECTION 26817 PSF BENDING 4665 PSF SHEAR 2894 PSF COMPRESSION 1476 PSF 1476 PSF POSTS 6X6 STABILITY 13838 PSF BEARING 9560 PSF 9560 PSF ------------------------------------ TOTAL LOAD 705 PSF DEAD LOAD 10 PSF LIVE LOAD 695 PSF ------------------------------------------------------- STRINGERS 2X12 DEFLECTION 85 PSF BENDING 115 PSF SHEAR 134 PSF COMPRESSION 566 PSF ----------------------------------- TOTAL LOAD 85 PSF DEAD LOAD 10 PSF ------------------------------------------------------- LIVE LOAD 75 PSF STRESS"ANALYSIS FOR LEVEL 3 CUSTOMER: DATE: 03/30/13 DESIGN: DECK13089 REF: 13089082.ZP1 SALESMAN # RKDECKDAY ---------------------------------------------------------- MEMBER STRESS FACTOR COMPOSITE TYPE SIZE FACTOR LOAD LOAD JOISTS 2X10 DEFLECTION 213 PSF 16" BENDING 1514 PSF SHEAR 731 PSF COMPRESSION 880 PSF 213 PSF BEAMS 3-2X12LM DEFLECTION 14338 PSF BENDING 2493 PSF SHEAR 1547 PSF COMPRESSION 789 PSF 789 PSF POSTS 6X6 STABILITY 7396 PSF BEARING 5110 PSF 5110 PSF ----------------------------------- TOTAL LOAD 213 PSF DEAD LOAD 10 PSF LIVE LOAD 203 PSF -------------------------------------------------------- STRINGERS 2X12 DEFLECTION 85 PSF BENDING 115 PSF SHEAR 134 PSF COMPRESSION 566 PSF ----------------------------------- TOTAL LOAD 85 PSF DEAD LOAD 10 PSF LIVE LOAD 75 PSF -------------------------------------------------------- STRINGERS 2X12 DEFLECTION 85 PSF BENDING 115 PSF SHEAR 134 PSF COMPRESSION 566 PSF ----------------------------------- TOTAL LOAD 85 PSF DEAD LOAD 10 PSF ------------------------------------------------------- LIVE LOAD 75 PSF el WD �r f� J W _ LL O D O mE C t \ O O LL ?O V1 V 0. N V7 O d Z Z m C + 'O 7 O LL t m O d' aTi C E _ L U O LL O U a Z c7 z J d L MO O w O LL O W a Z J Q u J W L W O O V N VI m O LL O i- W H Z H to L � O CC @ O LL E- W g oC Q a LLIca G M LL N 7 m O Z CU .�, V) r+ ai 0 v 0 O E VI _ O _ Ci 0 -: •�. L • m Q :r N V Q L N _ CD c 0 L CO -• CD ccCL3 L m CD -a > L o o N 0� a� _ :tt.)Q � t O E0 L 0 o as z CY) > 00 L CL �W ca 0 'N _ as 0 O c = Q L L ca -0 = as F— O LLIW CD = 'a O O IL 2 d N = N .=mow WL- 0 O L V w 0 'a 0 CL co N -0 .> %— C O H t w Q. O ti u Z m \Y z W X LLIW CL O W :a Z_ C9 z W z na TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, -Suite 2-36 North Andover, Massachusetts 01845 Gerald A. Brown Telephone (978) 688-9545 } Inspector of Buildings A Fax (978) 688-9542 HOMEOWNER -LICENSE EXEMPTION BUIDING PERMIT APPLICATION Pleaseyrinf DATE: c� 1 JOB LOCATION: Number Street Ad ess Map/Lot IJOMEOWNER Name PRESENT MAILING ADDRESS !9._ Y78 655 YyZ3 , - Home Phone Is Y7.vS1= Work Phone Town S+w+� Zip Co_ The current exemption for thomeowners to allow such homPot:, ers t" was extended to include owner -occupied dwellings to •two units -or less and o engage an ncividual-for hire who does not possess a license, provided that the owner acts as supervisor). Siete Building (Code Section 108.3.5, i) DEFINITION OF HOMEOWNER Person(s) who gwns 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 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" certifies that he/she understands the Town of Forth Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements, HOMEOWNERS SIGNATUW<A APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERV.g770N 686-9530p HEALTH 688-9540 PLANNING 688-9531 The Commonwealth of Massachusetts NN Department of Industrigl Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/El Please Print" ibl Applicant Information Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: 97B 6t--, gyz3 Are you an employer? Check the appropriate box: 4. ❑ I am a general contractor and I 1111 am a employer with employees (full and/or part-time).* have Hired the sub -contractors listed on the attached sheet. 2. ❑ I am a sole proprietor or partner- These sub -contractors have ship and'have no employees working for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its [No workers' comp. insurance officers have exercised their required.] 3 am a homeowner doing all work right of exemption per MGL 1I myself. [No workers' comp. c. 152, §1(4), and we have no employees. [No workers' insurance required.]r comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12. ❑ Roof re airs 13.❑ Other�-- *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they a're doing all work and then hire outside contractors must submit a new 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 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 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certif r t1 ains and penalties of perjury that the information provided above is true and correct. Phone #: � 97 655 Z Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License N. 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 #: Inform.ati®n and Instructiois 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 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 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 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, # 617-7274900 ext 406 or 1-877�MASSAFB Revised 5-26-05 Fax # 617-727-7749 www.mass,gouldla