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HomeMy WebLinkAboutBuilding Permit #413 - 91 MILK STREET 12/4/2007 BUILDING PERMIT of "°RTH q tit`°O:, TOWN OF NORTH ANDOVER 32 "'- = °� APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received '! ��SSACHUS Date Issued: Jg'7 W IMPORTANT:Applicant must complete all items on this page z CAT10. ' — t PROPERTY OWNER 4 �/ Pant PARCEL ZONING ©�STRICTH�storicf3istnct yes ti ac"i �hOp V�Aage yes rio TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential e u m One anvil Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Se tic o�`dWetlands ` :r F Wateate.E:45w s- _a DESCRIPTION O W RK TO E PREFORMED: Y. In'fi ation Please Tor Print Cle rWE(?AOWNER: Name: l�! � LLCM yp o sa/ J Phone: Address: 4 *(ZESrST 01'5�'30 CONTRACTOR Nan Q'i Phone. � s h Superviso.r's Construction1L cense Expa safe ` HomE Improvement License 't Exp 'Date 3 ARCHITECT/ENGINEER Phone: Address: A 4Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 P R OS OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ - : $ 01C V Check No.: � Receipt No.: 43? NOTE: Persons cont ctin u egi e o r to s do not have acc to ara 5�gnature of Age , O n nature of con - i 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 ❑ 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) ❑ 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 O _. WERAGE DISPOSAL ublic Se 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 4 CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street FIRE DEPARTMENTTernp Dempster on site yesno L-ocated at:324.Main�Street i x 'Fire"Department signatureclate ,COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions.// -2� 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 ALI Som 100 ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 t i f FORM - U - LOT RELEASE FORM INSTRUCTIONS: This fora is used.to verify that all necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and`or landowner from compliance with any applicable requirements. �l.■..a.a.ae.■..a..!■aaaa.a.aa..aa.aaa.l..a�a.a■ lr.a...l..al.a.l.lra!!a!!!aa APPLICANTS ji^ j,7` PHONE ASSESSORS MAP NUMBER ;� '�_LOT NUMBER SUBDIVISION LOT NUMBER GIS STREET 91 Zk°S/. STREET NUMB1✓R / a..,...a.l...l.a.........a.a.. aaaaa.aa...summons &means .m.l.I..l..aa.. OFFICIAL USE ONLY �..aaa.saa..•sfa■.•s.■a■ua•rare.arra!a-a..■.n..a■aaae....a.aa.a.aaa.a.!-aa.aaaaa e RECO ATIONS OF TO AGENTS ��..si. •.a.a masa, •.l.a.. ' .■ ...aa.aa.:....■■a..a,.a.ar..aa.aana.lraaaasummon �( C� �� DATE APPROVED CONS VATION ADMINISTRA R DATE REJECTED � � F CON MENTS il PLANNER DATE APPROVED /C) z��-- DATE REJECTED CO1�riMEN"IS DATE APPROVED FOOD INSPECT - DATE REJECTED DATE APPROVED SEPTIC INSPECTOR- iTH DATE REJECTED CONRVIENI'S PUBLIC WORDS-SEWER/WATER CONNECTIONS ll WAY ERMIT �^ �3 DATEAPPROVED FI E DEPAR DATE REJECTED CONQAMS RECEIVED BY BUILDING INSPECTOR --_------- DATE ` NQRT►y ® of No. '1/ - �`yy © y dover, Mass., T O - LA .44 T COCHICHEWICK y1. 0/;? ? ATED O' G � 7 6 BOARD OF HEALTH Food/Kitchen PERMIT T D. Septic System THIS CERTIFIES THAT a° �... ,r'.....1 .. .t'r .. i." x'117 ................... FoundationBUILDING ........... ......... ........ 5has permission to erect........................................ buildings on ....... .............................. Rough to be occupied as........... r... ,�`. `" . Chimney �..r ..... ..... .....�f.. .... ............................................................................................. provided that the person accepting this permit shall in eve 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO STARTS Rough .............. ................." -` ................................,. ............ Service ..�,... BUILDING INSPECTOR 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. Name Location �7 ! Check# l Date /® ®S Note: cF Nip*H, TOWN OF NORTH ANDOVER ti Sewer Mitigation Fee $ p * l/W Sewer Connection Fee $ CHU Water Connection Fee $ 'Z, � V-10 Meter Fee $ 5019 Other $ RECEIPT NO. TOTAL $ 1435 Div.Public Works WHITE: Applicant CANARY: Department PINK: Treasurer GOLD: File The Commonwealth of Massachusetts Department of Fire Services Office of the State Fire Marshal P.O.Box 1025 State Road,Stow,MA 01775 PERMIT Date:North Andover Permit No Dig Safe Number (City of Town) (If Applicable) In accordance with the provisions of M.G.L.14 8 Chapter_jfl_as provided in section-121—LMR 34 Start Date This Permit is granted to: yc�Sf Full name of person,Firm or Corporation Petmissionto locate dumpster for construction/renovation/demolition of building. Comments: dumpster must be 25 ' from structure if unable to place with required Restrictions:clearance dumpster must be covered with plywood or tarp end of work day at �� (Give location by street and no.,or describe in such manner as to pr 'ed adequate identification of location) Fee Paid$ 50.00 �� 1 Fire Chief This Permit will expire -30 " 06 (Signature of offical granting permit) Offical granting permit (Title) MW=00' TNIC PERMIT MI ICT RF f_nm-gPI(_I inn ICI Y P(1CT;=n I ipr)M TNI= PRFMICI=C ° NORTH 1, TOWN OF NORTH ANDOVER � ao X6'9 DIVISION OF PUBLIC WORKS 384 OSGOOD STREET a NORTH ANDOVER MASSACHUSETTS 01845 ��SSacEr+usEt�y Telephone(978)685-0950 Fax(978)688-9573 2 DRIVEWAY PERMIT June 1, 1999,Revised 06-01-02 DATE: /0—/3-1K � ct (Please Print) STREET &NUMBER: -eF LOT NUMBER: CONTRACTOR: TEL: ADDRESS: FAX: OWNER: TEL: ADDRESS: PROPOSED PLAN OF DRIVEWAY ATTACHED: PROPOSED SITE DISTANCE: DIG SAFE NUMBER: SITE INSPECTION IS REQUIRED BEFORE FINAL SURFACE IS INSTALLED AND A FINAL INSPECTION WILL BE MADE WITHIN 48 HOURS OF NOTIFICATION OF COMPLETION. INITIAL INSPECTION DATE: BY: FINAL INSPECTION DATE: BY: FAIL URE TO COMPLY WITH THESE CONDITIONS OR TO OBTAINREQUIRED INSPECTIONS AND APPROVALS VOIDS THIS PERMIT. APPROVAL OF THIS PERMIT DOES NOT RELIEVE THE APPLICANT FROM MEETING ALL OF THE REQUIREMENTS FOR SAFETYAND DRAINAGE.A SEPARATE STREET OPENING PERMIT IS REQUIRED FOR WORK PERFORMED WITHIN THE STREET PA VEMENT. Attachments made a part of this permit: Fonn U & Driveway Application Re is Sketch "A" Proposed Drivew e 6-01-99 Sketch "B"Typical Dri a etail APPLICANT SIGNAT DATF-4 DIVISION OF PUBLIC WORKS SIGNATURE: DATE: /Q 13�d horns u&Driveway Applications Rev 6-7-01 Y 2062 APPLICATION FOR SEWER SERVICE CONNECTIONS North Andover, Mass Application by the undersigned is hereby made to connect with the town sewer main in Street, subject to the rules and regulations of the Division of � f Public Works. f The premises are known as No. `7�( � Street 0 71- or subdivision lot no. )?tl z,,l114 h Owner Address // Contractor Ad re AP ica s Si4zure PERMIT TO CONNECT WITH SEWER MAIf� The Division of Public Works hereby grants permission to r to make a connection with the sewer main at Street subject to the rules and regulations of the Division of Public Works.. All Divisj n of Pub 'c Works C By Inspected by Date See back for rules and regulations RULES AND REGULATIONS FOR GOVERNING THE INSTALLATION OF SEWER SERVICES 1. No unauthorized person shall uncover, make any connections with or opening into, use, alter, or disturb any public sewer or appurtenance thereof without first obtaining a written permit from the Division of Public Works. 2. All costs and expense incident to the installation and connections of the building sewer shall be borne by the owner. The owner shall indemnify the (town) from any loss or damage that may directly or indirectly be occasioned by the installation of the building sewer. 3. A separate and independent building sewer shall be provided for every building; except where one building stands at the rear of another on an interior lot and no private sewer is available or can be constructed to the rear building through an adjoining alley, court, yard, or driveway, the building sewer from the front building may be extended to the rear building and the whole considered as one building sewer. 4. Old building sewers may be used in connection with new buildings only when they are found, on examination and test by the (Superintendent), to meet all requirements of this ordinance. 5. The size, slope, alignment, materials of construction of a building sewer, and the methods to be used in excavating, placing of the pipe, jointing, testing, and backfilling the trench, shall all conform to the following requirements. The sewer shall be 6"diameter SDR 35, PVC pipe. Minimum slope shall be 1/8" per foot. The minimum depth of sewer shall be four feet below finish grade. Sewer pipe shall be installed on a stable trench bottom of hard durable crushed stone to a minimum (6) inch depth below the pipe. After the pipe has been installed, crushed stone shall be brought up to the crown of the pipe. Care shall be taken to carefully grade and compact the stone, and prevent pipe displacement. The remainder of the trench shall then be backfilled in one foot lifts with mechanical tamping after each lift. 6. Whenever possible, the building sewer shall be brought to the building at an elevation below the basement floor. In all buildings in which any building drain is too low to permit gravity flow to the public sewer, sanitary sewage carried by such building drain shall be lifted by an approved means and discharged to the building sewer. 7. No person shall make connection of roof downspouts, exterior foundation drains, or other sources of surface runoff or ground water to a building drain which in turn is connected directly or indirectly to a public sanitary sewer. 8. The applicant for the building sewer permit shall notify the (Superintendent) when the building sewer is ready for inspection and connection to the public sewer. The connection shall be made under the supervision of the (Superintendent) or his representative. 9. All excavations for building sewer installation shall be adequately guarded with barricades and lights so as to protect the public from hazard. Streets, sidewalks, parkways, and other public property disturbed in the course of the work shall be restored in a manner satisfactory to the (town). 1413 APPLICATION FOR WATER SERVICE CONNECTION North Andover, Mass. 19 Application by the undersigned is hereby made to connect with the town water main in �i�l Street, subject to the rules and regulations of the Division of Public Works. l t` The premises are known as No. �` ��( � Street or subdivision lot no. �C) 40" Apu�,, Owner Address Zoe Contractor A ress A can ' ignat PERMIT TO CONNECT WITM WATER MAIN The Board of Public Works hereby grants permission to J to make a connection with the water main at Street subject to the rules and regulations of the Division of Public Works. Board f P is Works By l (7 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 4Y2 foot rod and brass plug type cover. 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: P � f is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: lL-- S� r�oJ. (Location of Fac' it Signature f Permit Applicant Fire Department Sign off: Dumpster Permit Date b�_ Permit Number REScheck Compliance Certificate Checked By/Date 2000 IECC REScheck So$ware Version 3.6 Release 2 Data filename: C:\Program Files\Check\REScheck\Milklotr#85.rck PROJECT TITLE: Milk Stree85 Milk St. CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: Single Family WINDOW /WALL RATIO: 0.17 DATE: 10/16/05 DATE OF PLANS: !0/13/0510/13/05 PROJECT DESCRIPTION: Colonial DESIGNER/CONTRACTOR: Highview LLC P 0 Box 160 Merrimac Ma. 01860 COMPLIANCE: Invalid Area(s) Gross Glazing Area or Cavity Cont. or Door Perimet R--Value R-Value U-Factor Imo, Ceiling 1: Flat Ceiling or Scissor Truss 1272 30.0 0.0 45 Wall 1: Wood Frame, 16" o.c. 2012 13.0 0.0 132. Window 1: Vinyl Frame:Double Pane with Low-E 344 0.340 117 Door 1: Solid 58 0.270 16 Floor 1: Click here to select Assembly 0 0.000 0 Floor 2: All-Wood Joist/T russ:Over Unconditioned Space 1272 19.0 0.0 60 Furnace 1: Forced Hot Air, 92 AFUE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street ;l etc, Boston, MA 02111 f..; www.mass.gov/dha Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Legibly Name (Business/Organization/Individual): �jJC)IEW / -( Address: City/State/Zip: �� / � �/ Phone Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4,X I am a general contractor and I 6.XNew construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. '+ 7. ❑ 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.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1 I.❑ 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' 13.❑ Other comp. insurance required.] *Any applicant that checks box#I must also till out the section below showing their workers'compensation policy information. t Homeowners who submit 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 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:/Q 'qtr' Job Site Address: 76— gl Zk f , City/State/Zip: /11)0, 0�_d 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 tine 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 insura e cove ra e verification. I do hereby cer ' at' res of er' that the information provi71�711 is true and correct. Signa Date: 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 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 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-contractor(s)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 cant'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 confinnation 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 pen-nit 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 till in the pen-nit/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 infonnation(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. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 - www.mass.gov/dia � , j