HomeMy WebLinkAboutBuilding Permit #606-14 - 92 MEADOW LANE 2/25/2014TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit N0. U'U Date Received
Date Issued:
yes no
vel no
TYPE OF IMPROVEMENT.
I IM
ANT: Applicant
must complete
all items on this pa
Non- Residential
❑ New Building
One family
❑ Addition
❑ Two or more family
LION `7 _�- t,cJ/IG•_
OCAT'j/RrintPROPERTY
_
0� 4-m-
❑ Commercial
OWNE..K._
❑ Assessory Bldg
❑ Others:
-
❑ Other
..�^
MAP NO: _ PARCEL: _ ZONLNG4D.ISTRICT
Print
1`00 Year Old sty,
Histonc'Districf
❑ Watershed' District
E Water/.Sewer
�_--:Machine Shop
yes no
vel no
TYPE OF IMPROVEMENT.
PROPOSED USE
Residential
Non- Residential
❑ New Building
One family
❑ Addition
❑ Two or more family
❑ Industrial
ZAlteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
D Septic- ❑Well
❑ Floodplain 0 We a
❑ Watershed' District
E Water/.Sewer
DESCRIPTION OF
C
TO BE -PERFORMED:
L/ Identification Please Type or Print Clearly)
OWNER: Name: V Phone:7t�—
ArlrirPss
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.
Total Project Cost: $_ 12 �Rp FEE: $
Check No.:Receipt No.:� 5�
NOTE: Persons contracting with unregistered contractors do not have access to the uaranty f nd
Si _nature -of A -ent/O'wner�, - Si nature ofcontractor., - - ��
g
Plans Submitted E Plans Waived ❑ Certified Plot Plan ❑ Stamad Plans
Plans Submitted. -Plans Waived -0 Certified Plot Plan ❑ Stamped Plans ❑
TYPE_OF.=S) WERAGEDiSROSAL
Public Sewer ❑
Tanning/MassageBodyArt ❑ ....Swimming
Pools ❑
Well ❑
Tobacco.Sales
ToodPackaging/Sales ❑
Private:(septic tank, etc-- ❑ ..- _ _
-permanent D'umpster on-site ❑
THE- FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
Reviewed on Signature
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Comments
Conservation Decision: Comments
Mater & Sewer Connection/Signature & Date Driveway Permit
�APW Toiva: Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMr N' .Temp Dumpster on site yes no
L6cated-at:124iMair .Street ,
Fire Depa`rune►it'-signature/ddte
COMMENTS
.-Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions._
:Total- land -area; sq. ft.:
.ELECTRICAL:-itfllovement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter166 Section 21A =F and G min.$100=$1000 fine
NOTES and DATA — (For department use
El Notified for pickup - Date
Doc.Building Permit Revised 2010
Building Department
`rhe fol�.owing'is`=ali'st of the req uired .forms to be filled out'for the appropriate. permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
❑ Btailding Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/O'(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 casts if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the apw?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.Building permit Revised 2012
Location
4�OLA) 10AZ---
No. 00 Date
Check #
27317
TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee
TOTAL
$1-A L
'1561illdinga lnsrpec4--��
:zJ
ir"
I-$
VJ
Ll
2-26-14
KeyBem
8:48arr1
�. loft
KeyBeam® 4.600d
kmBeamEngine 4.6026
Materials Database 1472
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: 30 PLF Deflection Criteria: U360 live, U240 total
0.900" max. LL
Dead Load: 10 PLF Deck Connection: Nailed
Member Weight: 4.6 PLF
Filename: KYB1
Other Loads
Type Trib. Other
Dead
(Description) Side Begin End Width Start
End Start End Category
Replacement Uniform (PSF) Top 0' 0.00" 5' 0.00" 12' 0.00" 30
10 Live
Additional Uniform (PLF) Top 0' 0.00" 5' 0.00" 0
65 Live
Additional Uniform (PSF) Top 0' 0.00" 5' 0.00" 12' 0.00" 30
10 Live
Ti
500
LO
i
5 0 0
Bearings and Reactions
Input Min
Gravity Gravity
Location Type Material Length Required
Reaction Uplift
1 0' 0.000" Wall SPF Plate (425psi) 3.500" 1.579"
2349# --
2 5' 0.000" Wall SPF Plate (425psi) 3.500" 1.579"
2349# --
Maximum Load Case Reactions
Used for applying point loads (or line loads) to carrying members
Live Dead
1 1643# 706#
2 1643# 706#
Design spans
4'
Product: 2,0 RigidLam LVL 1-3/4 x 5-1/4 2 ply
PASSES DESIGN CHECKS
Connect members with 2 rows of cont "
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
Positive Moment 2679.'# 4309.# 62%
2.5' Total Load D+L
Shear 18984 34914 54%
4.55' Total Load D+L
Max. Reaction 23494 5206.# 45%
0' Total Load D+L
TL Deflection 0.1189" 0.2281" 0460
2.5' Total Load D+L
LL Deflection 0.0832" 0.1521" 0658
2.5' Total Load L
Control: Positive Moment
DOLS: Live=100% Snow --115% Roof --125% Wind=160%
All product names are trademarks of their respective owners
Jackson Lumber 8r Millwork Co.
215 Market St
Copyright (C) 2013 by Simpson Strong -Tie Company Inc. ALL RIGHTS RESERVED. Lawrence, MA 01843
"Passing is defined as when the member, fioorjoI,L beam shown on this drawing meets applicable design criteria for Load;, Loading C d =Ions, end Spens listed on this sheet. The
Zgilrder,
designmust be revlewetl a uallfied dem' ner or fessional as re wired forapproval. This design assumes product Inslallatlon accoMi to the manufacturer s s ctfications.
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This foi= satisfies all basic seg1tements of the state's Home Improvement Contractor Law (tv> GL chapter 142A), but does not include standard
language to protect homeowners. Seek legal advice if necessary. Any person Planning ain a copy of "A
obt
home i:npxovements should first
Massachusetts Consumer Guide to Home Improvement" before agrecingto any woxlc on your residence, You may obtain: first
copy by callit~g the
obt
0�.xce of Consumer.Adfaixs and Business $egulation.'s Consumerinfol7nationHotiine at 6.17-973-877 or 1-888-283-3`757 or on our website. '
Homeowner oTrJUm��710�1
'Contractor lu f6r mition
The Contractor agrees to do the following work for the Homeowner: V V
(Describe in detailthe worlcto completed, specitdngthe typo, brand, and grade of materials to be used 'Lisa additional sheets ifnecessa ,)
h4y�' woo
Jlzequired Permits -The follgwlg building pm=jts are required
and will be secured by the .edntractor as.th.e homeowner's agent;
(OT -Meas Who secure their own Pen'.uauits wM.be
excluded from the C Qgxaniy Fund Provisions o:c
:LTJ GL chapter 1.42.A.)
11e -A)
J?roposed Start anal Completiozx Schedule � The following schedule will
be adhered to unless citcumstmces beyond the coni.tactor's control arise
�7 ate when contractor will b egm. contracted woxlc,
ate when contracted work will be substaniialhy completed.
Total Contract Price andl'aymentSchedule
The Contractor agrees to peadorm,tlte woT'c, 4=nishthe material and labor specified above for the total sum of -
Payments will bemade according to the following schedule:
upon signing contract (not to exceed 113 bfthe total contract price or the cost of special order items, whichever iseat
by 1 1 or upon completion of � er)
-- ------ by 1 1 or upon. completion of
upon, completion of the conttaot, (Law forbids demanding full paglnentuatil.eontractis completed to bothpaxty's satzsfaciion
Tile followingmateriallequipmentmustUespecial � ) '
ordered before the contractedworlebegins inorder "— to bepaidfor
to meetthe completion schedule.(°�°°t) $
to bepaidfor
1'T0TLS: ('l°) Including all finance charges ,1.211
notexceedchmus the greaser or (a) one thud d to tothat
to q trideposit
pri a or Cb) the GttuQnt ual cost of any uired spa special equ pmentothe contractor or custom s may
which must be special ordered in advamoe to meet the completion schedule
. e material
Subcontractors - The contractor agrees to besolelyxesponsibled:ox completion, of the work describedregardless ofihe actions of any third
'Yes aII terms ofthe wvnrran •must be attached to the cantraei
party/subconiractox utilized Tiytbe contractor. the contractor orther agrees to be solely xespox�sible fox all a y
materials and labor under this a cement payments to all subcontractors for
Contractallnotimp -Upon,signing, this documentbecomesabindingcontractunderTaw. Unless otherwise noted within this document e
contract shall, not imply that wy lien or other security interest has been, placed on the residence. Review the following cautions and notices
carefoily before signing this conixact, h
° Don`tbe pressured into
signing ° gning the contract, Talce time to -read. and fuliy understand it..A.s1c questions i f something is unclear.,
alce sure the contractor has a valid Home Xm rovement Contractor Registration,
subcontractors to be registered with the Director ofHome Improvement Contractor Registration. You may inquire about contractor
Tile law requires Most home improvement contractors and
registration by writing to the Director at 10 ParlcPlaza, Room 5170, Boston, MA -02116 or by calling -617-973-8787 or 88g-283-37;57.
Does the contractor have insurance?
Asume Contractoxfdxhis insurance eoml?auyi oxmatxon so thatybu can contu7n coverage, or aslcto
see a copy of a "proof ofinsurance" document.
° 7 t'OWnide t ou e 1-10ms and res vemQ inti s.n Reaactor L e 7snpoxtaut lnfo�nation on. the reverse side of this form. and get a copy Ofthe e Consume
Guide to the Dome Improvement Contractor Law;
Consumer
You may cancel this agreement-ifit has been, signed at a place other •than hire contractor's normal place of business, Provided contractor in writing at his/her main office or branch office by ordinary mail posted, by telegram sent or by delivery, not later than Midnight t'Lvrd business day followin the si p d you za.otify the
g gning ofthis agreement. Seethe attached notice of cancellation form for an explanation ofthis right, g °f tUe
Two identical copies ofte contract must be completed and signed, One copy should go to the IwmeeiWner � �� PACE S I 1 f
` ysltouldbelceptbytho coniractor,
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The Commonwealth of Massachusetts
Department of IndustriqlAccidoints
Office of Investigations
k1i 600 Washington Street
Boston, MA. 02111
www.mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Address: li `�, J__M A dl, P o; *A7/i V-(-,`� M+
v .-
City/State/Zip: ) Phone #:
Are you an employer? Check the appropriate box:
L ❑ I am a employer with
4. ❑ I am a general contractor and I
ployees (full and/or part-time).*
have hired the sub -contractors
2. I am a sole proprietor or partner-
rship
listed on the attached sheet.
and'have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. ❑ We are a corporation and its
required.]
officers have exercised their
3111 am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
c. 152, § 1(4), and we have no
insurance required.] t
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
1111 Plumbing repairs or additions
12.❑ Roof repairs
13.❑ Other
*Any applicant that checks box #1 must also fill 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.
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. 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 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.
Idoherehyctiryunth77��
inalties of perjury that the information provided above is tru and coorrrect.
Rianafirra nntn- 9- / LJ J Y'
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 Instrutiolis
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 till 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 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 0211 t
Tei, # 617-727-4900 ext 406 or 1-877:MASSAFE
Revised 5-26-05 Fax ## 617-727.77449
wWW mass,govfdia
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