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Home My WebLink AboutBuilding Permit #426 - 94 BLUEBERRY HILL LANE 2/13/2007 BUILDING PERMITo`"°oTH qti TOWN OF NORTH ANDOVER c '` - APPLICATION FOR PLAN EXAMINATION :4 70 Permit NO: 3, Date Received 1,4, 13 —6'4` 0° fa, ACFIus�� Date Issued: SX� IMPORTANT:Applicant must complete all items on this page LOCATION zall Print PROPERTY OWNER�- 1n 474rXAn/k1 C rl�'xelle Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yesno Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ne famil Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: i e to 'my e and I ebu1'1 Identification Ple se Type or ril Clearly) OWNER: Name: Phone:9 7,N,, 7' Address: CONTRACTOR Name: 1 Phone: ' Address: Supervisor's Construction License: Exp. Date: Home Improvement 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. Total Project Cost: $_�(. O�(� FEE: $ Check No.: -1 Y' Receipt No.: � NOTE: Persons contracting with unregistered con Tactors do not have access to the guaranty fund ;Signature of Agent/Ovv� Signature of contractor Location /7 416'K41�,111 Ad No. l Date 0 NORTH TOWN OF NORTH ANDOVER 3? 0 SOL Certificate of Occupancy $ ,SSACHU Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ *" TOTAL $ Q Check # 20858 Building Inspector Plans Submitted Plans Waived Certified.Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools f 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 / o� COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS t Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments I Conservation Decision: Comments i Water & Sewer Connection/Signature&Date Driveway Permit Located at 384 Osgood Street FIRE DEPARTMENT Temp Dumpster on site yes___)(- no Located at 124 Main Street Fire Department signature/date 11 P r. S k til r d- COMMENTS P/j/Y1PS'�-eT Feh vn ` /SSV& 1 Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: I I I ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No I DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine I NOTES and DATA— For department use ' t 4 Notified for pickup - Date ❑ p p I ------....-------._........................................................... __._._.._.-_._........._......................... ........_ Doc.Building Permit Revised 2007 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 ❑ Building Permit Application ❑ Workers Comp Affidavit o 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 o Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Phete Gepy of W.I.G An 1- .a es ❑. 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 ENERGY CONSERVATION APPLICATION FORM FOR LOW-RISE RESIDENTIAL NEW CONSTRUCTION and ADDITIONS 780 CMR Appendix J Applicant Name: -,"_j0//,k.- Site Address: "AFP „o o !<<L� own: �t/ • y �t��• se Group: ye coS/�r�iLT/�— Date of Application: Applicant Phone: 5? Applicant Signature: Compliance Path (check one): ❑ Prescriptive Package (Limited to I-or 2-family wood frame buildings heated with fossil fuels only) Package(A through KK from Table J5.2.1 b): Heating Degree Days (HDD65)from Table J5.2.1 a: (For items d. through i., fill in all values that apply from Table J5.2.1 b:) a. Gross Wall Area sq.ft f. Wall R-value R- b. Glazing Areal sq.ft. g. Floor R-value R- c.. Glazing%(100 x b_a) % h. Basement wall R- d. Glazing U-value U- i. Slab Perimeter R- e. Ceiling R-value R- j, Heating AFUE ❑ Component Performance: "Manual Trade-Off' (Limited to wood or metal framed buildings only) Climate Zone(from Figure�6.2.2) ❑ Zone 12 ❑ Zone 13 ❑ Zone 14 Attach Trade-Off Worksheet from Appendix J, [and HVAC Trade-Off Worksheet, if a licable PP j ❑ MAScheck Software Attach Compliance Report and Inspection Checklist printouts ❑ Home Energy Rating System Evaluation Attach Home Energy Rating Certificate(HERS rating score must be 83 or higher) ❑ Systems Analysis : .OR ❑ Renewable Energy Sources Attach Mass Registered Architect or En.aineer Analysis ALTERNATIVE FOR ADDITIONS ONLY: a. Gross nail +Ceiling Area 930 sq.ft. b. Glazing Areal f a sq.ft. c. Glazing % (100 x b . a) % ❑ ADDrrION with GIazing % (c.) up to 40% may use 780 CMR Table J1.1.2.3.1 below: MAXIMUM ii_value MINIMUM R-Values I FenestrationZ I Ceilina3 Wall ±5:: R oor Easement wall I lab Perimeter I}e th 0.392 R-37 R-I3 -]0 R-10.4 ft I Glazing Area may be either Rough Opening or Unit dimensions. 2 Based on NFRC Iisting. Applies either to every unit,or to area-weighted average of all units. 3 R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area (i.e.-not compressed over exterior walls, and including any access openings.) ❑ "SUNMOOM"addition (greater than 40% glazing-to-wall and ceiling Bross area) Attach "Consumer Information Form"from 700 CNIR Appendix B. 4fficial's Name: Official's Signature: IAORTH c 0" O ? '' Andover 0 dover, Mass.,.f�- /3 Q - LAKE COC MIC ME WICK V �oRATED vv 4 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System C4voeloamla' BUILDING INSPECTOR THIS CERTIFIES THAT........�.��..... ................................................. ... ....................VY Foundation .................has permission to erect ..... ................................. buildings on .... .......9.��..... .............. .......... . ................. Rough / Chimney to be occupied as... .. .L.. ��.� ...S✓.. .fir!' .....T...... A................................................................. provided that the person accepting 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 I � PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRU TS Rough Service BUILDING INSPE OR 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. 1 I ' rhe Ua u - 00r Ivo f�W-113 -11"a� D fU9; uo �� - 7 Ipy bi?pp )9 bb �IORTp TOWN OF NORTH ANDOVER °.�"" '•�"o OFFICE OF BUILDING DEPARTMENT �, ;�: 1600 Osgood Street Building 20, Suite 2-36 North Andover,Massachusetts 01845 1sswcaus�t .. Gerald A Brown Telephone,(978)688-9545 Inspectpr of Buildings Fax (978)688-9542 J, HOMEOWNER LICENSE EXEMPTION Please>? ` DATE: Lac7 JOB LOCATION: Y� !ALU-4-e'Irz 92 L /Number Sded Address / Map�Lot HOMEOWNER �f 4mW- - 7NV Name Home Phone Work Phone PRESENT MAILING ADDRESS City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow sack homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who owns 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 North Andover Building Department minimwm inspection procedures and requirements and that he/she will comply with said procedures and reglrir+emerns. HOMEOWNERS SIGNATURE B=e' APPROVAL OF B OFFICIAL Revind 10.2005 Form Homw waw FAwVUon ; BOARD OF \PPE:IL.S 683-9541 CONSERN'NFION 638-9530 HEALTH 698-9540 PLANNING 1,88-9535 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street .Boston, MA 02111 t M 5 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information J ) Please Print Tie ibl Name(Business/Organization/Individual): A-1— Address: 9y I/.6P/rV h'i// ZA,e_ City/State/Zip: /��`h /l/I(,lD /� 013 �SPhone.#: ��0 �� Are you an employer?Check the appropriate box: Type of project(required):` 1.❑ I am a employer with ' 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. EJ 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 g, ❑ Demolition workingfor me in an capacity. employees and have workers' Y P tY• $ . 9. ❑Building addition [No workers' comp,insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10..❑Electrical repairs or additions 3. ]C 1 am a homeowner doing all work officers have exercised their 11.0 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 Homeowners who subnut this affidavit indicating they are doing all work and then hire eu+side contractors must sub-nit a new affidavit indicating such. XContractors 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 workerscompensation 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 u er the p and pe glties fperjury that the information provided above is true and correct Si a ` � Date: /D _ 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#: i 01merican Raub *urbep Zfooc. , 31nc* * 42 CMERRTSTUET GLOVCESTEX 914.9 01930 978-281-7878 Owner: John Jr. &Cheryl Carbone L a T- Z-�- ` Address: 94 Blueberry Hill Ln. . 1pZ , DD Deed Ref: Cert. 14472 I � Plan Ref: L.Ct. 27868-B T � LOT 35 �rJ 0- LD T 3 Lb F 37 7 I— PRoPvsD� Suu2oonn uNfleaz yx AID, 9H i Cu/ST/n/& -- 4.1 I , I B L uc aaz2.y 1-11LL L. ANr_ PLOT PLAN OF LAND I HEREBY CERTIFY TO THE NORTH ANDOVER Located In EB BUILDING INSPECTOR THAT.THIS PLAN IS BASED ON N. ANDOVER, MA " THE REFERENCED PLANS,,DEEDS,AND THE RESULTS OF A FIELD SURVEY AS OF THIS DATE.NO Prepared BY CERTIFICATION IS INTENDED AS TO PROPERTY TITLE American Land SurveyAssociates, Inc. OR AS TO THE EXISTENCE OF UNWRITTEN OR .UNRECORDED EASEMENTS.THE BUILDINGS AND Kirk W. Benson, President, PLS POINTS SHOWN HEREON ARE LOCATED AS FOUND OR SET. 42 Cherry Street Gloucester, MA 01930 978-281-7878 <�'�P��oFMRuJ9 SCALE 1" = 30' DECEMBER 12, 2007 cy KIVRVK �� Prepared For AEiENSON� y JOHN & CHERYL CARBONE W.BENSON,PRESIDENT, PLS No.4W36 9pFESSti��P Q. sua\?�° J-842' / 2- Z o e 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 the commonwealth nor an of its political P § ( ) y p 1 kcal 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-contiactor(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 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 inthe 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.#617-7274000 ext.406 or 1-877-NIASSAFE Revised 11,22-06 Fax# 617-727-7749 w.mass.gov/dia 3 Date. . Of.NORTH 1ti TOWN OF NORTH ANDOVER • - PERMIT FOR GAS INSTALLATION SSACMUSEt< r Z/ :,. This certifies that . . . . ..,:�. . .. . - �1 has permission for gas installation, in the buildings of at � �. ; Norfh/Andov r,Mass. Fee. , a Lic. N4aZA l4 . . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR Check# 9 5G34 MASSACHUSETTS UNIFORM APP CATON FOR PERNUr TO DO GAS F rrrING (Type or print) Date 2/16/05 NORTH ANDOVER,MASSACHUSETT Building Locations 94 Blueberry *Hi 1 Ln Permit LAmount$ ,.,John Carbone Owner's Name 978 687 7794 New Renovation ❑ Replacement ❑ Plans Submitted ❑ a $30.05 w w a z ° o w 1 o C o w goW d x F � GL a w d Cw7 F Z U 9 a > W o a a °� o c x 3 A --t � � a � A a H O SUB-BASEMENT BASEMENT IST. FLOOR .2ND. FLOOR 3RD. FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) Eastern Pr op a ne Gas C one: Certificate Installing Company Name ec Corp. Address 131 Water St. ❑ Partner. Tian rPr. MA nl 2�3 Business Telephone 1 g00 app 6h?R ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter [INSURANCE COVERAGE Checkave a current liability Insurance policy or it's substantial equivalent. YesNo❑ you have checked yes,please ndicate the type coves e b checkin the ag Y g ppropriate box ability insurance policy Other type of indemnity Bond Lel ❑ ❑ L Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and CMapte ��eral Laws. By: Signature of Licensed Plumber Or Gas Fitter Title Plumber /G l� City/Town Gas Fitter (cense Number ❑ Master APPROVED(OFFICE USE ONLY) ❑ Journeyman