HomeMy WebLinkAboutBuilding Permit #165-13 - 95 OLYMPIC LANE 8/28/2012 NORTH
BUILDING PERMIT 0�<sLE°;6;�'►'o
TOWN OF NORTH ANDOVER o
APPLICATION FOR PLAN EXAMINATION
,.
Permit N0: Date Received �qss
Date Issued: a
IMPORTANT:Applicant must complete all items on this page
LOQAA,,T N -S D C 1cm,f
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FROPERTsY
-MM4 1pt'L/ � 1I S �1l
- - a
P�rnt1 10Year{Stnic"ture'w W yes! no)
MA,P)2i10 ii 6 PARCEL:' ZO;NINGIDIS�TRICT_ H stonciQistnct? yes; nod
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TYPE OF IMPROVEMENT PROPOSED USE
Resi ' I Non- Residential
❑ New Building
V
ddition 0 Two or more family 11Industrial
lteration No. of units: ❑ Commercial
Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
* ` D{Septic, Well � I q#Floodplami ❑+UVetlands., t ' Watershed;Distnet;
I _ r r+
-
DESCRIPTION OF WORK TO BE PR FORMED:
60, t (0 =ion S r
r
1S {?X 141-butt (41 hri M �N � Aeu) 1--ib 01-CeivtY�T-4
.1 W Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address:
C_ ®N-TRACT®R Name:i
JA
Address _ 1P�''F^t►h _ _ _
S_ upervi'so�ts)ConstructiontLicense _ a , p' �.
033 ' Ex Date
_. _ _
_ ;r
j
IHomeImprovementlLicense:/. �o:� _ p. __
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ c> , Sa��F �U FEE: $__�� �
Check No.: C S 4 Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of-Agent/Owner Signature of contractor'
f
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 DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION Reviewed on Si nature l
COMMENTS
HEALTH Reviewed on Si nature
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
DPW'Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENTS `Temp `umpsfer on-site yes ` ' no
Locatedtat+124MainxStreett
° FreDepartmentsgnatu're/da"te >R' F
COMMENT'S c {
I
i
i
Dimension
jNumber of Stories: Total square feet of floor area, based on Exterior dimensions.
i
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location mast or service drop q pp 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 - Date
Doc.Buildini;Permit Revised 2010
1
1
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
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
MOTE: 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
10TEe 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 2008
Location 6 T
No. Dat.-,I-
TOWN
at TOWN OF NORTH ANDOVER
�---^ Certificate of Occupancy , $
Building/Frame Permit Fee
Foundation Permit Fee $
Other Permit Fee
TOTAL $
Check 4q?
25658 Building Inspector
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
/V l
Name (Business/Organization/Individual): Ap t /Ivol-
Address:
N FV-J- S-11
City/State/Zip: I1ACYT 1 rvc-L (C 6t03 Phone#:(ti 03) / 7yO�o
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 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.E] I am a sole proprietor or partner- listed on the attached sheet. Remodeling
ship and have no employees /We
e sub-contractors have 8. E]Demolition
working for me in any capacity. ers' comp.insurance. 9. ❑Building addition
[No workers' comp.insurance 5. re 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 l.❑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' 1311Other l�ljt1 E r= U/Z j/Lf
ni
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 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 Name:
Policy#or Self-ins.Lie.#: Expiration Date:
fob 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
'me 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
if 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.
do hereby cerliW under the pains andpenalties ofperjury that the information provided above is true and correct.
ii nature: Date: cT
'hone#: 05 ZOR-0
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-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 for,
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 Common�vealth 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
Fax#617-727-7749
revised 5-26-05
www.mass.gov/dia
c10RTH
Town o E . 1, Andover
No.
C,, h ver, Mass, ` •
COC MIC Nl WICK y01.
AERATED
S V
BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
��THIS CERTIFIES THAT �...., ... Ucrmms,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, BUILDING INSPECTOR
..................... . .....
•
has permission to erect .......... ..... buildin s on .� &. Foundation
..� .... ....... �.�..�. .... � Rough
to be occupied as ...... ... .`/.:r...... ... .. ..!!�. ....... � .. .. ....J.9.....S.#�o Chimney
p
provided that the person accepting this permit shall in every respect conform to the terms of the 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
3qa PERMIT EXPIRES IN 6 MO.NTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCT Itl 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.
SEE REVERSE SIDE
NORTH
T;
o EAownndover
0
No.
h ver, Mass, "16 •
COC MIC„l WICK y01'
RATE0
S U
BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
��THIS CERTIFIES THAT .....................�..... ... ...........U.�ir..rm�4r$............................................. BUILDING INSPECTOR
•
buildln s on ,.... Foundation
has permission to erect ........&V-*
...... ...... �► .�'*..�.�....... gRou h
to be occupied as ...... ... . �...... ... .. .. ....... .. ....J.0.....IS# . ..... chimney
provided that the person accepting this permit shall in every respect conform to the terms of the 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 CONSTRUCT N Rough
Service
Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Buildinz 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.
SEE REVERSE SIDE
i
,
i
I
office�t o mcr irc" i"�(iiiCinc� iiTafori
C - HOME IMPROVEMENT CONTRACTOR
�{ ) Registration: ,,161236 Type:
Expiration: 10/1/2012 Individual
CHILES R SCHULER JR
CHARLES SCHULEi
153 WOOD ST
HOPKINTON, MA 01748 .' Undersecretary
�i iss;1chusetts- Department(if Public S:tfet%
9 Bnar(I t)f Buil(in! Re�Ltilations.tnd Standards
Construction Supervisor License
License: CS 74036
CHARLES R SCHULER
153 WOOD ST
HOPKINTON, MA 01748 -
Expiration: 2/11/2013
(',r�ntni•�iner Tr": 15090
A & D MILLWORK LLC
Anthony Licata Date:
42 Erik Street 8/28/12
Merrimack, NH 03054
603-765-7020
www.admillwork.com
Customer:
Mr. & Mrs. Matt and Michelle Verminski
95 Olympic Lane
N. Andover, MA 01845
Fixed Price Agreement
Portico
Frame new portico around front entry door. (Matching photo, supplied by owner, as close as possible.)
Portico to be finished with solid PVC mouldings and trim boards.
Roofing (Existing roof and portico)
Remove all layers of roofing, exposing sheathing-on main roof only.
Install ice and water shield on entire roof.
Install 30 year architectural shingle to meet MA state code. (Color TBD by customer).
Siding: (Front and two sides only)
Remove existing siding,window trim, corner boards, garage and entry door trim.
Remove and save down spouts to be reinstalled, if any.
Install Tyvek house wrap,taping all seams.
Install 1 X 5 solid PVC trim on all windows.
Install 1 X 10 solid PVC corner boards.
Install PVC trim on entry door. (Trim TBD)
Install HardiePlank lap siding with 4" exposure. (Color TBD)
Price for above work: $32,511.00
on
Deposit due u signing of agreement: $14,000.00
p p g g g
Payment due upon framing of portico $ 5,000.00
Payment due upon completion of siding and trim of front facade $ 5,000.00
Payment due upon completion of two sides $ 4,000.00
Payment due upon completion of roof $ 4,511.00
Customer Signature A & Millwork
GG;�t �Gl
Thank you for choosing A & D Millwork!
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N(If o N/F GOLINI EASEMENT �+
0O Z #83 -211
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100' BUFFER �\ \
ZONE 105 \\ \� ,73� �2- AREAS:
LOT 33A = 51,823±S.F.
oGG EXISTING AND PROPOSED BUILDING AREA = 1,895±S.F.
PAVEMENT AND WALKWAY AREA = 1,740±S.F.
50' NO BUILD \ \ �� TOTAL IMPERVIOUS = 3,635±S.F.
ZONE \ \ wo a� UPLAND (BUILDING) AREA = 22,437±S.F.
\ � \ IMPERVIOUS
IS
"7 ��\ OPEN S SPACE (BUILDING)ND A 1
( ING) AREA = 83 8%
SGG #1" F.F.EL\1
25' NO DISTURBANCE
ZON _� B 2' arden
E I y s \
�-- SGG #2 POSEit
se p is
\ \ � p
200' RIVER FRONT SG tan
o� >pRopo
SGG #4
0 5 •s.
SGG #5
6 \ < n
0�0 eOROF 01-A,ggS
tl 'p W§X"Wo SOS �pJ S9C'
SGG 6 DREA9E AY o� TODD
# 7`
FIRMAE B.F.E.243F 07-03-12 SGG #7 NSTALL APPROPRIATE BARRIER ® v
. CHAPIN
\ ZONE AE B.F = 95.0' SGG #8 EROSION CONTROL LINE 07CJ�
LOT 33A !q OF�SSxO�o�
\ AREA = 51,823tS.F. SGG #9 a0 SURA
UPLAND
\-% #107
pFRiN N/F WYARD
k'ET�No O
PLOT PLAN PREPARED FOR
PROPERTY OWNER(S)
95 OLE P C DANE HELLE VERMINSKI
G HW#2 NORTH ANDOVER, MA 01845
SGb\MAHW#1
\\ 40' DRAINAGE SOS. \ ASSESSORS PARCEL ID: 106.8
\ \EASEMENT/ / ' \\ ON DISTRICT: RI
BROOk WETLANDS FLAGGED BY: BUILDINZONING
YARD SETBACKS: PROPOSED ADDITION
\ SCOTT GODDARD, PWS FRONT = 30.0' PLOT PLAN OF LAND IN
\ GODDARD CONSULTING, LLC. SIDE = 30.0'
ss \ REAR = 30.0' NORTH ANDOVER, MA.
s
N/F NEW ENGLAND ATLAS LAND SURVEYING, INC. SCALE: 1"=40' DATE: 07/11/2012
POWER COMPANYDEED BOOK 10653 PAGE 155
o' So' loo' 150' atlaslsurveying.com
508-523-4559 atlaslandsl�yahoo.com PLAN #8368
8 MOORE LANE, NORTHBORO, MA 01532 RECORDED ® ESSEX NORTH REG. DEEDS
3 74 7Date...
.............
f �aOR7M -
" TOWN OF NORTH ANDOVER
�• o
3? �•A --..� �s OL
PERMIT FOR WIRING
�,SSACNUS��
This certifies that .... . ...... ..............J :"C....................
haspermission to perform .......:1�................................... ..........................
wiring in the building of........l .L.. l ................................................ ....
at ......... ,.. ........ ,Nort d" Mass.
Fee... ................ Lic.No�..,--/1..A ....................
ELECTRICAL INSPECTOR
Check # 6
\ 2YWC0HV0NW-F_4LTH0FaJLM Office Use only
DF.PARTMFIVI'OFPtIBLICS%fFL?Y � . 7
BOffRDOFFIREPAEWN1701V Permit No.
. > l{i'.".vu+iaVlliJJL/IAII IZW —
Occupancy&•FeesL-7
Checked
--------------
APPLICATIONFOR PEUff TO PEUORMaE=CAL WO
RK
ALL WORK TO BE PERFORMED IN ACCORDANCE WrTH THE MASSACHUSSTS ELWMCAL CODE,$2 J p�gt I2 OO H
(PLEASE PRINT IN IMC OR TYPE ALL INFORMATION)
Date � G Q dr-
Town of North Andover
To the Insp of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location(Street&Number) S� Q ( � ;r f ` �•
Owner or Tenant
Owner's Address
s this permit in conjunction with a building permit:
yes Q No (CheckAppropriate Box)
)'urpose ofBuilding Utility Authoization No.
;xisting Service UU. Amps t/ azavoltij Overhead U -
No.ofMeters
'ew Service Amps ! Volts Overhead U
Q " No.ofMeters
umber ofFeeders and Ampacity
)cation and Nature ofPn"ed Electrical Work
lo.of Lighting No of Hot Tubs
,. ... Nraruforrners
a Of
o.of Lighting Fixtures
Total
swimming Pool Above K.V�4
Below
K VA
r.of Receptacle Outlets Na ofOH Burners Na Of Emergency Lighting B
atttry Udits
of Switch Outlets
of Ranges No.of On Burners
No.of Air Cond. Total FIRE ALARMS
Tons No:ofZooEs
of Disposals No.of Heat Total Total
W o(1>etectiosand .
of DishwashersPWJWS space Area Heating ?o(o- W. beriees
Na of9owd*,Deriaes
Na.oftaro6ptg
Dry :
of ers ` Heating.Devices Devices
.
KW Local Municipal Other
)f Water Heaters KW No.ofNo:of Comiections
Si Bailasis
iydro Massag.Tubs Na ormotors Total HP
eCotsc�Asv'�rtbthetae�erl���'r�aiIa►�►a -
�a�tlia�hylns�rdnczpt�ig,;,dutfrttg - -
l � 0
�,d�aGdpiod'dsaneblhe0ioe YES ND g� Y _ NO �J
ebaoc 0
J.
.3 u UNAE
Fpt> .
Pt>�esd'pajt>Ey �.
BusimsTdNia
131NSURAMMWANER;tamawatethattheLimisednesnot/ the' A1tTdIsh
sigie,mtlkpmndappkabmwm,tsgwmgt� � bY�C -alLaws
reek one) Owner � Agent
Telephone No. PERMIT FEE
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