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HomeMy WebLinkAboutBuilding Permit #593 - 967 JOHNSON STREET 5/7/2009 BUILDING PERMIT cf NORTH ttLeo 06 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received �1 �SSACHUS�� Date Issued: Jr' 7 IMPORTANT: Applicant must complete all items on this page LOCATION (1 30 knS Q� ��' Print PROPERTY OWNER CX M,�5 Print Print MAP NO: 1+ PARCEL: ZONING DISTRICT: E'�— Historic District yes no Machine Shop Village yes no 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 Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: or ti 2� (mow Y `Q t Identificationlease Type or Print Clearly) OWNER: Name: CLty" � G e.C-0 Phone: Address: ��©� Si CONTRACTOR Name: Phone: A- Address: 1,12trCf',,.t- , I 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: 2OC90 FEE: $ Check No.: 62-3 Receipt No.: p�aOb� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor 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 X CONSERVATION Reviewed on o Signature A 9, COMMENTS /HEALTH Reviewed on Signatr y COMMENTS t� 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 DEPARTMENT - Temp Dumpster on site yes no Located at 124 MainStreet Fire Department signature/date COMMENTS 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— For department use � n ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 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 ('q? Building Permit Application ❑ Certified Surveyed Plot Plan C)Workers Comp Affidavit Li ❑ Go L3 Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hyd.....4e GeAeuis ions-f-i#-A pt cam ❑ Mass check Energy Compliance Report (If Applicable) -4 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 2.2008 Location n rz?H No. Date a, N�oT:�ti TOWN OF NORTH ANDOVER f41 D s Certificate of Occupancy $ JACMUS Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 3 2LVUu Building Inspector COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION V TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:_967 Johnson Street North Andover_ Owner's Name:_John Richards_ Owner's Address:_967 Johnson Street _North Andover,Ma.01845_ Date of Inspection: 3/20/2002_ Name of Inspector: Neil J.Bateson_ Company Name: Bateson Enterprises Inc._ Mailing Address:_111 Argilla Road_ _Andover,Ma.01810_ Telephone Number:_(978)4754786_ CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: _X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fi Inspector's Signature: Date: 3/20/2002_ The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of 11 • OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: %7 Johnson Street_ _North Andover— Owner: Richards Date of Inspection: 3/20/2002 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _X_ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 957 Johnson Street North Andover — Owner: Richards Date of Inspection: 3/20/2002 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_967 Johnson Street_ North Andover_ Owner: Richards Date of Inspection: 3/20/2002_ D. System Failure Criteria applicable to all systems: You must indicate"yes"or`no"to each of the following for all inspections: Yes No _ _No_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _No_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _No_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ _No_ Liquid depth in cesspool is less than 6"below invert or available volume is less than'/2 day flow _No_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _No_ Any portion of the SAS,cesspool or privy is below high ground water elevation. _No_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _No_ Any portion of a cesspool or privy is within a Zone i of a public well. _ _No Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ _No— Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] No (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304,The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:_967 Johnson Street North Andover — Owner: Richards Date of Inspection: 3/20/2002_ Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No Yes_ _ Pumping information was provided by the owner,occupant,or Board of Health No Were any of the system components pumped out in the previous two weeks? Yes_ _ Has the system received normal flows in the previous two week period? No Have large volumes of water been introduced to the system recently or as part of this inspection? _Yes_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) Yes _ Was the facility or dwelling inspected for signs of sewage back up? Yes_ _ Was the site inspected for signs of break out? Yes _ Were all system components,excluding the SAS,located on site? _Yes_ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _Yes_ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no Yes_ _ Existing information.For example,a plan at the Board of Health. No Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance_ is unacceptable)[3 10 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:_967 Johnson Street _North Andover— Owner: Richards Date of Inspection:_3/20/2002_ FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_4_ Number of bedrooms(actual):_4_ DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):_600_ Number of current residents:_3 Does residence have a garbage grinder(yes or no): Yes_ Is laundry on a separate sewage system(yes or no):_No_ [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no):—No_ Water meter readings:_Aug 99 to Aug 01=11,100 Ft'x 7.5=83,250 Gals./730 Days=114 Gals./Day_ Sump pump(yes or no):_No_ Last date of occupancy:_Current COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sg8,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Oct 99,owner Was system pumped as part of the inspection(yes or no): Yes_ If yes,volume pumped:_1500_gallons--How was quantity pumped determined?_Measured tank_ Reason for pumping:_Inspect tank,tees&baffle TYPE OF SYSTEM _X_Septic tank,distribution box, soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information:_18 years old. 10/3/1984. As built plan_ Were sewage odors detected when arriving at the site(yes or no):_No Page 7 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_967 Johnson Street North Andover — Owner: Richards Date of Inspection: 3/20/2002_ BUH,DING SEWER(locate on site plan)X Depth below grade:____13" Materials of construction:—X—cast iron _X_40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.):_4"Cast iron thru wall.3"PVC in house. No leaks. SEPTIC TANK: X locate on site plan) Depth below grade:_1" Material of construction:—X—concrete_metal_fiberglass__polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) Dimensions: 10'x 5'x 4' Sludge depth 6" Distance from top of sludge to bottom of outlet tee or baffle: 21" Scum thickness: 6" Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle:_15"_ How were dimensions determined: Subtract scum&sludge depth to tee length._ Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.):_Pumped septic tank.Inlet baffle ok.Inlet tee ok.Inlet pipe not in inlet tee.Outlet tee corroded on top.Depth of liquid at outlet invert.No evidence of leakage._ GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 967 Johnson Street _North Andover — Owner: Richards Date of Inspection: 3/20/2002_ TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: X (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:_0 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.):—D-box level.Distribution equal.No evidence of leakage.Evidence of solid carryover,pumped d-box to clean._ PUMP CHAMBERS (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_967 Johnson Street _North Andover— Owner: Richards Date of Inspection: 3/20/2002_ SOIL ABSORPTION SYSTEM(SAS):_X (locate on site plan,excavation not required) If SAS not located explain why: Type _X leaching pits,number:—2— leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.):—Soil ok.Vegetation ok.No sign of ponding to surface.Camera inside of pits thru outlet pipes in d-box, both pits holding water.Water level 7"below both inverts._ CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_967 Johnson Street North Andover— Owner: Richards Date of Inspection:_3/20/2002` SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. House Garage Driveway Water A Meter Septic Tank 2 1 Pit#1 D- Box Ato1 =16'8" Ato2=13'5" A to D-Box=33' Bto1=31'5" Bto2=38'7" B to D-Box=44'5" Page 11 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_967 Johnson Street_ _North Andover— Owner: Richards Date of Inspection:_3/20/2002_ SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 6 feet Please indicate(check)all methods used to determine the high ground water elevation: X Obtained from system design plans on record-If checked,date of design plan reviewed:_5/23/1983_ Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: As per design plan_ Tel: (978) 475-4786 Fax: (978)475-5451 B ATE S ON ENTERPRISES, INC. Excavating-Water.& Sewer Lines-Septic Systems&Pumping Service 111 Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property Address: 967 Johnson Street, North Andover Owner: Richards Date of Inspection: 3/20/2002 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. Ne41at,son Bateson Enterprises, Inc. NORTH 0 P 9p "� S's ACHUS Soh CONSERVATION DEPARTMENT Community Development Division May 7, 2009 Jim&Maureen Pacheco 967 Johnson Street North Andover, MA 01845 967 Johnson Street, North Andover Expansion of an Existing Deck Conservation Conditions of Approval, NACC #51 Pursuant to section 4.4.2 A of the North Andover Wetlands Protection Regulations,Jim&Maureen Pacheco,applicants/ homeowners,filed for a small project for work proposed at 967 Johnson Street, North Andover. The work consists of the construction of a 10' x 12' 6" deck addition on three (3) sonotube footings. Approximately 125 total s.f. of work is within the 100-foot buffer zone to a wetland resource area which is located to the southwest of the existing house. Soil disturbance for the work is limited to the installation of three (3) new sonotube footings. Installation of the sonotubes will be performed by hand. Work will be conducted 51 feet from the edge of a Bordering Vegetated Wetland (BVW) at its closest point. The Conservation Department conducted a field inspection of the property and agreed with the location of the wetland boundary. During the May 6,2009 public meeting,the North Andover Conservation Commission (NACC)voted unanimously to approve this project as described above. The following conditions were hereby mandated for the proposed work: RECORD DOCUMENTS: Proposed Plot Plan,967 Johnson Street,North Andover, Massachusetts,Assessors map 107-A Parcel 221,Scale 1" =30' dated April 21,2009,sketch of deck and wetland boundary prepared by Jim Pacheco,applicant/owner; Memorandum of proposal/description of work prepared by Jim and CONDITIONS: Maureen Pacheco dated April 28,2009. 1. Accepted engineering and construction standards and procedures shall be followed in the completion of the project. 2. Excess material and construction debris shall be properly disposed of off site. 1600 Osgood Street,Building 20,Suite 2-36,North Andover,Massachusetts 01845 Phone 978.688.9530 Fax 978.688.9542 Web www.http://xvww.townofnorthandover.com/conservel.htm tAORTH Town of f 4Andover 0 0 S 9'3 -= dover, Mass., 0 - LAKE COCKICKE WICK V RATED PPP` S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THATTAM*4P�, .6....................... . ............................... . .. "' Foundation has permission to erect........................................ buildings on .......NO T.*0%S.6ft........ .....W1............I.. Rough It to be occupied as......la... D. ................................................................................... Chimney 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 304, Final PERMIT EXPIRES IN 6 S ELECTRICAL INSPECTOR UNLESS CONSTRU N S 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 Until Inspected and Approved by the Building Inspector. Burner FIRE DEPARTMENT Street No. SEE REVERSE SIDE Smoke Det. 3. Upon completion of the approved project and site stabilization, please contact the Conservation Department for a final inspection. 4. This permit shall expire on November 30 2009 Please do not hesitate to contact me should you have any further questions or concerns in this regard. Thank you in advance for your anticipated cooperation. Respectfully, NORTH AN OVER CONSERVATION DEPARTMENT J nnifer A. Hughes onservation Administrator 1600 Osgood Street,Building 20,Suite 2-36,North Andover,Massachusetts 01845 Phone 978.688.9530 Fax 978.688.9542 Web www,http://xvww.townofnorthandover.com/conservel.htm I Residential Property Record Card PARCEL_ID:210/107.A-0221-0000.0 MAP:107.A BLOCK:0221 LOT:0000.0 PARCEL ADDRESS:967 JOHNSON STREET FY:2009 PARCEL INFORMATION Use-Code: 101 Sale Price: 405,000 Book: 06943 Road Type: T Inspect Date: 09/13/2005 Tax Class: T Sale Date: 07/14/02 Page: 0140 Rd Condition: P Meas Date: 09/13/2005 Owner: Tot Fin Area: 1938 Sale Type: P Cert/Doc: Traffic: M Entrance: X PACHECO,JAMES A Tot Land Area: 1.02 Sale Valid: Y Water: Collect Id: SGC PACHECO, MAUREEN Grantor: RICHARDS,JOHN E Sewer: Inspect Reas: M Address: 967 JOHNSON STREET Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% / NORTH ANDOVER MA 01845 RESIDENCE INFORMATION LAND INFORMATION Style: CL Tot Rooms: 7 Main Fn Area: 950 Attic: N NBHD CODE: 7 NBHD CLASS: 7 ZONE: R2 Story Height: 2.00 Bedrooms: 4 Up Fn Area: 988 Bsmt Area: 950 Seg Type Code Method Sq-Ft Acres Influ-YIN Value Class T Roof: G Full Baths: 2 Add Fn Area: Fn Bsmt Area: 1 P 101 S 43560 1.000 224,769 Ext Wall: FB Half Baths: 1 Unfin Area: Bsmt Grade: 2 R 101 A 0 0.020 152 Masonry Trim: Ext Bath Fix: 0 Tot Fin Area: 1938 VALUATION INFORMATION Foundation: CN Bath Qual: T RCNLD: 244287 . Current Total: 469,200 Bldg: 244,300 Land: 224,900 MktLnd: 224,900 Kitch Qual: T Eff Yr Built: 1987 Mkt Adj: Prior Total: 482,000 Bldg: 257,100 Land: 224,900 MktLnd: 224,900 Heat Type: HW Ext Kitch: Year Built: 1984 Sound Value: Fuel Type: G Grade: G Cost Bldg: 244,300 Fireplace: 2 Bsmt Gar Cap: 2 Condition: G Aft Str Vail: Central AC: N Bsmt Gar SF: Pct Complete: Att Str Val2: Aft Gar SF: %Good P/F/E/R: /100/100/91 Porch Type Porch Area Porch Grade Factor W 220 SKETCH PHOTO 22 W ;' so 220 Sq.Ft so . �= 22 1A FU JFM/B 950 Sq.Ft 25 25 I, s 11 FW 1 967 JOHNSON STREET 38 Sq.Ft Parcel ID:210/107.A-0221-0000.0 ai of 4/24/09 Page 1 of 1 Town of North Andover Page I of I ] Base Map� Zoning 2005 Aerials Watershed Zone IF—Utilities Size 0[]E] Selection I. Help Scale 1" = 112 777j ft Select tj Owner wn P C ACHECO, ]AM �,4 !�!' ��•:_ �'� _ /psi 4 I'd PI r 1 selected T( Property b-I 4 Ownerl I Owner2 Address Map/Lot Lot Size Fiscal Year Land Use Code Last Sale Get—Pictom( Go v2.5[beta 2] AppGeo Save Map lg—Image li- http://maps.mvpc.org/NorthAndovennimapNiewer.aspx 4/24/2009 The Commonwealth of Massachusetts j ! Department of Industrial Accidents z' Office of Investigations 600 NTashington Street L lti,� Boston, MA 02111 www_nuws gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information, Piease Print LeQibi Name (Business/Organ ization/Individual): Tam Ps V,-t,k (� Address: S-T- City/State/Zig: N-o mL AY4- - t1,4 kt Phone Are you an employer?Check.the appropriate box: I.F-1I am a employer with 4. ❑ I am a general contractor and I Type of projec employees(full and/or part-time).* have bred the sub-contractors 6. ❑New cont(required): struction 2.[] I am.a.sole proprietor or partner. listed on the attached sheet.x 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demoiition working for mein any capacity. workers' comp.insurance. [No workers'comp. insurance 5. ❑ We are a corporation and its 9. Building addition required-)officers; have exercised their 10 ❑Electrical repairs or additions / I am a homeowner doing all work right of exemption per MGL I l.❑ Plumbing repairs or additions myself.[No-workers'comp. c. 152, §1(4),and we have no 12. Roof required.)t employees. ❑ repairs insurance re q ]. p yees. [No worfcers comp. insurance required.] 13.7 Other Any licant that � aPP checks bob It t must also Sit out the section below showing their workers'oompensation policy infotmatio Homeowners who submit this affidavit indicatinga ihey are riving all work and then him outside contractors must submit a new affidavit indicating such. ?Contractors that cheap this box must�rtached t n additional sliest showing the name of the sub-contractors and their workers'comp.p^„Eicj information. t ane an employer that is: rotadin :wor ' P g kers compensation assurance for►rey entplayees: Below is the policg and job site information. Insurance Company Name: ' Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/Statelzip: 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 penaities of a fine up to $4500.00 and/or one-year imprisonment,as well its civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 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 cerfify under th sins and penalties of perjury that the information provided above is true and correct Si Lure: fir^ Date: Q Phone#: Of j`wi&use only. Do not write in this area,to be conViet�ed by city or town o�ciaL City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Cierk 4. Electrical Inspector S. 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." r f An employer is defined as"an individual,partnership,assodiation,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 Ccensing 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 numbers)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,notthe 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 permittlicense number which wilt 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"alt 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 fart= 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 bum leaves etc.)said parson 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 1-8.77-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia 0ORTp TOWN OF NORTH ANDOVER O•ST`•� "° OFFICE OF p BUILDING DEPARTMENT JA 1600 Osgood Street Building 20,Suite 2-36 �►'b�,,,e. " North Andover,Massachusetts 01845 1sswctt Gerald A Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION IP ease DATE: YI/9 Y<O JOB LOCATION: �''� -J��nSon S+ Number Street Address Ivp/I,ot HOMEOWNER `Sa �� c���'t v 9 g - 3 i y -2-1(`f Name Home Phone Work Phone PRESENT MAILING ADDRESS City Town State . Zip Code The current exemption for 4'homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such 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 taro-yeaz 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 helshe understands the Town of North Andover Building Department minimum inspection procedures and requiremem and that he/she will comply with said procedures and Imo• HOMEOWNERS SIGNATURE c .YCi° APPROVAL OF BUILDING OFFICIAL Rid 10.2005 Form Homeowners F.=W ion 110ARD OF APPEALS 688`15-41 C0N9ERV-vrK)\6.,88-9530 HEALM 488-9540 PI_.V\-NI\-G 6.W9535 -