HomeMy WebLinkAboutBuilding Permit #613-12 - 99 BEAR HILL ROAD 2/24/2012BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: "/2 nnfo
Identification Please Type or Print Clearly)
OWNER: Name:_ All co% ,,,, Phone.74-1
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: $ 9,0; (DO C9 -- i
FEE:
Check No.:--
'2Receipt No.:
NOTE: Persons contract\ g wi unj�gisteylztractors do not have access to the guaranty, fund
Location. ��
N /37 -12- Date glo2
o.
Check # -12,!r2 -11
25043
TOWN OF NORTH ANDOVER
Certificate of Occupancy $_
Building/Frame Permit Fee $42-4-16, 0
Foundation Permit Fee $_
Other Permit Fee $_
TOTAL $_
Building Inspector
Plans Submitted . Plans Waived Certified Plot :Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer j(
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 Signature
COMIViENTS
HEALTH Reviewed on _ Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Comments
Conservation Decision: Comments
a Water & Sewer Connection/signature & Date Driveway Permit
DPW Town Engineer: Signature:
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)
❑ Notified for pickup - Date
Doc.Building Permit Revised 2010
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
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: Building Permit Revised 2008
S U M M I T
��- E N G I N E E R I N G
25 May 2012
Mr. John Conaton
99 Bear Hill Road
North Andover, MA 01845
RE: Framing Construction -at 99,Bear Hi11 Rd. — N. Andover, MA
Dear Mr. Conaton:
Per your request, I visited the above referenced address on 23 May 2012 to inspect the wood
framed dormer construction. Earlier this year I designed the structural framing for this portion of
your home.
To the best of my knowledge and belief and based upon my observations, the construction is in
accordance with my design.
If you have any questions or need any further assistance, please do not hesitate to call.
Sincerely,
44 4
D a-��
Anthony D. Coviello, P.E., S.E.
Summit Engineering, PLLC
ti OF Has
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ANTHONY D. yGJ'
COVIELLO
STRUCTURAL "'
No. 46380 J
SU''?AIT ENGINEECING PV_C . Iii., ,:: u ..,CITE E . PJRTSMOUTH, NH 03801 OFFICE: 603.314.1817 FAX: 877,808.1817 WEB:. UMMITENGINEERINGINC.COM
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TOWN OF NORTH ANDOVER
OFFICE OF
BUILDING DEPARTMENT
600 Osgood Street Building 20, Suite 2-36
North Andover, Massachusetts 01845
Gerald A. Brown Telephone (978) 688-9545
Inspector of Buildings Fax (978) 688-9542
HOMEOWNER -LICENSE EXEMPTION
BUIDING PERMIT APPLICATION
Please print
DATE: % 2 0
JOB LOCATION:_ Reg? 1 -
Number
HOMEOWNER JO ftpJ I
Name
PRESENT MAILING ADDRESS
o - VIAdc
City Town
A<W ped
Street Address
1. 17K-&9"7-377
Home Phone
'72 0-Pzr .*i-(( kW
rM �
Map/Lot
C e(l W4Wr-Phone
d �BYs
Zip Code
The current exemption for "homeowners" was extended to include owner -occupied dwellings to two units or less and
to allow such homeovrners 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 Awns 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.11
The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building Department
minimum inspection procedures and requ�ements and that he/she will comply with said procedures and
requirements. ",-) A
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Revised 7.2009
Form Homeowners Exemption
130ARD OF APPEALS 688-9541 CONSERVATION 688-9530.•
HEALTH 688-9540 PLANNING 688_95535
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The Commonwealth ofMassachusetts
Department oflndustrialAccidents
Office of Investigations'
600 Washington Street
Boston, MA 02111
S'
www.ma_ssgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers
plicant Informaiin'n
Name
Address: q9
13,--*,- mw
0 tfv%J
City/State/Zip: / /o,* Acfoyr 1'. Nof Q l N(—
Phone #:_ 4 2 C- p y-3 i 7 L/
Are you an employer? Check the appropriate box:
L ❑ I am a employer with
4. ❑ I am a general contractor and I
employees (full and/or part time).*
2. ❑ I am a sole proprietor or
have hired the sub -contractors
listed
partner
on the attached sheet.
ship and have no employees
These sub -contractors have
working for me in any capacity.
[No workers' comp. insurance
workers' comp, insurance.
5. ❑ We are a corporation and its
3. Xrequired.]
I am a homeowner doing all work
.officers have exercised their
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 i
Type of project (required):
6. ❑ New construction
7. El Remodeling
8. [3 Demblition
9. [M Building addition 5 � age t
10. El Electrical repairs or additions
11. El Plumbingrepairs or additions
12-ElRoofrepairs
13-Elother
!Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
#Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information.
lam an employer that Is providing workers' compensation insurance for my employees Belo
information. w is the policy and job site
Insurance Company Name:
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 required, under Section 25A ofMGL 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
Investigations of the DIA for insurance coverage verification. forwarded to the Office of
Ido hereby certify
Eliepins anrlyr�na ofperjury flzat the information provided above is true and correct.
9- - y9✓ -
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):
I. Board of Health 2. Building Department 3. City/To1sn Clerk
6Other 4. Electrical inspector 5. PIumbing Inspector
.
Contact Person:
Phone #:
C 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
ofthe 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 shallwithhold 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 insurancd 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 ofpublic work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers; compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(S)name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. if an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial
Accidents for confirmation o£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 peimit/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 (ifnecessary) 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 NOTrequired to complete this affiddvit.
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.
mthd Com- onweal'la o .iYfassaf.aC�1�,5(: S
Department of f dustrial Accidents
Office ofInvesUgations
600 Washington Stroet
Boston; MA, 02111
Tol. # 617-727-4900 ext 406 or i-s77-mAsS.AFE
Revised 5-26-05 Fax # 617,727-7749
wv w—mass.gov/ilia
23 February 2012
Bill Conaton
BC Building and Remodeling, LLC
121 Lowell Road
Windham, NH 03087
Via email: bcbuild@comcast.net
RE: Structural Review of John Conaton Residence Construction Drawings
North Andover, MA
Bill:
I have reviewed the construction drawings for the proposed project above. My understanding is
that you will be constructing two dormers in a 20 -ft x 36 -ft garage second floor space.
I have reviewed the proposed LVLs for the roof and floor framing. Please see the attached
building cross-section and floor plan for my proposed sizes. I have boxed my notes to distinguish
them from the other handwritten notes.
If you have any questions regarding this matter, please feel free to contact me.
Sincerely,
Anthony D. Coviello, PE
Principal
ANTHONY D.
COVIELLO
STRUCTURAL
No. 46390
SUMMIT ENGINEERING PLLC . 111 Maplewood Ave.. SUITE E . PORTSMOUTH, NH 03801 OFFICE: 603.319.1817 FAX: 877.808.1817 WEB: SUM MITENGINEER INGINC.COM
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