HomeMy WebLinkAboutMiscellaneous - 31 FULLER ROAD 4/30/2018 (2) i
% 31 FULLER ROAD
J/ 210/065.0-0076-0000.0
1
Location
No. ?�Sr Date
NORTH TOWN OF NORTH ANDOVER
00
* ; ; Certificate of Occupancy $
Building/Frame Permit Fee $
s•►CHus
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ /
Check #
61871
/�
87 1 �
f "`-13uilding Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
D$ QI'( I+CiAI<,l(}BC'�111(
BUILDING PERMIT NUMBER. � DATE ISSUED: TIP
O
SIGNATURE:
Building_Commissioner/Inspector ofBuildin Date
SECTION 1-SITE INFORMATION Z
1.1 Property Address: 1.2 Assessors Map and Parcel Number: O
Map Number Parcel Number
1.3 Zoning Information: v 1.4 Property Dimensions:
Zonin District Pr ,sad Use Lot Area Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
R uired Provide R red Provided Required Provided
1.7 Water Supply M.G.L.C.40.§34) 1.3. Flood Zone Information: 1.8 Sewerage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record M
Name(Print) Address for Service
Signature Telephone
2.2 Owner of Record:
OName Print Address for Service: Z
Signature Tele hone M
SECTION 3-CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
Licensed Construction Supervisor: O
License Number
Address
Signature Telephone Expiration Date
r
3.2 Registered Home Improvement Contractor.
Not Applicable ❑ C�
Company Name
00 ('+, ,-T-�-0 9� Registration-Number ! r.
LZAd f JJlbExpiration Dateture Telephone ^
P1
r
SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes.......0 No.......0
SECTION 5 Description of Proposed Work(check_all applicable)
New Construction 1l Existi Buil ' Repair(s) ❑ Alterations(is) v r*Addition ❑
Accessory Bldg. ❑ DemoliAon ❑ Other ❑ Specify
Brief Description of Proposed Work:
51 D/A1 6r
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be QFFT IA USE,Q ,y,
Comleted by permit applicant i
_ .
1. Building (a) Building Permit Fee
Multiplier
2 Electrical (b) Estimated Total Cost of
Construction
3 Plumbing Building Permit fee(a>X (b)
4 Mechanical(HVAC) 70.----
5 Fire Protection
6 Total 1+2+3+4+5) Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf,in all matters relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
I, 124 V/7) C_14 S T k L t✓Dv as Owner/Authorized Agent of subject.
property
Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of m_y knowledge
and belief
VA V c/14 S.
Prim( G� z= Y G�J l La=��
Si nature of Owner/Agent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TINMERS 1ST2ND 3 KU
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
DIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
NORTH
_ Townof
RAndover
S �� O ♦V� ,`,KI
No.
C, dover Mass.
LA E ' '
COCMICMEWICK ORATED
BOARD OF HEALTH
Food/Kitchen
PER IT T D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT...........l............... ................................................. ............. Foundation
has permission to erect......... Rough
r...........�............... buildings on .... ..., ............
t0 b8 OCCUp18d as. Chimney
. . . .. ...... ...............................................................................................................................
provided that the person accepting t ermit shall in every respect conform to the terms of the application on file in Final
this office, and to the provisions of t 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 CONSTRUCTIO STARTS Rough
.................. ....... .. Amrm.. Service
ECTOR
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.
�; . � . The CommonweaCth of W assachuse=
H;
w, Department of IndustriaCAccidents
7.' J
"�;:., ` '' Office of Investigations
,` 600`GVashingwn,Street I
Boston, 49 02111
Workers'Compensation Insurance Affidavit
APPLICANT INFORMATION Please PRINT Legbly
Name: ERIC &d1PkfWMhN
Location:
City: A `D b Telephone#: R/_ 9
❑ I am a homeowner performing all work myself.
❑ I am sole proprietor and have no one working in my capacity
❑I am an employer providing workers' compensation for my employees working on this job �+ --7'
Company Name: -DAV 1 b G A JT R I LW E 'R0y r— !ii Ct- � J 1 J) I Il?G ,�L0(.
Address: C-0— O9 to �S'c�T�
City: [/V o R-nt A o D d u Lp- Telephone#: 9 7
Insurance Company: /! I, Policy#: V W d (o U0 f Y? 001 .0 0*
❑I am(circle one) sole proprietor,general contractor or homeowner and have hired the contractors listed below who have the following
workers' compensation policies:
Company Name:
Address:
City: Telephone#:
Insurance Company: Policy#:
Company Name:
Address:
City: Telephone#:
Insurance Company: Policy#:
Attach additional sheet if necessary
Failure to secure coverage as required under Section 25A of MGL 15B can lead to the imposition of criminal penalties of a fine up to 51,500.00
and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I
.understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do herebyc i unde the pains nd penalties of perjury that the information above is true and correct
i
Signature: Date: L� o
Print Name: 4V �'6 OM�C"0�� Phone# 7 Z0 Oy J`1 r�
Official Use ONLY-Do not write in this area
0 Building Department
City or Town: Permit/License#: 0 Licensing Board
0 Selectmen's Office
0 Health Department
o Check if immediate response is required o Other
i
INFORMATION &INSTRUCTIONS
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation
for their employees. As quoted from the "law" 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 section,25 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, 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 in the workers' compensation affidavit completely,by checking the.box that applies to your situation
and supplying company names, address and phone numbers as all affidavits 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.
City or Towns
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. The
affidavits may be returned to the Department by mail or FAX unless other arrangements have been made.
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
Fax# (617) 727-7749
Telephone # (617) 727-4900 ext. 406,409, or 375
6
v
NORTH ANDOVER BUILDING DEPARTMENT
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
at: is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
c 11, S 150 A.
Also, note Permits are required under Fire Prevention laws Chapter 148 Section
10A.
The debris will be disposed of in:
(Location of Facility)
Signature of Permit Applicant
Fire Department Sign off:
Dumpster Permit
b
Date
Date. Zi/: .c�.G 7
. .. . . ....... .
r NpRT#1
fO TOWN OF NORTH ANDOVER
Fitg � 9
• - PERMIT FOR GAS INSTALLATION
s i •
s16
o '•
9
�,SS^CMUSEt�
This certifies that . . . . .'`. . . . . . . . . . . . . . . . . .
has permission for gas installation . . . ./1.":. t . . . . . . . . . . . . . .
in the buildings of . . . . . . . . . . . . . . . . . . . . . . .
at . . . . . . . . 1 ., North Andover, Mass.
Fee . . . . Lic. No l ?. . . . #. . . .1�._
I GAS INSPECTOR
Check# 2 '
45 '10
1
MASSACHUSETTS UNIFORM APPUCATON FOR PERNIlT TO DO GAS FT-rnNG
(Type or print) Date 9 a �j
NORTH ANDOVER,MASSACHUSETTS
Building Locations 3' V-y%iec ?A Permit"#
Amount$
Owner's Name
New❑ Renovation Replacement Plans Submitted
� w
c
c ° a z c
d
SUB-BA SEMEN
'BASEMENT
1ST. FLOOR ( .
1N D. FLOOR
3R D. FLOOR
4TH. FLOOR
STH. FLOOR
6TH. FLOOR
7TH. FLOOR
8TH. FLOOR
(Print or type) C 12&k one: Certificate Installing Company
Name ® Corp 2�zz
Address 20 ��� 7 c. ��n 3- 1 Icy El
Partner.
Business Telephone�q�Psl Co�S-�i,383 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes No❑
If you have checked M please' dicate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity ❑ Bond ❑
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 Chapter 142 of the General Laws.
Signature of Licensed Plumber Or Gas Fitter
� b
Ef Plumber Title a3
City/Town Gas Fitter License Number
Master
APPROVED(OFFICE USE ONLY) Journeyman
of Deeds. i
- - - - - e recorded at the North Essex Registry um five(5)foot
ermit shall b _ have a minim
c. The Special P _four(64) square feet shall h
1-g.-Accessory buildings no larger than sixty
setback
from side and rear lot lines and shall be located no nearer the street than the building line
of the dwelling.
19.Day Care Center by Special Permit.(1985/23)
20.Independent Elderly Housing by Special Permit in Residence District 3 only.
4.122 Residence 4 District per lot.
1. One residential building p persons
2. Place of Worship.
Renting rooms for dwelling purposes or furnishing table board to not more than four y
3. R geed inches
not members of the family resident in a dwelling soused,provided there be no display or
on such dwelling or its lot other than a name plate at no dwelling shall be erectedoraltered
not to exc
advertising
by twenty-four(24) inches in size, and further provided t for a home occupation,
primarily for such use.
4. For the use of a dwelling in any residential district or multi-family district
the following conditions shall apply: may be employed in the home occupation,one of
a. Not more than a total of three(3)People
whom shall be the owner of the home occlbuildingding said dwelling r
b. The use is carried on strictly within the principal or displaywhich aro not customary
c. There shall be no exterior alterations,accessory building, he dwelling unit so
with residential buildings; gross floor area of t
d. Not more than twenty-five(25)per cent of the existing
connec
used,
not to exceed one thousand(1000)square feet,is devoted es or products which occtupy
with such use,there is to be kept no stock in trade,comm
space beyond these limits.
es visible from the street;
e. There will be no display of goods or wardetrimental to
building or premises occupied shall not be rendered obbjeactioenTanceremission of odor, gas,
f. The bu g
residential character of the neighborhood due to the exteriorpp
smoke, dust,noise,disturbance,or any other way become objectionable or detrimental to any
smo ,
residential use within the neighborhood.
g. Any such building shall include no feature of design not customary in buildings for residential
use within the neighborhood. inches in size which shall
which they are
5. Real estate sign
- s not to exceed twenty-four(24)inches bythirty-six(36)
advertise only the rental,lease,or dale of thepremises suo chards,plant nurseries,and
6. a. Farming of field crops and row crops,truckg
greenhouses. the keeping of a total of not more than three(3)
b. On any lot of at least three(3) acres,
of an kind or assortment of animals or birds in al acre of lit on to six to five(5) pets of a the
Y
family living on such lot, and for each addition of any animals,birds or
keeping of one additional
pets of persons not resident on suanimal�hl �but notthe.keeping lot.
c. On any
lot of at least five(5) acres the keeping of any number of animals or birds
regardless of ownership and the operation ofequestrianriding academies,stables,
stud farms,dairy farms,and poultry batters
d. The sale of products raised as a result of the above uses on the shall be considered a structure and permitted
7. Swimming pools in excess of two suitable
feet deep 4 feet in height to be
provided they are enclosed by a suitable wall or fence at least four( )
the Building Inspector to prevent the entrance of persons other than those residing
determined by 30
{
with such use,there is to be kept no stock in trade, commodities or products which occupy
space beyond these limits;
e. There will be no display of goods or wares visible from the street;
f. The building or premises occupied shall not e t rendered he exterior appearance,omissionbjectionable or tof odor,gas,
residential character of the neighborhood due to t
smoke,dust,noise,disturbance,or in any other way become objectionable or detrimental to
any residential use within the neighborhood;
g. Any such building shall include no features of design not customarily in buildings for
residential use. six 36 inches in size which shall
5. Real estate signs not to exceed'tw e f her remises upon inches ywhi h they are placed.
advertise only the rental,lease, sal p
6. Agriculture,horticulture,floriculture,viticulture or silvaculture. (1986/100)ore than three(3) of any
a. On any lot of at least three(3)acres,the keeping of a total of not m
kind or assortment of animals or birds in addition o five to household pets of a(5),),the keeping of onemily additional
on
such lot,and for each additional acre of lot size
animal or bird but not the keeping of animals,birds, or pets of persons not resident on such lot.
(1993/36)
b. On any lot of at least five(5)acres,the keeping of any number of animals or birds regardless ultr
of ownership and the operation of equestrian riding academies, stables, stud farms, and poultry
batteries.
c. The sale of products raised as a result of the above
useslon the subject land.(1or g6/100) well
d. The sale of products of agriculture,horticulture,er on who is primarily engaged in ay of the above
as accessory or customary items,by any p
activities. The operation must be on at least ten(10) contiguous acres used primarily for any
of these activities. (1986/100)
7. Swimming pools in excess of two(2)feet deep shall be considered a structure and permitted
provided they are enclosed by a suitable wall or fence at least four(4)feet in height to nt the nt ante of persons other han those residing
determined by the Building Inspector to prevent
line of the dwelling,except by Special Permit.
at the pool location. Pools shall have a minimum ten(10)foot setback from side and rear of lines
and be located no nearer the street than the building
8. Museums.
9. a. Public and private non-profit educational facilities. (1986/17
b. Private for profit educational
facilities
tons(Special Pey Special lrmit Required),but not including
ce co
10.Public building and public sere corporations
public works garages.
11.Golf Course.
12. Swimming and/or tennis clubs shall be permitted with a Special Permit.
13.Cemetery.
14.Nursing and convalescent home-see dimensional requirements of Table 2(Special Permit
Required).
15.Municipal recreational areas. permittedve provided that such
16.Any accessory use customarily injurious,noxious,orf the offensive to the nghborhood.
accessory use,shall not be i J
-- -
�17.Family Suite—a separate dwelling unit within or attached to a dwelling for a member o a
'household is allowable by Special Permit provided:
f'a. The dwelling unit is not occupied by anyone except brothers, sisters,maternal and paternal
r arents and grandparents,or children of the residing owners of the dwelling unit;
b. .That the premises are inspected annually by the Building Inspector for conformance to this
�" section of the Bylaw; 29
r
i
c:The S ecal Permit shall"be recorded at the North Essex Registry of Deeds. foot
p four 64 s uare feet shall have a minimum five(5)
18.Accessory buildings no"larger"than"sixty— ( ) q
setback
from side and rear lot lines and shall be located no nearer the street than the building line
of the dwelling.
19.Day Care Center by Special Permit.(1985/23)
20.Independent Elderly Housing by Special Permit in Residence District 3 only.
4.122 Residence 4 District per lot.
1. One residential building p
2. Place of Worship. dwelling purposes or furnishing table board to not more than four(4 persons
3. Renting rooms for dwelling p rovided there be no display or
not members of the family resident in a dwelling so used,p
advertising on suad that no dwe plate or elling shal
by twenty-four(24not to exceed six(6)inches
, dwelling or its lot other than I be erected or altered
)inches in size, and further prov
primarily for such use.
the use of a dwelling in any residential district or multi-family district for a home occupation,
4. For
the following conditions shall apply:
a. Not more than a total of three(3)people maybe employed in the home occupation,oneof
whom shall be the owner of the home occupation,building;
an drl sliding said dwelling
b. The use is carried on strictly within the principal
display or dis which are not customary
C. There shall be no exterior alterations,accessory building, e dwelling unit so
with residential buildings; gross floor area of th
d. Not more than twenty-five(25)per cent of the existing g
d to such use. in connection
used not to exceed one thousand(1000) square feet,immodifies di nes or products which occupy
with such use,there is to be kept no stock in trade,co
space beyond these limits. le
e. There will be no display of goods or wares visible from the street;
detrimental to
f. The building or premises occupied shall not bethex rendered ioreappearance,
pe rance,emission of odolregas,
residential character of the neighborhood due to the ext er way become objectionable or detrimental to any
smoke,dust,noise,disturbance,or any oth
residential use within the neighborhood.
g• Any
such building shall include no feature of design not customary in buildings for residential
use within the neighborhood. six 36 inches in size which shall
5. Real estate signs not to exceed twenty
of thefour 24remises)inches upon which they)are placed.
advertise only the rental,lease,or da p plant nurseries,and
6. a. Farming of field crops and row crops,truck gardens,orchards,p
greenhouses. the keeping of a total of not more than three(3)
b. On any lot of at least three(3) acres,
of any kind or assortment of animals or birdsadditional ain cre of lit on to six to five(5) acres,the
he
family living on such lot, and for each add u of an animals,birds or
keeping of one additional denanimal t on such bird;
but not the keeping Y
pets of persons not re
c. On any
lot of at least five(5)acres the keeping of any number of animals or birds
regardless of ownership and the operation of equestrian riding academies,stables,
stud farms,dairy farms,and poultry batt
d. The sale of products raised as a result�deep above uses on the shall be considered ua structure and permitted
7. Swimming pools in excess of two suitable
fee P4 feet in height to be
provided they are enclosed by a suitable wall or fence at least four( )
fined b the Building Inspector to prevent the entrance of persons other than those residing
determined Y 30