HomeMy WebLinkAboutMiscellaneous - 36 CHAPIN ROAD 4/30/2018' Location 2i:04� �''fl�.�.Cl 4A)
No. Date
4
TOWN OF NORTH ANDOVER
°c
Certificate of Occupancy $AM
Building/Frame Permit Fee $ U
^°''�<�
s�cHuse
Foundation Permit Fee $
Atter Permit Fee $
'}
Sewer Connection Fee $ o
"
Water Connection Fee $
TOTAL $
Building Inspector
Div. Public Works
W
C 0
W z
C 0
F
0
J
LL
0
W
C9
m
Z
k �
Z
} K
F L
w F
W
a.
0 F- u u
IL 8.
u m g
z F F
z
0
D
k
In
W
0
z
Z I
r
64
I (�
C I
J I
u
�
IA
IA
�
�
z
W
N
m
�
<
O
�W
om
a
IL
w
W
<
0 v
N
m
0
`
W
H
I
W
W
Z
3
o
o
O
U
0
0
z
z
z
OL
�
Z
t
W
0
Z
o
J
O
•
z
G
000
W
p
a
m
W
;
a
W
0
0
Z
W
�
j.
a
a
W
2
a
L
L
Y
K
0
i
r
e
O)
,m
"
W<
W
W
i
o
z
ZO
I
Z
U
OJ
z
Z
U
I.
N
L-
I
N
0
0
t
m
0
W
d
s
Z
Q
;:
t.i
V
O
F-
o
1
d
c
>
,.
W
C 0
W z
C 0
F
0
J
LL
0
W
C9
m
Z
k �
Z
} K
F L
w F
W
a.
0 F- u u
IL 8.
u m g
z F F
z
0
D
I
In
0
z
Z I
Z
0
I (�
C I
J I
u
�
IA
IA
�
m
z
�
<
O
�W
om
a
w
W
<
0 v
�
0
0
W
H
r
3
o
o
O
U
i
p
z
i
z
OL
�
�
m
Z
2 v
Z
<
O
a
z
O
W
p
a
m
W
0
>
O
J 2
N
11
0
Z
<
j.
m
F
a
L
L
a
m
"
W<
W
W
i
o
z
ZO
t
Z
U
OJ
z
Z
U
�
N
L-
I
N
0
0
t
m
0
W
C 0
W z
C 0
F
0
J
LL
0
W
C9
m
Z
k �
Z
} K
F L
w F
W
a.
0 F- u u
IL 8.
u m g
z F F
om
' 0
I
I
In
s a
1 Z
Z I
Z
0
I (�
C I
J I
u
�
IA
IA
�
0 1
o!
z
�
<
O
�W
om
a
w
=
0 v
�
0
0
z
o �
■ 9
H
H
J
3
o
o
O
U
U. 92
0
m
j
OL
�
�
m
Z
2 v
�
~
<
Z
m
M
W
p
a
m
W
>
O
J
^
0
>
O
J 2
N
11
IOL E
Ir-
l
F l
W FFF�
a
L
L
W /
om
' 0
I
u
� W
� L
s a
1 Z
I (�
V\
�
�O
N
�
<
O
�W
om
a
�'
L
i L
�
J
V
F -CC
LU
Z
H
J
3
o
o
O
U
U. 92
om
' 0
I
u
� W
� L
s a
1 Z
I (�
O
� �
m
W
' Y
� m
�
<
O
�W
om
a
�'
L
i L
I
O
t
�
<
K
0
p
J
C
z
I
W
0
m
j
OL
�
�
m
Z
'Y'
Im
�
~
<
Z
C
O
r
•y
ti
$
�oT
~
N -.
A O
1N�Q
o/w
�o
O
0'
Aafll'
80
Ny
=
^
TTS
NOp
A /0�Q^sN
Nc'
2aa
O
7po
P
N9-
w
w>
N
Z
G G
O N
N
W N
as
w
NOS
r
NT;x
O
T AT
0
�jN
;10
u
ii
N
N 'O
w
i
T 7zo
K
II
3
C
ITTFTT
I I
ZTyCA>x�wv_
0-20
r.
1
A Q;
7Q T+
�3'AZIR
Q>
O^
�r
>
�
_
>N
T
y
sAxTA
U Q
D>
QZ
n
U
>A
;mnri
T
T
DTT=
Q
O �e
A;
o AA
DA
�^yZ�
OC`
n>[QZNC2QA~
�r�i�r-v
W
DO
A
:O
T
fA
O
Z
'�
S'J
r_Q
70xT
m N
Z
K r
TN
3
x
T
t
N
T Z
�
T
QZ
_>
p
~
l
D
�v0
A>
CT
'�
O
T
N
T
x
v
2
Z v
g
Q
g
at
I I
T JO
O
O
M
a°y a
(A
Zm
ANS
• D0
WZ
COX
mx
D�
0�0
NO*
mim
• mx
xwn
id"
�Zo
mw3
SAM
;N cw
Am- _
0
002 p
orm
o°p
�Z
-�r O
•o r;� 0
r • -+ x
?:*z In
A
xo O
04
v
nz
x
mm
!n-n
0m
00
.3
r
0
FORM U LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT: `� �� Cn l A Phone
LOCATION: Assessor's Map Number �--Parcel O �
Subdivision Lots)
Street�'_ �(1 J i _ St . Number
Use Only************************
RE:COMMENDATIO S OF ,I GENTS :
Conservation Admirrist for
Date Approved Date Rejected
a_
Comments �� 1,� uV �Ic��bin3l.� 1 �c�l/�i►�
Date Approved
Town Planner Date Rejected
Comments
Date Approved
Food Inspector -Health Date Rejected
Date Approved
Septic Inspector -Health Date Rejected
Comments
Public Works - sewer/water connections
- driveway permit
Fire Department
Received by Building Inspector Date
Town,of.North Andover
OFFICE OF
COMMUNITY DEVELOPMENT AND SERVICES
146 Main Street
WII.LIAM J. SCOTT North Andover, Massachusetts 01845
Director
SHPMNG POOL REGULATIONS
4
NOTE: PERMIT CARD SHALL BE POSTED IN A VISIBLE AND ACCESSIBLE
LOCATION FOR OBTAINING THE VARIOUS INSPECTORS, SIGNATURES.
ALL SWIMMING POOLS IN EXCESS OF 2 FEET IN DEPTH ARE REQUIRED TO
HAVE A BUILDING PERMIT AND CONFORM TO THE FOLLOWING REGULATIONS:
1. ELECTRIC:
An electrical permit must be obtained prior to an application
for a Building Permit to install a pool.
2. ZONING:
`Pools shall be located to the rear of the front building line
of the house and no closer than 10 feet to the side or rear
lot line.
3. HEALTH:
a. Location from subsurface disposal system must be
approved.by the Board of Health.
b. Semi-public and public pools must have plans approved
by the Board of Health prior to construction and must
also have an annual operating permit from the Board of
Health.
4. SAFETY:
Pools .must be enclosed by a suitable wall and fence, at
least 4 feet in height with self-closing and. -latching gate
that meets the approval of the Building inspector.*
No water allowed in pool until fence is erected.
Pool cannot be used until inspected and approved by the
Electrical Inspector and Building Inspector.
*Fencing on corner lots must be erected 20 ft. inside lot line.
FEES: ELECTRICAL PERMIT - $35.00
BUILDING PERMIT - 6.50 per thousand on estimated cost;
35.00 minimum permit fee
D. Robert Nicetta,
Building Inspector
r
ROARn OF APPF.AT,S 6SR-9541 BTIUMNO 689-c445 i'OR1RPRI A ,ON 693-9530 T-. AT ^" 4A$-9540 PI -ANNN 499-94Z5..._
MORTGAGE INSPECTION PLAN
-JL BOSTON 97 04805
SURVEY, INC.
P.O. Box 220 Charlestown, MA 02129
(617)242-1313 MAIN (617)242-1616 FAX
APPLICANT: TINO T & PAMELA J. ARDAGNA
LOCATION: 36 CHAPIN ROAD DEED/CERT. 7339
CITY, STATE: NORTH ANDOVER, MA PLAN REF: 8893-M
1: 3.29
3
rA
W
n•,
E
N
zip
c
0
73
cm
to
cc
32
cc
L.0
CO
c
03
c
m
Z
0
Z
CD
0
zip
a
7a
�7
v J
z
0
a
z
O
U
F—A
50
o
o
a
Q,
O
Q
a
cm
C C
O C
Q
MECDCn
m
CD
�3
.0
A
d�
O
G O
CL
d C
m m
D 0
M
JC
go
ca
Z CD
C
C.)
ce
O
C
C
eO
C
w
�•
+m..
m 0
a
�
�: 0 CL
h
a
�
ow
0
cm
�C_+
v�. m J
_�
C
N
�Em
w
w°
cGo
U
w
Me ACD
n°'
w
0
cs4o
w
ao'
w
cr'a
0
cn cn
E
N
zip
c
0
73
cm
to
cc
32
cc
L.0
CO
c
03
c
m
Z
0
Z
CD
0
zip
a
7a
�7
v J
z
0
a
z
O
U
F—A
50
F
o
Z
Q,
O
Q
cc
cm
C C
O C
Q
MECDCn
m
CD
�3
.0
A
d�
O
G O
CL
d C
m m
D 0
M
JC
go
ca
Z CD
C
C.)
ce
O
C
C
eO
C
CO3
�•
+m..
m 0
�: 0 CL
h
0
cm
�C_+
v�. m J
_�
C
N
�Em
o.w
—t
Me ACD
0
c ma
C3 '� Z
m
r
coao
Q
L
y C
m3
=
m
W
C
=0S
'fl 0 --I'm
LL -
.to
at `°5
H
•m
Go
'
u
CL
�1� co
p� C
Go
I
J7
aim
E
N
zip
c
0
73
cm
to
cc
32
cc
L.0
CO
c
03
c
m
Z
0
Z
CD
0
zip
a
7a
�7
v J
z
0
a
z
O
U
F—A
E
F
LM
Z
Q,
O
Q
h
C
cm
C C
CIO
Q
MECDCn
m
CD
�3
.0
C
O
G O
CL
Mcco�aC
M
JC
go
ca
Z CD
C
C.)
y
O
C
C
eO
CO3
Q
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO•6 �3 Date Received
Date Issued:
IWORTANT: Applicant must complete all items on this page
LOCATION C/`���'''?//
t Print/
Print
MAP NO: P.A-RCEL: ZONING DISTRICT: Historic District yes
Machine Shop Village yes
TYPE OFM
❑ New Building
❑ Addition
❑ Alteration
,,0'F`tepair, replacement
❑ Demolition
p S eptic ` LJ W e.
rl Water/SeweT-
Wt Is
OWNER: N
Address: -?
PROPOSED USE
Residential
,-,�ne family
❑ Two or more family
No. of units:
❑ Assessory Bldg
❑ Other
Non- Residential
❑ Industrial
❑ Commercial
❑ Others:
Wetlands I i D Watersl
DESCRIPTION OF WORK TO BE PERFORMED:
CONTRACTOR Name:
Address:
y
Identification Ple se Type or Print CIearly)
moi . Phone
Phone:
Supervisor's Construction License:
Home Improvement License:
ARCHITECT/ENGINEE
Exp. Date:
Exp. Date:
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: $_r� FEE: $
Check No.:� U 5 Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
---- -O:
- -
—
- e of. ii i
- - S riatur
Plans Submitted ❑ - Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑
Tanning/MassageBodyArt ❑
Swnm ffi 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
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
1�-
DATE REJECTED
❑sEl
DATE APPROVED
Reviewed on Si nature
Reviewed on Si nature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Comments
Conservation Decision: Comments
Water & Sewer Connection/Si nature &Date Driveway Permit
DPW Town Engineer: Signature: Located 384 Osgood Street
FIRE DEPARTMENT - Temp Durapster on site yes no
Located at 124 Main Street
Fire Department signature/date
r'1l1T ?T AT XTrVC(
pimension
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 Z®NE{ on 2EARA aUR min.$1o0--$1000 fine n E: Yes No,
MGLChapter
NOTES and DATA — (For department use
® 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
❑ 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
DOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
iat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
lust be submitted with the building application
Doe: Doc.Building permit Revised 2008mi
Location
Date
NO.
�oR,M TOWN OF NORTH ANDOVER
01.'`n' �00
certificate of pcc
upancy $
Building/Frame Permit Fee $
SAC Mus
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check
239Building Inspector
O
FM4
ER �
x
w
-
L
C
o
z
ai
gym.
.G
C.2
Z
OQ
O
G
o
�
a
I
CO CM
� C
O =
x
w
a
rr
N_
m m
CD
C CD
o
w°
a
CO
f
c
C
w°
' .
v
U
w
_O
O
pG
q
w
W
f j
no
0
c�
"
U)
w
c
Cc Cc
-[ou
a°4
w
w
v
C
z
�i
cn
Q
ec
O
cn
�d
L
C
Y
ai
gym.
.G
C.2
O Q.
OQ
O
G
c �
I
CO CM
� C
O =
�NL� �
rr
m m
CD
C CD
CJ C.3
CD
f
CD
' .
CD
O
_O
O
c
, Q
C
c
Cc Cc
0 CDv
C
Z ts
CD
V
�d
L
C
Y
ai
gym.
.G
C.2
O Q.
OQ
O
G
Q =
I
CO CM
� C
CO)
�NL� �
v
0 CM
C. c
N R
•
O
CIO � 3
cm m
c �
� C �
m
N O
y
E job
mo
•� N m
t JZ O
C G Q
N
O O �
Cc �Z
o
O Qo
_ C.:s 01O
F.-
r.+ N m y0.
� W c Ow
LU
H .y .L P -E ca ca
LU O C
V •® p ® cm
C
O y O. O.9 O'O
z = A � h •�
F— z .w a4 m
E
a
y
r
N
O
�N
av
CM
m
CD
c
m
0
cm
c_
�c
N
0
t
r.+
O
Z
O
F.
0
CD
O
E
ai
■
L
O
C.2
Z
°D
CL
O
G
CO)
C
I
CO CM
� C
CO)
O■�
p 'p
H
O O
m m
CD
C CD
CD
f
CD
' .
CD
cma
_O
O
CL
, Q
C
c
Cc Cc
0 CDv
C
Z ts
CD
V
h
O
C
C■�
C
�
O
&
h
D
�dRTH TOWN OF NORTH ANDOVER
0 4.TLV. ,6 4o
6 OFFICE OF
BUILDING DEPARTMENT
1600 Osgood Street Building 20, Suite 2-36
�s�",o•�4�15 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:__c3 Z
JOB LOCATION: 6
Number
Street Address
Map/Lot
HOMEOWNER 7/,-'-,l e"1,0- / !F ,> 6�- % % S// J
Name Home Phone Work Phone
PRESENT MAILING ADDRESS -,' U 117X'%__�_ J12c/
City Town Sta*.e . Zip Code
The current exemption for "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 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 requirements and that he/she will comply with said procedures and
requirements.
HOMEOWNERS
APPROVAL OF BUILDING OFFICIAL
Revised 7.2009
Foran Homeowners Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
The Commonwealth of Massachusetts
Department of Industrial.Accidents
Office of Investigations
600 Washington Street
t .Boston, MA. 02111
www.mass.gov1dia
Workers' Compensation Insurance Affidavit: ]3tiilders/Contractors/FIectricians/JPlumabers
Applicant Information Please Print Legibly
NaMe(B.usiness/Organization/Individual): r1 /- o
Address:
City/State/Zip: tip /?•fid tllf� /�,6� Phone #: % 2 /V
Are you an employer? Check the appropriate box:
1. ❑ I am a employer with
4. ❑ I am a general contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
2. ❑ lam a sole proprietor or partner-
listed on the attached sheet.1
ship and have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. ❑ We are a corporation and its
required.]
officers have exercised their
3�
I am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
c. 152, §1(4), and we have no
insurance required.] i
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling .
8. ❑ Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
11.❑ Plumbing repairs or additions
12.❑ Roof repairs
13.❑ Other
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
7 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.
I am an employer that isproviding workers' compensation insurancefor my employees Below is the policy and job site
information.
Insurance Company
Policy # or Self -ins. Lie. #: Expiration Date:
lob Site Address: City/State/Zip;
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
Ido liereby cert untJ -a'insandpenal#s ofperjury that the information provided above is true ad correct.
Phone #:
Official use only. Do not write in this area, to he 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 CIerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #:.