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Home My WebLink AboutBuilding Permit #124-14 - 1500 Forest Street 8/6/2013 TOWN OF NORTH ANDOVER PPLICATION FOR PLAN EXAMINATION Permit NO: Z Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LQCATlONJ_-5'0() �Q+(ZC-S 7r. S?"�L�C;% �XT, �t��L�f-/ A��t,�'/Z.�_�:�i� Oi$tf- - - P�.. PROPERTY OWNER LJ Print 1MYear�01d Structure yes: no:�. MAP NO' U PARCELA ZONING DIS�TiRICT 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 4A�1JL-v� 94-1& ❑ Others: ❑ Demolition ❑ Other D.Septic. El Well- ❑ Floodplain, 0 Wetlands ElWatershed District' .11 Water/Sr, Floodplain, f DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: MA121-c �5-nCi-cso-"J : Phone: R-1-B- gg - - 9'Z 7�- ctitZ�S� Address: �00 /V0t'--7-1-1 AA201 0L_1&-/2_ C:ON TRACTOR NameF{.2 -Y__-Sf-1Ei7S.Phone: Address: _ T - Su,pervisor's-Construction License; __ Exp: Date: Home,Improvement'License,: Exp. Date; ._ ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASS/ED ON$125.00 PER S.F. Total Project Cost: $ 3 00 FEE: Check No.: I Receipt No.: 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 0 Stamped Plans ❑ Location�..t Yet` L ST , No. L ! Date8 01- 1 • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ Tuo TOTAL $ C � Check# 26704 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE-OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBodyArt ❑ Swimming Pools El , 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 EVELOPMENT ❑ ❑ CO ENTS CONSERVATION Reviewed on �'�'�( 3 Signature COMMENTS HEALTH Reviewed on 3 Signature COMMENTS i 1 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments i Water & Sewer Connection/Signature& Date Driveway Permit DPW To-vv;� ]Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Mair`Street Fire Depai-inerit-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.$10041000 fine NOTES and DATA— (For department use I i I i ® Notified for pickup - Date ill i Doc.Building Permit Revised 2010 i I' Building Department The foE13wing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofivg, 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 o 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 Applicabe) ❑ 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 PP uildin 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 app,-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application I Doc: Doc.Bui!ding Permit Revised 2012 r , NORTH � � � � . � )) : :. .c . . ve" 'o O No. 174-- Iq 2n h ver, Mass, O • LAMS � C0C"1C"t W/CK V1. ASR^TED S V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System WTHIS CERTIFIES THAT ............ . .�....� ....................................................... BUILDING INSPECTOR ...... . .... ................. has permission to erect buildings on i.700Folemep"i. Foundation ....................................................... Rough to be occupied as ........'.0..x...1.�..........5. ...�� Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. - Final i4q , PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTJ2 ST Rough Service .............. . .. ...... ................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE The Cd wnafth of Massachusetts Dep2elmeht of Fire Services Office of the State Fire-Marshal P.O.Box 102i Shite Road,Stow,ivL4 OI775 PERMIT / North AndoverDate: p ern it No (Cihj of Town) (LEApplicable.) Dig Safe Number In accordance with the provisions of lbC GL-1 4 8 Ghapter1 0 as provided iu section•��R 34 1 Start Date This Permit is grantcd to: �U, Full name of person,Firm or Corporation Pennissionto locate dumpster for construction/renovation/demolition of building. Comments: dumpster must be . 25from structure if unable to place with required Restrictions:clearance dumpster must be coveted with plywood or tarp end of work -day at d g C ,� ✓. (Give location by street and no.,6�V`ddescnbc in such manner as to pro-vied adequate ideatiFcation of lbcation) Fee Paid,S 50 .00 �._..._. .. , _ �,� Fire Chief This Permit will expire.��J ( ignature o l ant rmi ) i gran c [ (Tide) The Commonwealth of Massachusetts Department of Industrigl Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leibly Name(Business/Organization/Individual): � C ��5 ��C�\►A °� Address: bo 2 s City/State/Zip: &, Phone#: q A�—`��1 ZA\4� Are you an employer?Check the appropriate boy., Type of project(required): 1.❑ I am a employer with 4. WI am a general contractor and I 6 ❑ construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. 7 Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9• E]Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' q � 13.0 Other comp.insurance required.] *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. Below is thepolicy and job site information. -z--iIusuratic Company Name;. w <,zSZ C 5 Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: 116 AMIZAAe/Lihe 60.% City/State/Zip: �m- Oi�SF� . 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. Ydo hereby rt' under the pains andpenaldes ofperjury that the information provided above is true and correct. - SiMature: Date: � --'Z> ZD Phone#• _ ��` 6\_19D C> Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - Contact Person: Phone#: r 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 o£hire express or implied,oral or written." ' An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the-issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships'(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions 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 permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The GoMMOR wealth of Massachusetts Department of%dustrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel,#617-727-4900 eXt 406 or 1.-877:MASSAFE Revised 5-26-05 FaYO 617-727-7749 i APPLICATION FOR WATER SERVICE C�Nt4ECTfON North Andover, Mass.`�-� 2 20 _43 .. I Application"by the undersigned is hereby made to connect with the town water main in l Street, subject to the rules and regulations of the Division of Public Works. The• re.mises are known as No. L r G C C� C/` Street P or subdivision lot no ke Owner Address Contractor Address �nt's ignature PERMIT TO CONNECT WITH WATE MAIN The Board of Public Wor s hereby grants permission to4 f % UJ i to make a: ,ion wi h the water main at. 41 r 1 4 Street subject,to therules and regulations of the Division of Public Works. Board of Public Works By , Inspected by Date I See back for rules and regulations 1�t Massachusetts -Department o :Pu'Dlic 5aie y Board of Building Regulations and Standards Construction Supervisor License: CS-051123 1'^ M SCOTT MCLNNIS 100 HESPERUS AVE Gloucester MA O1930 , Co!nTussion r 02/27/2015 N31°11'31"E a, 130.00' CQ to co cq14, co NIF PICARIELLO c TP2-6%9/05 z 40 MIL IMPERVIOUS BARE M PT1 VENT TP1-6/9/05 43.75DISTRIBUTION BOX E Y o LIMIT OF SAND N o B 15' X A INSPECTION 58.23' PORTS. (TYP.) N31011'31"E x—x—x—x—x—x—x—x—x— x—x—x—x—x—x—x—xr\ TP 32"-46" TP 35" ® \ TP 17"-47" BENCHMARK 2: SPIKE \ BETWEEN TWIN OAK TREES P ELEV. 100.89 (ASSUMED DATUM) tia 0 S �Q 32 PVC FORCE MAIN Icp TPS_ 2500 GALLON 5/5/05 TWO COMPARTMENT SEPTIC TANK/ PUMP CHAMBER . $ 5 TP 42" 16' CA1 —�i� Z ►._` O CLEANOUT G] , S + •a Lwayt�� 100' WELL 'OFFSET �- trJ / \, DEC BENCHMARK CORNER OF CONCRETE LEFT ° ROOM NG E/GH j OwE<<� ELEV. 100.00 (ASSUMED DATUM) a, Sett E-L NG El! 10 60 GARAGE E W 00 u WELL 1500 FOREST STREET EXTENSION ASSESSORS MAP 105B, PARCEL 4 1.2485 f ACRES j3�Y f .s 124.25' S39* ,., 1"7 3813 f S f FOREST S 'R EE TEXTEN