HomeMy WebLinkAboutBuilding Permit #474-2011 - 810-812 Salem Street 12/10/2010TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit N0: y7 Y- �2b l/ Date Received
Date Issued:
IMPORTANT: Applicant must complete all items on this
_LOCATION 81 S� �..4tAd Lue�
Print
MAP NO: (>650 PARCEL: 030OZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Resid tial
Non- Residential
❑ dew Building
QfiYne family
Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
0 Septic ' ®Well
'.rMJF11 ddp—qu D , t o a,,®I
Waters;;;;; D� iS ct . ,
®Water /Sewer_,
DESCRIPTION OF WORK TO BE PERFORMS. :
OWNER: Name:
Adrlress: C%
CONTRACTOR Name:
Address:
Identification lease�Vr Print Clearly)
Supervisor's Construction License:
Home Improvement License:
ARCHITECT/ENGINEER
VK
Exp. Date:
Date:
1/22
Phone: ; ='
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT.- $12.00 PER $1000.00 OF THE TOTAL ESTIMATED CO'ST/BASED ON $925.00 PER S.F.
Total Project Cost: $
d)0 U FEE: $
Check No.: Receipt No.: 3 ��
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Sig ir_atre,of°Age Owner{ 4.�. _: X' Signature of;contractor
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
o Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o 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
❑ Flo or/Crossection/Elevatio n 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 App
liaa&e) -�
❑ Copy of Contract
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineer..ed-products
n off from Fire Department prior to issuance of Bldg Permit
V®TE: All dumpster permits require sig
n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
hat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
gust be submitted with the building application
Doo: Doc -Building permit Revised 2008mi
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
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed on i a
DATE APPROVED
COMMENTS_
HEALTH Reviewed on Signature
COMMENTS
c -
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Com
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 Main Street
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 us
Notified for pickup - Date
Doc:.Building Permit Revised 2008
r-
Location
No.
Check # o `�
23774
Date /2 �� /a
TOWN OR NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Building Inspector
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NORTH TOWN OF NORTH ANDOVER
OFFICE OF
BUILDING DEPARTMENT
e� * 1600 Osgood Street Building 20, Suite 2-36
�9s�'nc'p�c1y 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
DATEJ I 1 W /10
JOB LOCATION: A1C) S vel -11 S
Number Street Address
IiOMEOWNER A aTh /e,4-,
Name
PRESENT MAILING ADDRESS
N
City Town
Phone
stwfw .
3�
n v�
Map/Lot
Work Phone
01<f �Y
Zip Code
ole --T
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. I ,
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Revised 7.2009
Form Homeowners Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
The Commonwealth of Massachusetts
Department of IndustrialAccidents
Office of Investigations
600 Washington Street
Boston, MA. 02111
�� s�• www.mass.gov/dia
Workers, Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/OrganizationAndividual): ��! Q .r 1 '�
Address: C? SG1 OnoS
City/State/Zip: ) li( 01 Q U -e_2 Phone
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).'
have hired the sub -contractors
2. ❑ I am a sole proprietor or partner-
listed on the attached sheet. t
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.] t
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
11.0 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.
T 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 is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name;
Policy # or SeIf-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 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 DTA for insurance coverage verification.
Ido hereby ce fy under the pains andpenaldes ofperjury that the information provided above is true and correct.
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. EIectrical Inspector 5. PIumbing Inspector
6. Other
Contact Person: Phone 4:
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2. Excess material and construction debris shall be properly disposed of off site and all stockpile
areas shall be located more than 50' from the resource area.
3. The applicant shall contact the Conservation Department upon completion of the project for a
post -construction inspection.
4. This permit shall expire six months from the date of issue.
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 ANDOVER CONSERVATION DEPARTMENT
Heidi Gaffney
Conservation Field Inspector
1600 Osgood Street, Building 20, Saute 2-36, North Andover, -Massachusetts 01845
Phone 978.688.9530 Fax 978.688.9542 Web www. http://«-v�tiv.toxvnofnorthandover.com/consen=el.htm
December 2, 2010
Samuel Curry
c/o Matt Meuse
810 Salem St
North Andover, MA 01845
CONSERVATION DEPARTMENT
Community Development Division
810 Salem St, North Andover
Expansion of an Existing Deck
Conservation Conditions of Approval, NACC #77
Pursuant to section 4.4.2 A of the North Andover Wetlands Protection Regulations, Matt Meuse,
contractor, filed for a small project for work proposed at 810 Salem Street, North Andover. The work
consists of expanding the existing deck from 120 s.f. to 300 s.f. Existing and new footings will be used
to support the new deck configuration. The decking and railings will be removed from the old deck
and replaced. The proposed deck is within the 100 -foot buffer zone to a Bordering Vegetated
Wetland (BVW) and Riverfront (project is exempt from Riverfront) which is located to the north and
east of the site. Additional work includes placing gravel under the deck. Work will be conducted
outside of the 50 -foot No Construction zone from the edge of the Bordering Vegetated Wetland
(BVW)
During the December 1, 2010 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: As -Built Plan of Land, North Andover, MA
Prepared by: Merrimack Engineering Services
Dated: November 25, 2008 Revised: December 1, 2008
Proposed Deck Added by: Matthew Meuse - B&M Builders LLC
Project Description done by Matthew Meuse
CONDITIONS:
Accepted engineering and construction standards and procedures shall be followed in the
completion of the project.
1600 Osgood Street, Building 20, Suite 2-36, North Andover, Massachusetts 01845
Phone 978.688.9530 Fax 978.688.9542 Web www. http://tivww.to�vnofnorthandover;com/conservel.htm
r�
CBA & UPLAND
= 18,750 S.F. AS PER
VARIANCE GRANTED 12/18/2007
AND RECORDED 01/23/2008,
E.S.D.R.D.
00 NOTES
N 1. PROPERTY LINES FROM EXISTING PLANS AND RECORDS.
M SEE TOWN OF NORTH ANDOVER ASSESSORS MAP #65 LOT #15
\ AND DEED BOOK #1046 PAGE #89 E.N.D.R.D.
2. ZONE DISTRICT IS R3
Lal
fl-
" I HEREBY CERTIFY THAT THE FOUNDATION
IS LOCATED ON THE LOT AS SHOWN."
4/23/2008
DATE
Neal ENC�q N/F
Np pCWER \
pCMPAAl
�J
PLAN OF LAND
IN
NORTH ANDOVER, MASSACHUSETTS
DRAWN FOR
JOHN CARROLL
.1501 MAIN STREET -UNIT 15
TEWKSBURY, MASSACHUSETTS 01876
SCALE: 1"=80' DATE: APRIL 23, 2008
0 40 80 160 240
MERRIMACK ENGINEERING SERVICES
66 PARK STREET
ANDOVER, MASSACHUSETTS 01810