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Home My WebLink AboutBuilding Permit #542 - 105 HILLSIDE ROAD 3/25/2008 BUILDING PERMIT cf No DT anti TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION * 1y b T Permit NO: P Date Receivedrao ACHl15 Date Issued: J `6 IMPORTANT: Applicant must complete all items on this page Ep KE � -Af xj-Offil ME� �I�1�►P �a - � � �, �'I��'F3`C�T�� __ . ttflr�c ��s�tr�ct�'L- �� es�� o TYPE OF IMPROVEMENT _ PROPOSED USE Residential Non- Residential New Building One family Addition' Two or more family Industrial Alteration ✓ Noof units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other �C'.� 3 .Pf �Ill �at� ;_ end '. � alershetlasnct �00i�"�K�74s-Swr'��,-%,"�5`a+Yw`�'s"�'�� DESCRIPTION OF WORK TO BE PREFORMED: . (�G.`�e O�Y►� � vin c� Identification Please.Type or Print Clearly) OWNER: Name: �� • �`- -7 ��,�, eQ �. � �� - 37 Phone. � �5� Address: t c.9 I 1 Is k1a 2a N1 , 4M4O V air 4,U _,IV4C�ffl� lel noe "� may` �,i`�� "`"'� .� f� �•,.��'� �" `"ti��" a�� ,_.. -, ��E "�,"sn`_ �e z'� a '�t`�.�� „�, .y � - -,x„ +r.�'� �-�+� k r '` p errors sru # n icerse � h � � � f - 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: $ FEE: $ 1 Check No.: ® CJ p Recei t No.: odd NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund - z f � �tue�fgen# Own�rr . .m gnatcreofcon# car tor' 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 DATE APPROVED PLANNING & DEVELOPMENT COMMENTS DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Con nection/Si-qnature&Date Driveway Permit Located at 384 Osgood Street ^F�REDE�P �►RATnTebrp�, Y'tA�k-`he �u ocated f12, �lair� reet rt :�$: _� d ire e�art erg s gna tune' ate � _ � k x rte.:14 � `3yc, 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 � i i I ❑ Notified for pickup - .Date Doc.Building Permit Revised 2007 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 _-�orkers Comp Affidavit ❑ Photo Copy Of HSI 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 j ❑ 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 j ❑ 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 j ❑ 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 i Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Location No. Date czy �aRTh TOWN OF NORTH ANDOVER Certificate of Occupancy $ 7 'sJ�cNustt Building/Frame Permit Fee $ j' Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2 , 0116 Building Inspector i NORTH o of 4 over 0 ti.. .r ...... ... No. XA1 ao -_ x C. __= Mass.,3 • dower, t _ O COC.44 MIC EwICK y�. �9S RATED BOARD OF HEALTH PERMIT T Food/Kitchen Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT..I doIr.h.. ................... J.*.W* ............ ......• Foundation ............... has permission to er t......... .............................. ildings on .'.. .........1:'�'.1 (s.f ............. �......... Rough to be occupied as A� .......... .. ... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough MONTHS Final PERMIT EXPIRES IN 6 MONTHS UNLESS ELECTRICAL INSPECTOR. dJ 1�I LESS CO S ® Rough �.... Service BUILDING INSPECTOR 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 Commonwealth of Massachusetts Department of Industrial,4ccidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricans/Plumbers Applicant Information PIease Print Legibly Name(Business/Orgm&abon/Individual): t�tr�� , ��ehG2us i Address: eV %,,I- City/State/Zip: iCity/State/Zip: W 06 Uv r M , Mk. 01 �-o i Phone.#: Areyou an employer?Clieck the appropriate box: 1.❑ I am a employer with ' ., 4. Q I am a general contractor and I Type of project(r7ed employees(full and/or part-time).* have hired the sub-contractors 6• ❑New constru 2• I am a sole proprietor or partner- listed on the attached sheet, 7. []Remodelingship and have no a to ees These sub- comP Y retractors haveDemolition working forme in any capacity. employees and have workers'[No workers' comp.insurance comp. insurance.$ 9• ❑Building-addrequired.] 5. We area corporation and its 10.❑Electrical re3.❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL I ZI Plumbing rep insurance required.]t c. 152, §1(4); and we haveno 12.0 Roof repairs employees. [No workers' 13.❑ Other comp. insurance required *Any applicant that checks box#1 must also fill out the section below showing their workers'compeasatio policy.information. ! t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contmq- must submit a new affidavit indicating such. 'Contractors that check this box must attached an additional sheet showing the name of the sub-eont�ctors and state whether w not those entities have employees. If the sub-contractors.have employees,they must provide their wor kers'comp:policy number. I am.an employer that is providing workers'compensatio information. n insurance for my employees. Below is the policy.and job site Insurance Company Name: Policy#or Self-ins. Lic.#i 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 ) ! fine up to's 1,500.00 and/or one-year imprisonment, as well as civil penalties in.the form of f a STOP WORK �E of of up to$250.00 a day against the violator..Bfine e advised that a copy.Of this statement may be forwarded to the Office of Investiations of the DIA for insurance covers a verification. I do hereby certify under the pains-and penalties of perjury that the information provided above is true and correct ! Si' ature� Date: 3 Phone#.: 0 ' _73,1— FOther only. Do not write in this area,—lobe completed by city or town official Town: Permit/License# thority(circle one): Health 2.Building Department g p 3•City/Town Clerk 4.Electrical Inspector 5.Plumbin las ecg p for son• Phone#: 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 pesrsoii 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 aparbnents 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"ever state or local licensing agency shall withhold the issuance or renewal of a license or permit to,bpera'tera business or to construct buildings in the commonwealth for any', applicant who has not produced acceptable evidence of co implianee with the insurance coverage required." ti Additionally,MGL chapter 1.52,§25CO)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 authDrity.11 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 certificates)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 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 peraait 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 sureto fill in the permittlicense 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 burn 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 Comunonwealth of Massachusetts Department of Industrial Accidents office of Investi pt Gns 644 Washington Street Boston,MA 02111 Tel.# 617-727-40DO ext 4.06 or 1-877-MASSAFE Revised 11-X22-06 Fax 9 617-727-7749 �.mass.govlclia Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: UT 'i Registration:, 950219 Board of Building Regulations and Standards One Ashburton Place Rm 1.301 Explratt n 3716/2010 Tr# 264823 Boston,Ma.02108 typo: Individual ROBERT JSTENQUIST•ra..;,. : ROBERT STENQUIST ' 6 FOSTER STREET.,.'! WOBURN,MA 01801 Administrator Not valid wit"t signature ROBERT J. STENQUIST 6 Foster Street Woburn, MA 01801 781-938-5011 751-854-8867 - Cell CONTRACT March 25, 2008 Mr. & Mrs. Donald Gregoire 105 Hillside Road No. Andover, MA 01845 978-258-7437 Bathroom Remodel All material to be used was agreed upon with the homeowner. $4,200.00 Contractof Date -b-�-�o S-- Homeowner , ' .. Date ok C Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registrat on; 150219 expiration 3/15/2010 Tr# 264823 r Tie Individual fx r ROBERT J STENQUIST ROBERT STENQUIST 6 FOSTER STREET WOBURN,MA 01801 �"� ` Administrator °RTM TOWN OF NORTH ANDOVER °f,"se .16 '`1" OFFICE OF C, BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 North Andover,Massachusetts 01845 . sswClgt�t•( Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOM$OWNER LICENSE EXEMPTION Please gdm DATE: ca JOB LOCATION: `o-7I�S�V� (� �1J . �Q V/ Number Street Address Map/Lot HOMEOWNER �.6� y C� r � ,� Name Home Phone Work Phone PRESENT MAILING ADDRESS City Town State 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$ection 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who owns a parol of land on which helshe resides or intends to reside,on which there is,or is intended to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undersigned homeowner"certifies that helshe understands the Town of North Andover Building Department minimum K inspection procedures and requirements and that he/she will comply with said procedures and HOMEOWNERS SIGNATURE A APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Foam Homeowners Exemption i BOARD OF \PPE:M—S 689-95:11 CONSERVArIOt 638-953() ITEAL 1'11698-95"i0 PLANNING 6$g-9535