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HomeMy WebLinkAboutBuilding Permit #159 - 114 SOUTH BRADFORD STREET 9/3/2007 BUILDING PERMIT of "°pT" q� TOWN OF NORTH ANDOVER 3Qu `- `=,.,°*° vL is APPLICATION FOR PLAN EXAMINATION Permit NO:� Date Received ' ��SSACHUS Date Issued: IMPORTANT: Applicant must complete all items on this page ,7. .F':,p; ::Py` '�' s- •??' $° ,'` -s-5„ y -"h45 ru.'} c�y-m ..,Y' 3 ?- s�-,.� a'e'.?`Pt°" � �r+� �� i� ,, �- s �har.,�a'"` .� .. „� �,��i�,✓<�„� #-�, .��ct�r�'"`,��"�'- "`'�,�.��s Si•.wwx�. f'9 :..� �+�"`+,,+,C - �ir� �_: ^r � � F IT'�t�5s'4o"�-c �`k'`k'.T'Ti'' r{"3 a. cis , r *#; ., r .4a�' s4 �rG4 �uz, ', z -�..a,-�- rn T,x.='� `' 1 y-.£ I GM lf:y`�;sl !t3� ;'o 'qtr 0n4.Ci�j4�aYt "-1v�1 4 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building —,6ne family Addition Two or more family Industrial Alteration No. of units: Commercial repair, replacement Assessory Bldg Others: Demolition Other ,r.'�� y. ->� ti;ya,r�'� n u�s''^`" �'u- e^ `�! 4!�"' bxu.:;.#r- ',�•'t�i�' 4T`St �l,"�:- ,� � �f i* � -s$". r ,�,`j.,d .} " t,�"' �- �� DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: -7— Phone: Address: z55?0 7 t-✓s�v`� :577 /UO WAi,00,G,,e tI� k' "fix a.. p -�,.zP. .k ner 'r'*r*-v -'+S``a`-r�+�';z,.iYE�a✓1,` .::c. ''x . n1 " "', �; r.,max' "'x.. +Ga tau, 4 `rq": E�'" 3a X. r' '-:` ai PS V%, . F "5a a 'F,."� �^r�i. r.; -r,ryvj� � Od�T� � ,3Y79 le "tu r r` .h �..a3i } 'd.. �+'f' ty Ty'h`d'f. s3. Ytr. L u#". p• s' ', Rei a F fir r �^ r cy fr i :�, ref ,2+ ,,, y_,�.t�C4 s,,,- rY-',.� fZx r„_ .�-- �x 4'-aro 'Tte. „ �u r'S*� `-u � '''„✓` `°x” °�'% r` ., .aa +n',',f' '9*kr ,a�,y_o a3"5 .: n ..w ;ra,.".a '^,€ YY -cT' ,a3w5a ,ri.�.r *" -ta�,.' '4^> s`- +'`k'-. �#it; 7.t`3 ati7-a'i. -�i,'.r '- -4'rot "Y *•.�. y�.taySx;.. y'+`"ptr`w.Ns,'� '.� * c°, .>,.$^..,?w I •.fa;*k`�+ `-,,-F�S,'r">1%',jr`"'"' 'v'* a` Y �i�3: ^7s°-F2{ r> •- s{ w t^ :--m � era�JrC �astrztctaocer ��( c0�Oatea ' 3wT 3 �, *;1Yw�.`T .k�r7�-.����+ r � .� a�"4 -n. a tw '�'�.b 7�- � -rz-�'jr•�'z�s ,�." �,t�.p�C 3r+ r,�Fth�€�.�: 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: $ I Check No.: h� Receipt No.: Il NOTE: Persons contracting with unregistered contractors do not have access to g ranty f agnature, geaa / anertn�tre;�f cnntracto .�. . . _ _ 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 f 4 PJ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature&Date Driveway Permit Located at 384 Osgood Street FtRE3E �► T�1 +1T � � xia�pser`#alte fires" �� no Locate,bt are" epa S Caen N'si tl� �e/�la u s.:�f �X tt 2� a.�`i �{'k, .:�,�u�J�r...,�.h �,.. ,i�'.;. � 'Sy`��._ �}` rt'�• ui t -c0z .! d,''s+•�,��},..t-.:. `�.,.t... fi.try �wy`�.. s�,x '�`:';�' �'' � �,.;,...�r ,�r„.� �;,x� ,{�jf;r n �� G�3 a^.'� 'y};u'.. � a, £' °�` t f`'� {c' C -rad r ` w ?tht t � .moi_,... o. :!'.a,..� ., •c:' ._.._.waa:xr-5 F,��.-.:. 3 �' �.s � ,A � � E. "mss.� 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 ❑ 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 Li 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 L3 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) ❑ IV[ 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 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 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 j Revised 2.2007 i NORTH Town of6Andover No. 151 _ o dover, Mass., OCOC MICKEWICK , %ps RATEO P.? Cl 7 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System w BUILDING INSPECTOR THIS CERTIFIES THAT.......... ......... ........... .. ... . ..... Foundation has permission to erect........................................ buildings on .... .......�.0.......a(Ar.� ... �.s. Rough • Chimney to be occupied as.......... ftriliMilt-in-levery 01 . ............�Je. .... .. .... ....................................... provided that the person cceptin s pl 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 Final PERMIT EXPIRES IN b MONTHS sow UNLESS CONS U ., � � TARTS ELECTRICAL INSPECTOR 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. I PROPOSAL Janet Cahill 114 South Bradford Street North Andover, MA 01845 978-687-0722 September 1, 2008 Window Replacement: Remove window sashes on six first floor windows and install six Anderson Woodwright replacement windows. TOTAL LABOR AND MATERIAL $4,850.00 Submitted By: Chris Rivet MA Lic#CS072173 MC#139962 207 Winter Street (C) 508-265-3115 (H)978-794-1165 North Andover, MA 01845 ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments vAl be made a utli d above. Date �" -G P Signature Date 2 3 0 Signature {F 4, BOAW& OF BUIL DAN R :;. License: CONSTRUCTION SUPVISLR° =4 �': � • Number:CS 072173 Birth t"ate. 06102l961 ' - EzPi{es 66102/2008 Tr.no .26821 ♦ // Restnczl; Ob Q CHRISTOPHER F;RIS:: o 7. fER ST * t D0 6ER, MA Zito' . 1�,• /� � ` Corrmissioite ". L'o / eeaa�uael a Board of Butldthg Rlguiations and Standards ' . HOME IMPROVEMENT CONTRACII'OR Registration;. 139962 Expiration 918/2009. Tr# 132286,. ,Type: Indvdual C14RISTOPHER F RIVET CHRISTOPHER RIVET 20WINTER'ST N ANDOVE .-MA' t7T84a"y AdministratGri `Y I ACORD,. CERTIFICATE OF LIABILITY INSURANCE D04/10/DD/08 04/10/2008 'JRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION MacDonald &Pangione Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. BOX 428 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 104 Main Street North Andover, MA 01845 INSURERS AFFORDING COVERAGE NAIC# NSURED Christopher Rivet INSURERA- PREFERRED MUTUAL INS CO 15024 207 Winter St. INSURER B: N Andover,MA 01845 INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT, TERMOR CONDITION-Of.ANY CO TRACT OR—OT WITH.RESP.ECT_TO_WtIICH THIS CERTIFJCATE MAY BE ISSUED OR . -MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR= POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER LIMITS A GENERALUA13HAY CPP 0140 57 0105 09/26/07 09/26/08 EACH OCCURRENCE $ . 1.000.000 DAMACOMTO RERTOD MERCIAL GENERAL LIABILITY PREMISES Ea occurence $ 100,000 CLAIMS MADE ©OCCUR MED EXP(Arty one person) $ 5,000 PERSONAL 6 ADV INJURY $ 1 000,000 GENERAL AGGREGATE $ 2.000.000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 1,000,000 POLICY PROJECTLOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per pew) $ HIRED AUTOS BODILY INJURY NON-oWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESSNMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ s RETENTION $ $ WORKERS COMPENSATION AND WC STATU OTH EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Certificate holder as listed below CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of North Andover DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 120 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR No Andover, MA 01845 -- - — — — --- REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001108) ©ACORD CORPORATION 1988 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Le 'bl Name(Business/Organization/Individual): Address:�� City/State/Zip: o} ou Phone.#: 15-0 Are you an employer?Check the appropriate box: 1.❑ I am a employer with ' 4. E] I am a general contractor and I Type of project(required). �-,�e loyees(full and/or part-time).* have hired the sub-contractors 6. E. 1 New construction 2.L�i am a sole proprietor or partner- listed on the attached sheet. 7. 2Remodeling shipand hemployees These sub-contractors have have no a� Y 8. E]Demolition working for me in any capacity. employees and have workers' co insurance.$ 9• ❑Building.addition [No workers' comp,insurance comp. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption,per MGL insurance required.]t c. 152, §1(4), and we have no 12.[]Roof repairs employees. [No workers' 13.[1 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this aflidw.rit indicating they are doing all work and then hire outside contrztors 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. 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 Self-ins. Lic.#:'4f 0/3O S O S Expiration Date: �-U26—0 Job Site Address:_ Z <o. 0p �,- 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 hereby certify#Ader the pains an penalties ofperjury that the information provided above is true and correct Si ature: / Date: Phone Offceial,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#• 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 of hire, express or implied,oral or written." i 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"ever state or local licensing agency shall withhold the issuance or renewal of-a license or permit to,bperate�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-contractor(s)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 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 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 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel.#6.17-727-4904 ext.406 or 1-877-IviASSAFE ` Revised 11.22-06 Fax# 617-727-7749 wwrv.mass.gov/dia Location No. e f Date i TOWN OF NORTH ANDOVER ' Certificate of Occupancy $ MU;<� Building/Frame Permit Fee $ AC S Foundation Permit Fee $ Other Permit Fee $ c— TOTAL $ Check # 2 ,, 467 Building Inspector