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Home My WebLink AboutBuilding Permit #035-15 - 117 MAIN STREET 7/11/2014 o�NORTH BUILDING PERMIT <,Leo -6;�tio 2.�, ...•.. op TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION h 35 Date Received °1.^rea� Permit No#: � Oq�liEO'•Pp •(`� VS US Date Issued: 1 I PORTANT: Applicant must complete all items on this page LOCATION Print , PROPERTY OWNER .`.SGL e tl T G1ct 1)6-'!� Slcl et '1 Print 100 Year Structure yes o MAP PARCEL: ZONING DISTRICT: 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 VAlteration No. of units: w6ommercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: 661466EIZrr t 64 G ( 0 tD4-7 (dentification- Please Type or Print Clearly OWNER: Name: `! �. /1/165%� S :� /Ji'�SS�� Phone: Gl1 cF 9C5� �� Address: Contractor Name;-Zer/e. Silo la4 Phone: q7 F GU 0,':_~'/) � Address: 12c, 1 Supervisor's Construction License: CY ()T_J1;76 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 BASED ON$125.00 PER S.F. Total Project Cost: $ �066 60 FEE: $ �2 6z> t Check No.: Receipt No.: 2- 1 NOTE: Persons contracting , ith nre st c retractors do not have access to the guaranty fund Signature of Agent/Owne Signature of contractor I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ i TYPE OF SEWERAGE DISPOSAL Public Sewer ElTanning/Massage/Body Art E] Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ I i THE FOLLOWING SECTIONS FOR OFFICE USE ONLY i INTERDEPARTMENTAL SIGN OFF - U FORM I PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature y . COMMENTS 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 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 I 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 Call Email Date Time Contact Name Doc.Building Pen-nit Revised 2014 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 I ❑ 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/Cross Section/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 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:Building Permit Revised 2014 r-- Location No. > Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 2 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ I Check# U / G O Biu Idihg Inspector NORT#1 Town of : t E : ndover O :� 0 _n No. 035-16 * '-� h ver, Mass, /////--7/ c0c«1c.l.". 'I- 'Oo qAT E D IIP s U BOARD OF HEALTH Food/Kitchen PERMIT T D/ Septic System THIS CERTIFIES THAT ...... / I/ .� Y � `.,� i r ..s BUILDING INSPECTOR has permission to erect .......................... buildings on ..1f.. ..... ��.l.�l........................................... Foundation Rough to be occupied as . r,5Y_ ' e C��r-f�c�,� f� r a .S' /�� p ................./''.................................. ...... ... 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service ........ ..... .................. ...i,..................................... 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. Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-053176 STEPHEN M SMOLAK 762 DALE ST i North Andover WA 018.45r' f Expiratior Commissioner 02/15/201; -------------------------------------- I I I I I j Display Unit �j�///�/ p^ H.H,�Morant&Co.,1— I U7 it F 4,7K_/)i-!± SI Archilcctc I I Display 0 - I I � i (978)710-5025 I Display (978)607-0044 Fab t Display I I hhm 0&-005 Display 02/05/09 Retail I I � I I ::3O Display I 14-3'i I Fr6JttC I 5ullolnq F' 1 Display Floor F3Ian � I I I I I I Display Kt Honh A-dovi�,na I tilos. I I � I �� Storage Men's BuildF' Floor F31an i I � � I Temp. Controlled Wine Storage as noted 5n—e Tasting15-0, x 8'-0. Women's Table -------- --------------------------------------------- A1.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Unit F 1 Building 'F' - Floor Plan, 1/8' = f-0' (mvo5) I I --------- ---------------------------------------------------------------------------------------------- I 6gtj'�e' ion y 164 e,bejjrd* .16 ii Large a FormatLarge Format W ( Display Dis layC14 i'— �� ED- GJ`� , Q, Bins Below Counter am , I a, Bins Below Counter Q c C` c o rnE ImE �. c E ca V cu V ( V Ceiling Ht. C: o G°J� •=1c•I9 m ( \O r611 o �i I Wood Case Below Counter I I CLIENT, Wine - DESIGNED- DRAV� CHECKED, APPROVED, FIGURE ND TITLE, Connection [)NW ONW Proposed Wine PROJECTS North Andover SCALE, DATEd FILE NO, PROJECT NO, A Room MA 3/8��—i� I Mar 14 WineXA Retail II Date.1 .... .-./ ....... i NOR7F, TOWN OF NORTH ANDOVER O 9 PERMIT FOR WIRING SSCHUSEt �Y This certifies that ..... ...................:....................... ... ......................... has permission to perform .....L�!. �-- .......'-'..�...v .......................... wiring in the building of... vL 71,�� Wl ................. ............. ..... .................................... rt J ',��ti T ...................X.),North Andover,Mass. Fee..1 .5......L. Lic.No. 6.�/ / .............. :/ . TRI.C1A�L INSPECTfO� Check # / R,t 1 9193 Commonwealth of Massachusetts Official Use Only t4 Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONSOccupancy and Fee Checked [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT W INK OR TYPE ALL INFORMATION) Date: /,— 7 I' City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) h cV Owner or Tenant tJ �t i� Cp/7 Telephone No. Owner's Owner's Address Is this permit in conjunction with a building permit? YesNo ❑ (Check Appropriate Box) Purpose of Building / t// Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: Completion of the followin table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers YVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires I` Swimming Pool AboveElIn- ❑ o.o mergency ig g d. rnd. Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 5— No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. TonTR—s No.of Alerting Devices No.of Waste Disposers Heat PSP Number. Tons KW FDe�ectloTZe ffContained Totals: rtin Devices No.of Dishwashers Space/Area Heatin KW Municipal g ❑ Connection ❑ Other No.of Dryers Heating Appliances KW ity Systems:* No.of WaterNoof No.of Devices or Equivalent . Heaters �' No.of . Data Wiring: Signs Ballasts . No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total Hp Telecommunications Wiring: OTHER: No.of Devices or Equivalent Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) j Work to Start: %Gz �' Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [j]/BOND ❑ OTHER ❑ (Spec I certify, under the ains and enalttes o er'u that the information on this application is true and complete- . l ry, f FIRM NAME: ��% LIC.NO.: Licensee: /� Signature applicable, enter LIC.NO.: If "ezemp 'in the license number ( line.) Address: -Cc's' Bus.Tel.No.: Alt.Tel.No.:�o� frY *Per M.G.L c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations UT 600 Washington Street Boston, IWA-02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Naive (Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer? Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 1 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. g, ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ I 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' 13.0 Other comp.insurance required.] •�y applicant,that check-.box 4"1 mus`.also ill 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 isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Policy#or Self4ns. 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 DIA for insurance coverage verification. I do hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct Signature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: PermitlLicense# 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#: I I 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." 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 Iicensing 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-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 r 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 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 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington.Street Boston,MA.0211.1 Tel. # 617-7274900 ext 406 or 1-877 MASSAFE Revised 5-26-05 Fax # 617-72.7-7749 www.mass.govfdia