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Home My WebLink AboutBuilding Permit #597-11 - 12 HIDDEN COURT 3/9/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: / Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION 1 ,ol H vj coli r-4- Print PROPERTY OWNER S s e C C,rJ \ 4P- Print MAP NO: O(05 PARCEL: 11 °( ZONING DISTRICT: FHistoric District yes <0> I Machine Shop Village yes g) TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Buildingne family <� ❑Addition ❑Two or more family ❑ Industrial R-Alteration No. of units: ❑ Commercial ('Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ® ept1C? ell, �Flood )lainWetl __ands yUatershed is 'IM- ater/Sewers DESCRIPTION OF WORK TO BE PERFORMED: 2eMOj-C CK srs}c-in T'02s _✓-� S�� 1 N-t `� �� #c ham-.. CC's �;...s4-S a P)pPiigs�ceS. Identification Please Type or Print Clearly) OWNER: Name: O-e-r i:s,e Ca^rcz I e Phone: 9-2S - 31 7 6 9 7 Address: CONTRACTOR Name: Phone: 9? - 9 a-a O a 3 Address: 5- A VS,,\e_-No S}c-e t.A /\; c r 7- d�V1.3 C�w-cr` ak Supervisor's Construction License: `� I Exp. Date: �� ` k I j. Home Improvement License: 1 6 CA G Exp. Date: i ' I 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: $ 'i �, FEE: $ Check No.: � p Recei t No.: �' 3-5L/ 0 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund - 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 ❑ I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature i 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 i 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 z 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 i NOTES and DATA— For department use i ® Notified for pickup - Date Doc:.Building Permit Revised 2008 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 ❑ 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 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: Doc.Building Permit Revised 2008mi Location No. �" Date NO*Th TOWN OF NORTH ANDOVER O • s Certificate of Occupancy $ ,S.7 CMUSt' Building/Frame Permit Fee Foundation Permit Fee $ " Other Permit Fee $ TOTAL $ Check # 25940 Building Inspector The Commonwealth of Massachusetts e_ Department oflndustrialAccidents L 1. t J Office of Investigations 600 Washington Street Boston MA 02111 www.mass.gov/dia fidavit:SuiIdersJContractors/ElectricianslPlumbers Workers' Compensation Insurance Af Applicant Information . Please Prinf Legibly Name(Business/Organization/Individual): Address: l 2}yy.r S �- toSNf City/State/Zip: A+J 4ov-f_f_ /11 A Phone J#: 9-7 S " S a- �;LO I Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I air a general contractor and I inployees(full and/or part-time).* have hired the sub-contractors 6' ❑New construction 2. i I ain,a sole proprietor or partner- Iisted on the attached sheet. � 7• Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for mein any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their I0.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL - 11.❑Plumbing repairs or additions inyself.[No workers'comp. c. 152, §1(4),and we have no 12.0 Roof repairs insurance required.]T employees.[No workers' comp. insurance required.] 1311 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 thea hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors aiid their workers'comp.policy information. X 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.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). ra 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 maybe forwarded to the Office of Investigations of the DIA for insurance'coverage verification. .l do hereby certi nder the pains andpenalties ofpefyury that the information provided above is true and correct - 3 9 � Si ature: Date: I Phone 6-,)- Official use only. Do not write in.tliis area,to be completed by city or town offr-tial. 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." 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 w6rkers'compensation'affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)naine(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 confinnation 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 pen-nit or license is being requested,not the Department of Industrial Accidents. Should you have any.questions regarding the law or ifyou 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�je sure to fill in the Perm it/]icense 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 pen-nit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc. said person is NO . p T 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 phone and fax number: The CQmm.4nwC41th of Massachusetts De-partment of industrial Accidents - Offiee of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFB Revised 5-26-05 Fax#617-727-7749- Wwwmass.gov/dia NORT#q T0,11%M of 01 dover, Mass., ?v � • I � 'toCOC MIC NEWICK RATED 7 BOARD OF HEALTH Food/Kitchen ..PERMIT T Septic System BUILDING INSPECTOR BUI SPEC OR THIS CERTIFIES THAT.......... G �►L►.......,F.� !'1�.4........... 1!4..................... .....:............... ......................................:............... Foundation has permission to erect. buildings on ..f( ....... .. .!..� .......CA - ......... .... ..... Rough to be occupied as........... ..... ......... ........ ............. . :........ ...................................................................................... 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR a UNLESS CONSTRUC ST Rough ......... .................................................................................................: Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR � Display in a Conspicuous Place on the Premises - Do Not Remove Rough P Y P Final No Lathing or Dry Mall To Be Done -. FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. TESTA Building and Remodeling 5 Appleton Street North Andover, Ma 01845 HIC. 120296 exp. 11/19/11 (978) 682 2023 CS 54718 exp. 6/8/12 Ir ropoaai March 8h2011 Proposal Submitted To: Denise Canale Home Phone: (978) 12 Hidden Court Cell Phone: (978) -376-7697 North Andover, MA 01845 Job: Kitchen Job Description: Obtain building permit Complete removal of all demolition and construction materials generated by Testa Building and Remodeling and its subcontractors. CONSTRUCTION: Remove old countertops and cabinets. Install new cabinets and moldings in same layout . All windows and door location to stay the same. Remove part of the ceiling where you have a problem with pipes freezeing. Reinsulate around pipes and patch the ceiling. Skim sand finished ceiling so they are smooth. Tile back splash. A finance charge of 1 1/2%per month(18%per year)will apply to all accounts over 30 days past due. In the event collection activity is required the customer shall be responsible for all costs associated with collection,including reasonable attorneys fees. i propose hereby to furnish material and labor complete in accordance with above specifications,And according to architectural drawings with changes as noted for the sum of: $18,475 Eighteen Thousand Four Hundred Seventy Five Dollars One-third to start, one-third after installation, one-third upon completion. Authorized signature I reserve the right to cancel this contract if not accepted in_30_days Signature A44ei ,,X--6IZ Signature Proposal 2 ELECTRICAL: Add under cabinet lights. Make sure electrical is up to code. PLUMBING: Hook up new sink and disposal. Hook up new dish washer. Hook up new gas stove. HVAC : Vent new hood over gas stove NOTES: "NO ALLOWANCE FOR PAINTING STAINING . Work proposed to start 3/8/11 Work to be completed by 4/28/11 DO NOT SIGN CONTRACT IF THERE ARE ANY BLANK SPACES !I!! r ... fie r�omv�rcovuuea� of°,/�,Cioeac/u�aer�a Offce.,of Consumer Affairs&Bus ness:Regnlation ,HOME,IIMPROVEMENTCONTRACTQR •" 'Regis�ration�° 2096 ! - '`� Exp(ratoon X1`1 912011 Tr# 29.092..4 Y TYper,tan uaI !�^ ' TUTA BIVILDINU-Wk,EM LING JAMES TESTA 5„ARRLET_ON STF�E6 N.ANQ.OVER,'MA 01845 Undersecretary ALL., 'Wassachu:,setts- Depiwtment of Public.Sat'etA . Board (af Buildiwt g Re,,uit tion� AndSt.iii t . Construction Supervisor=License License: CS 54718 JAMES M TE _ STA - 5 APPLETON ST N ANDOVER;,MA 01845 =-;` a.• sI Expiration: 6/8/2012 I _('ununissi��ncr Tr#: 29825'