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Home My WebLink AboutBuilding Permit #546 - 1324 SALEM STREET 3/26/2008 BUILDING PERMIT "°pT" qti TOWN OF NORTH ANDOVER to O APPLICATION FOR PLAN EXAMINATION ' '0 {) T t h T Permit NO: Date Received Date Issued: 8 9SSAC HUS�� IMPORTANT Applicant must complete all items on this page Vie PR "Ow VR . L 'C T �"'9 Jvfl➢� 3k . l• ,'E 6fi. ".'S" z� rr�' ,„.sy y h, T7 QVIR x<: a rte.•'� �`� `� ''� - � - �;� � t xr' ,r r�. '- y� �z✓ � `., �,�. � rrR er ,�a: � ' �'� 1 � nci TYPE OF IMPROVEMENT PROPOSED USE I Resioential Non- Residential ❑ New Building 2110ne family ❑ Addition ❑ Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition; ❑ Other �et�,,�'i IW y✓ 1 1dlr� •'"� '`•; �,[a rr ems{ f t ' Zs.� a � �S " �xW4iEe��W �vd�I�ls�.r,E�it ��'��4�r��4�,,e,��i�. � �r{� ��' ' ✓��j at�yos rir �yy.� � �k rc� „� l� E ".:: ,� �..a", r�..:„ t DESCRIPTION OF WORK TO BE PREFORMED: /xJ0 A)S IZZe 3 //2,00QS Identification Please Type or Print Clearly) OWNER: Name: Phone: Addres77 s: ` AM MI wr r?� y ,"O � t31•1 TCR � tr�� t ��y �� r W�� t � � y � �ws Superv�� r�s `� tl�S�ref�ar�3 .le�s� V= � t 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: $ Check No.: G u � Receipt No.. 02 (0 a. NOTE: Persons contracting with unregistered contractors do not have access to th aran f d Signa#ure of4gent/Owner - - S� naure z� onfiracto J Building Department artment 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 i ❑ 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 1 ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses i ❑ 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 1 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 o 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 Revised 2.2007 i 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 i j 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 ItEDART MT -Trn Dumpste� ys�t es nc L a X124 i111ainSet rehepalr�tment gatur#da sY ..... a��s"�" � r wkDimension 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 E F i ❑ Notified for pickup - Date ....................................................................................................................................................................................................................................................................................................... Doc.Building Permit Revised 2007 Location 21 S,,,,l ff— No. a Date MORTM TOWN OF NORTH ANDOVER F w p + ; , Certificate of Occupancy $ '•••°''<� Buildin /Frame Permit Fee $ �Ss�CHusa Building /Frame Permit Fee $ Other Permit Fee $ TOTAL $ Check # U 1, ` 21021 'X"Z-- -_ V Building Inspector PROPOSAL Margaret Mottolo 1324 Salem Street North Andover, MA 01845 (H) 978-258-3133 (C) 508-982-7274 March 25, 2008 Remove two existing windows in dining room. Reframe wall to install three new Anderson windows as discussed. Finish interior and exterior. LABOR AND MATERIALS $ 4,600.00 PERMIT 60.00 TOTAL $4,660.00 s t Submitted By: Chris Rivet MA Lic#CS072173 HIC#139962 207 Winter Street (C) 508-265-3115 (I) 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 will be made as outlined above. Date SignatureV\ /"-A Date Signature NORTH Town of `. _tAndover 0 _ dover, Mass.> G • e LAKE L I� COC NIC ME WICK 7� 0R4TED S BOARD OF HEALTH PERM . IT T D Food/Kitchen Septic System BUILDING INSPECTOR 400 THISCERTIFIES THAT....................... .............................................................1 ................................................................ Foundation hass on ... ermission to erect........................................ buildings ................7..'...... d ............ ............... Rough . P 9 to be occupied as............. ........ . ... ..........................�. ... .#'.V..:�-............................ Chimney provided that the person accepting this,tpermit all 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 S s PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TS 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. VCN7i7i�►b7�76G�bLliL BOARD OF BUILDIN RSC 4L�1`(ONS License: CONSTRUCTION SUIOR- Number: CS 072173 Birthdate: 06/02/1961 Expires.06/02/2008 Tr.no: 26821 Resb ictied:..00 CHRISTOPHER F RIVET_ 207 WINTER ST N ANDOVER, MA .01846 f IN Commissioner Board omiaza�Ruvea��a�nd S°t�acnccd�aa"rd°esPiolt` ROME IMPROVEMENT CONTRACTOR Registration: 139962 Expiration 91812009 Tr# 132286 Type: individual CHRISTOPHER F RIVET CHRISTOPHER RIVET 20I'\VINTERST, N.ANDOVER,MA 01845 Administrator 1raC t,vmmvriwructR Vj MassacnUseus Department of Industrial Accidents Office of Invesfigadons 600 Washington Street Boston,11L4 02111 www.massgov/dia Workors' Compensation Insurance Affidavit: Bailders/Contractors/Electrielms/Plumbers Applicant Information Please Print Legiblyi Name(Business/OrgmAn ion/Individual): W4 . Address: City/State/Zip: fUo., 41,7 01//C2 gj, �T Phone.#: Are.you an employer?Check the appropriate box: of io'ect(require,*_, 1.Q I am a employer with ' 4. Q I am a general contractor and I � P J �-, p�ipyees(full and/or part-fime).* have hired the sub-cmttactors 6. Q New construction 2.U I am a sole proprietor or pifter- listed on the-attached sheet .7: emodeling . ship and have no employees These sub-contractors have g, Q Demolition working for me in any capacity. employees and have workers' 9. Q Building-addition [No workers'comp.insurance c�P•insurance. required.] 5. Q We are a.corporation and its 10.Q Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.Q 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.Q Roof repairs' employees.[No workers' 13.E]Other comp.msu rance required.] "Any applicant that cheeks box#1 must also fill out the section below showing their work=,compensation policy information. t Homeow:em who snbrmt this affidavit indicating they are doing all work and then hire outside conumdon mist submit a new affidavit indicating s rl►. 1Contractors dist check this box must attached an additional sheet showing the name of the sub-contncctom and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers' •Policy fi cumber. I am.an employer that is providing workers'compensation insurance for my employees. Below is thepolicy ob site information. P cl'and'J Insurance Company Name: �/� /�✓� G°�l/j� Policy#or Self-ins.Lie. J—;70/ OS Expiration Date:_1�1'o?6/— O F Job Site Address: City/State/Zip AD, 41V00 u fQ ,Z Attach a copy of the,workers'compensation policy declaration page(showing the policy number and expiration date). Failure,to secure coverake as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties.of a fine up to$1,500.60 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*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 kep ' malties of perjury that the information provided abov.is bzt3 and correct Signature � �P`e: / \l3� r Date: � _ Phone# Ofjtcial.use only. Do not write in this area,to be conepleted by city or town official City or Town:' PermitlUcense# Issuing Authority(circle one): J.Board of Health 2.Building Department 3.City/Town Clerk 4.El 6.Other ectrical Inspector 5.Plumbing Inspector Contact Person: Phone M In ormation 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 emplgygr 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,bperi te-a business or to construct buildings in the commonwealth for any applicant who has not produced a&9table evidence of compliance with the insurance coverage required." t Additionally,MGL chapter 1,52,§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-contiactm(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 notirequired 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 Investigaflons 600 Wasbkgtnon Street Boston,MA 02111 Tel.#617-727-4900 ext.40,6 or 1-877 IviASSAFE ` Fax# 617-727-7749 Revised 11-.22-06 t www.mass.gov/ilia xwm L CERTIFICATE OF UABIMY INSURANCE mp1e�'"°°" oatz3r�7 Iooucu 7HS CERTIM 1tE 6 ISSUED AS A IIOM OF WPORMAYM am w OM IM COMME P.O.B ald$�PEM�OIIB a Ag®Iq.SIG �� O01r, �L � OR P_O.6cAc 428 ALMM Me COMAE/ w ME MUM mow. iO4 i++�M Sim MOM Andwdw.MA (1845 AF�Iis1a0M3wAJE NMC x CWSkowmvet WMERk PREFERPH)MUTUM-O S00 15424 207 Waft St s N Andover.MA Of80 >�e SES THE POLICIES OF INSURANCE LIST®BELOW HAVE BEEN ISSUE TO THE INSURED MAMA®ABOVE FOR THE PO=PERIOD INDICATED.NOTINITHS'TANDM AMY REQUIREMENT.TERM OR CONDITION OF AMY CONTRACT OR OTHER DOCUM U WnW RESPECT TO WHM THE GATE MAY BE OEM OR MAY PERTAIN.THE INSURANCE AFFORDW BY THE POLICIES DESCFWED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONIXTM OF SUCH POLCI M AMMATE LOWS SHOWN MAY HAVE BEEN ROMM BY PAM CLAMISSR AM . 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