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Home My WebLink AboutBuilding Permit #340 - 1324 SALEM STREET 10/27/2009 BUILDING PERMITO� NORTH q tt` TOWN OF NORTH ANDOVER 3? 4� o APPLICATION FOR PLAN EXAMINATION ^OC R4 [KNICN Permit NO: Date Received 0CRAT!°'C WKII M 9SSACHUS�� Date Issued: 27� 6 IMPORTANT: Applicant must complete all items on this page LOCATION 1� - a Print PROPERTY OWNER 1,0V%6 MA Print MAP N0;//tPARCEL: ZONING,DISTRICT: Historic District yes n` Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District WatedSewer DESCRIPTION OF WORK TO BE PREFORMED: I on i egA l k' /��i L i Identification_Please Type or Print Clearly) Q OWNER: Name: ./'��/J�r o�7-flL_� Phone: / � o2S1��-33 Address: SX— /Vo, CONTRACTOR Name: �5'/ � Phone: a Address m ' I Supervisor's Construction License,: Exp. Date: 6 0/ 0 p Home Improvement License: Exp,. Dater ' — — c i ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$1200 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. i Total Project Cost: $ 7 ® FEE: $ � Check No.: �� Receipt No.: ;226-7r NOTE: Persons contracting with unregistered contractors do not have access to the guaranty f d nature of of Agent/Owner` Signature of contractor 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:Building Permit Application Revised 2.2008 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 CONSERVATION Reviewed on Signature COMMENTS I l HEALTH Reviewed on "-Signature 4 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 Drivewav Permit DPW Town Engineer: Signature: Located 384 Osgood Street .'F "DEPARTMENT -'Temp Dumpster tin site yep. no Locatedat 9 2,Main-Street. � ,= 3 `Fjn Department signature/date =.x COMMENTS -i C i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. t ELECTRICAL: Movement of Meter location, mast or service dro requires Electrical Inspector Yes P 4 ares approval of No DANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A—F and G min.s100-s1000 fine No NOTES and DATA— For department use s �I a ❑ Notified for pickup - Date ......................._....._.._.._.........................__...--........................._-- Doc.Building Permit Revised 2008 Location __ /_3 02 tv Ap No. Date d 2 6 � r NORTh TOWN OF NORTH ANDOVER 9 � y Certificate of Occupancy $ MUsE<� Building/Frame Permit Fee $ 00 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 22575 Building Inspector , NORTH Town of Andover 0 No. M .. I-IV 0 dover, Mass., 0 LAK COC HICHEWICK 00 TED P'?qL11 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT o'er .. % 77`o lo .... .......................................... ...................................................................... Foundation has permission to erect........................................ buildings .............................................. Rough Chi tobe occupied as..................Ce,v. ......Jeclllll?�. ............................................................................................. mney provided that the person accepting this permit shall In ry 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 E-EXPIRES, IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION, STARTS 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. too + PROPOSAL Margaret Mottolo 1324 Salem Street North Andover, MA 01845 (H) 978-258-3133 (C) 978-697-0799 October 18, 2009 Work to be completed includes: • Remove siding, corner boards, and rake boards from garage end of house. • Install tyvek,Hardie Board Cement Siding. e Install PVC Corner Boards and Rake Boards. • Install PVC trim around Garage Doors. Material $ 1,484.00 Labor $ 2,325.00 TOTAL LABOR AND MATERIAL $ 3,809.00 Install new Rake Boards above family room. $ 500.00 Submitted By: Chris Rivet MA Lic#CS072173 HIC#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 he eb acce ted. You are aut)ioriz9d to do the work as specified. Payments will be made din Date /� Contractor Signature Date-\ /C>q Customer Signature Massachusetts-Department of Public Safely . Board of Building Regulations and Standards Construction Supervisor License License: CS 72173 Restricted to: 00 CHRISTOPHER F RIVET 207 WINTER ST N ANDOVER, MA 01845 Expiration: 6/2M10 ('umnii,�iuner Tr=: 25403 i ✓fie U�a��z�sumu�ea a�./ju6efta Offee of Consumer Affairs&Business Regulation- HOME IMPROVEMENT CONTRACTOR Registration:. 139962 Expiration: 902011 Tr# 700076 . Type: individual CHRISTOPHER F.RIVET CHRISTOPHER RIVET 207 WINTER ST: o N.ANDOVER;MA 01845 Undersecretary i f8c c.uranwa rarrMn oJ Aw4usacauseas Depmrbxqit of I,Imdiad'lOjAcdden& Office of Invesfigadons 600 Washington Sired Boston,AIA 02111 wivesMassgav/dia . Workers' Compensation Insurance Affidavit: Bu>t a s/Contractors/Electricians/Plnmbers Applicant Information Please Print Leeffily Name(Business/Organi=on/Individual): �i�tGC 1C l f.�s Address: �itY/StatelZip: Are Ion an employer?Check tare appt*priate bow Type of project(regnireO.` 1.❑ 1 am a employer with ' :: 4. Q I am a geneml c ontutoi'and I , ,��Ployees(full a�/ar p s have hired the sub-conhactors 6. Q New conslrnction 2 I�I am a sole proprietor or paw listed on ate attached sheet: 7: �RemodeIiag . ship and have no employees These have 8. ❑Demolition working for me in any capacity. employees and have wodaeas' t- •9• ❑Burlding-addition [No wodcers'comp•instnance comp-msmanae. ] 5. Q We area c mporation and its 101]F1ectrical repairs or additions 3.ElI am officers have exercised 1 a homeowner doing all work 11.Q Phm>bing repairs or additions myself[No workers'r,oup• rigbt of exemption,per MGL 12.Q Roof repairs insurance required.]f c.152,§1(4), and we have empkoyees.[No workers' 13.Q Other comp.inmrance regal ed.] `•may aPPh=1 that chocks box#1 mast also HU out the section below showing then-woi1='con;ia�sation policy information. t homeowners who submit this affidavit Mcau►g they are doing all work and thea bac outside connectors must submit a new affidavit indicating such. ;Contractors dist check this box must am lied an addidmW sheet showing the name of the sub-c000actons and state whether or not dxw entities have employees. Uthe sub•conhacUft have employees,they must provide their workers,comp,policy number: I am an employer drat is pr>Dviding workers'oompensauiion insruance for my employees Below is the policy and job site information. Insurance Company Name: 7WL Policy#or Self-ins.Lie. Expiration Date: Job Site Address: 1,faW YdZ r,/J 2 City/State/Zip:AO a 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 S250.00 a day against the violator. Be advised that a copy of this statemmt may be forwarded to the Office of Imp ' 'ons of the DIA for insurance 29VUM Verification. . Ido ha ebJ'certify 94the P P . . �.PaIJ' Me informao�r provided above is true and correct Si `e' Rate:. /o, o Phone Ofjldd use only. Do not-write in this area,to be completed by city or town of fwjaL City or Town:- PermitfUcense# Issuing Anthor ity(circle one): J.Board of Health 2.Building Departmeit 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.worim,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." r association,corporation or other legal entity,or any two or ire An emp[oygr is defined as"aa individual,partnership, . of the foregoing engaged in a joint enterprise,and inclndmg 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 nxides therein,or tho occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work an such dwelling house or on the grounds or building appurtenant thereto shall not because bf such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"ever►state or Iocai licensing agency shall withhold the issuance or renewal of-a license or permit to.bpe*te-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 1ti2,§25C(7)states'Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the perfornnance 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,.mpply m h(s)ids),address(es)and Phase number(s)along with their cerbficate(s)of insurance. Limited Liability Companies(LLQ or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to catty workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Departni6 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 69 the application for the pemmt 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-tee license number on die appropriate City e- 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 tate permit/license nuhnhber which will be used as a reference number. In addition,an applicant that must subhmt nwltiple permit/license applications is ahs►given year,need only submit one affidavit indicating cuirent 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 foure.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 relatedlo any business or commercial venture (Le.a dog license or permit to brim leaves etc.)said person is ATOT 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 Massmchusttts Department of Industdal Accidents Clarke of Investigations 600 Washington Street Boston,MA 02111 TeL#617-727-4900 ext.406 cxr 1-877 MASSAFE Fax#617-727-7749 Revised 11-22-06 www-xnas&&ov/dia ACORD. CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDDIYYYY) PRODUCER 10/0712009 THIS TIFICATE ISOF MacDonald&Pangione Insurance Agency, Inc. ONLYCAND CONFERS NOE RIGHTS AS AM UPONTHEINFORMATION C RT1FICATE P.O. Box 428 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 104 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. North Andover, MA 01845 INSURERS AFFORDING COVERAGE MAIC# INSURED Christopher Rivet P INSURERA- PREFERRED MUTT. AL INS CO 207 Winter St. INSURER B: N Andover,MA 01845 INSURER C: INSURER D: I INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHEINSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE 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_ INSRDD L LTR NSRD POLICY NUMBER I DLICY MP=T(ON A LlMrrs GENERAL LIABILITY CPP 0160 57 0105 09/26/2009 09/26/2010 EACH OCCURRENCE S X'COMMERCIAL GENERAL LIABILITY j DANv�GE R 1,000,000 CLAIMS MADE t1 OCCUR PREMISES ocauerse S 100,000 ' MIB]EXP(Any one Person) S 5 000 PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN1 AGGREGATE LIMIT APPLIES PER: s I X POLICY PRO PRODUCTS-COMPJOPAGG S 2,000,000 JECT LOC AUTOMOBILELUIBBITY ANY AUTO COMBINED(EaaLS1NGLE LIMIT S ALL OWNED AUTOS SCHEDULED AUTOS ((PeerrPP�n)RY S HIRED AUTOS NOBODILY INJURY S N-0WNED AUTOS i (Per accident) (PRS ANY AUTO PROPERTY DAMAGE ' GARAGE AUTO Y AUTOONLY-EAACCIDENT S — OTHER THAN EA ACC f 5 AUTO ONLY: AGG I$ EXCESSNMBRELLA LIABILITY OCCUR EACH OCCURRENCE $ CLAIMS MADE AGGREGATE 1 � IS S DEDUCTIBLE � i S RETENTION S I S 'WORKERS COMPENSATION AND TOC STATUT -EMPLOYERS* JT LIABRY t ANY PROPRIETORIPARTNER/EXECUTIVE I EL EACH ACCIDENT S OFFICERIMEMBER EXCLUDEDY ff yes.describe under E.L DISEASE-EA EMPLOYEE S I SPECIAL PROVISIONS below E.L DISEASE-POLICY I OTHER S I � I 1 DESCRIPTION OF OPERATIONS f LOCATIONS 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&IIT FAILURE TO DO So SHALL No Andover, MA 01645 IMPOSE NO OBUGATRIN OR LUIBnJTY OF ANY KIND UPON THE OMRER,ITS AGENTS OR RE TATPIES- AUTHOROM REPRESENTATIVE ACORD 25(2001108) 0ACORD CORPORATION 1988