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Home My WebLink AboutBuilding Permit #706 - 14 BAY STATE ROAD 6/16/2009 BUILDING PERMIT o` p10RTh �,,ED 06gti 0? 4� 1' ` a sb O M TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 4 0 f0[.il[NMww 7` Permit NO: Date Received pDRATED �sSAcmuSE� Date Issued: - IMPORTANT:Applicant must complete all items on this page LOCATION 1 �SZ _Cb'G1 'Print _ PROPERTY OWNER W A -\- to t2Print MAP NO.- PARCEL: ZONING DISTRICT: Historic District yes mo Machine Shop Village yes rio TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family---- Addition amilyAddition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement' Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) r OWNER: Name: Phone:q -S'i1 CP Address: CONTRACTOR 'Name ° ` 1Y1` ' Rhone;: `�"Z` � Address:'--( Supervisor's Construction t=icense: � Exp. Date: G1 Q0\ Home Improvement License: Exp. Date-- ARCH ITECT/ENG I NEER ate.:ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULD/NG FjERMIT:F,7 PER$1 0 OF OTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ` pail 000 FEE: $ Check No.: "� I�z Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature ofAgent/Owne _ , igna#ure of-contractor �� ,.1' I Location Aq 'e-1- No. No. —70 Date v �oRT� TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ , Check # ►�r l 2 2 i 2 6i Building Inspector T 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 HEALTH Reviewed on Signature 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 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 2008 I 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 Li 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 Revised 2.2008 The Common wealth of Marsachuseta Department of Industrial Accidents '� - Offcce of Investigations a/ 600 *ashington Street Boston, MA 62111 P�7 www nzassgov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractor•s/Eiectrici8as/Piambers L flr nation. Alicant if Please Print LeQibl NaE a(Business orgaoizatior0ndividttal): T)k �e Address: 1.7 City/<State/Zip: Phone (A07 FE] j mployer?Check.the appropriate box: mployer whit 4, ❑ ]am a general contractor and IF7 =n tect(requfre�: es(full ander -,r-> have hired the subcontractors construction le proprietor or partner- listed on the attached sheet,t odeling ship and have no employees These subcontractors have working for me in any capacity, workers' comp.insurance. olition [No workers'comp,insurance . 5. ❑ We are a corporation and its ing addition required] officers have exercised their rical repairs aradditians am a homeowner doing all work right of exemption Per MGL ing repairs or additions myself[No-workers'comp, c 152, §1(4),and we have no insurance required.]t .employees.[No workers' 12.❑Roof repairs comp. insurance required.] 13.M-Other owing` their warkars Airy applicant firer tdMits bot:if I must also fill out the section below shbon sabot ori r Homeowners who submit this aflitiavit indicating Choy are doing all work end then hue outside con p infamra[ion 1Coatractors that check this box mustmteolred an additional shear,show' r uaeiots" submit a new affidavit Wioui4 such. the trema o.fire sub connectors alis their aorta'oc np.r,,::aV i formetson. !arn.an employer East is provi&rg:workers'compensation iesur mce or a ! infom adorn ! m1' mPo yew Bd Ow is Me policy and job site . lnsraance Company Name: Policy#or Self-ins Lic.#: Expiration Date: Job Site Address:_i City/State/Zip: j Attach a copy of the w Failure orkers'.compen ation policy deciaration page(showing the policy number and expirafioa date) . to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penal ics 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 5250.00 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 he under the airsnd en P erjury that the information provided above is true and carred Si tum: Date: Ca Phone#: 9-79�, � =Heitb early, do not write in this area,rn be completed bj, or town offtriaL n: Permit/License# hority(circle one): Health 2.Building Department 3.City/Town Clerk d.Electrical inspector 5.Plumbing Inspectorson Phone#: Information a nd Instructions f Massachusetts General Laws chapter 152 requires all emp foyers 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,associatian,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and includirig the legal representatives of a deceased employer,or the receiver ortnrstee-of an individual,partnership,associatiotn or other legal entity,empioying 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,const vct:6 or repair wont on such dweliing'house or on the grounds or building appurtenant thereto shall not because of such employment be de med to be an employer." MGL chapter 152,§25C(6)also states that"every state or local Deciding agency shat!withhold the issuance or renewal of a license or permit to operate a business or ito construct buildings in the commonwealth for any applicant who has not produced acceptable evidence.of compliance with the lasurance'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 pubiic work until-acceptable evidence of compliance with the insurance r equiremwrts of this chapter have been presented to the co=ttr acting authority." Applicants Please fill out the workers'compensation•affidavit completely,by checking the boxes that apply to your situation and,if necessary,suMlysub-contractors)name(s),address(es):attd 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 orpartners,are not retored,to cavy workers'ccsrnpensation 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 confirmation of insurance coverage.. Also be sure to sign and date the affidavit. The affidavit should be returned to the.city or town brat the app.Hcatiion for the permit or license is being requested,nottthe 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 atthe number fisted below, Self-insured companies should enter their sal€insurance'Iicanse number on the'approprim line. City or Town Offmiah; Please be sure that the affidavit is completeand printed legibly. The Department hes provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigatioms has to contact you regarding the applicant Please be sure to fill in the permit/license number which w-M be used as a reference number. In addition,an applicant that must submit multiple permit/liomm 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 trowm)."A copy of-the affidavit that has been.offiiciaily 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 felled out each year.When a home owner or citizen is obtaining a license or permit not related to any business or commercial vabre (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, pimse do not hesitate to give us a call. The Department's address,telephone and fax number.. The Commonwealth of Massachusetts Depwtment of F-ndustrial Aacidants Office of Envestigations 600 Wa&ington Strect Boston, MA 02111 TeL#617-7274900 east 406 or 1-977-MASSAFE Revised 5-26-05 Fax#617-727-7744 www.mass.govldia NORTIy 0 0 4 over o �_ 0 No. AKE dover, Mass.,`• & • O A-1, co HiC HE WICK y^� s RATED BOARD OF HEALTH Food/Kitchen . PERMIT T D . Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....... .. .. ......... .�. ... . ...............A.............. ........ .............. .... Foundation has permission to erect ...:. ..................:. uildings on ... .......� - � 4........ Rough ........................ Chimney to be occupied as....... �.. ........ .. �, ! .��. ............................................................................. y 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 S 6 ' PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR. UNLESS CONSTRUCTIO TS Rough Service BUILDING INSPECTO Final Occupancy Permit Required to Omipy 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. Board oof B i�ngr eg-u �✓�va¢�/iuoe g Regulations and Standards Construction Supervisor License Licensq: CS 58578 i EXRrattOn 2126/2010 Tr# 16547 . r striction 0�; DANIEL A MARCq(yTpNjtj 48 ANDOVER RDS BILLERICA,MA 01821 M . Commissioner ✓die "toomrzamuje-a�� o�✓l�Ga�czc�ivae�6 Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 109069 Expiration:.9/1/2010 Tr# 275797 „Type Private Corporation D.A. MARCANTOW-- Daniel Marcantoniq 48 Andover Rd. Billerica,MA 01821 Administrator --- -- - 1252' i -------------- 592V - - ;;i -„ — :Z4 -{---r 36" W4236BDR (--- — --- W1936R WD2436R ' I� - O ri Er RS42L S63 FTB POO SBL . I - 't� x W "' N C7 01 '. W CIJ CSO N A { 03 N r T ? LO O A W Ut W UC309024 f4.1 S STE` OCWD315 90D DB33 3 I t RW3718BD --- - - D-W273615BC) W33366D 1'z 1 za. All dimensions-size designations given are This is an original design and must not be Designed: 5/16/2007 subject to verification on job site and released or copied unless applicable fee Printed: 5/22/2009 adjustment to fit job conditions. has been paid or job order placed. of Rum Fd s�nes��idsst�ss r� 42509carneykit.kit 7:1M] 1 Drawing#:2 D.A. Marcantonio PROPOSAL General Contractor 48 Andover Rd. Billerica,MA 01821 (978)667-1955 Page No. of Pages PROPOSAL SUBMITTED TO PHONE DAT STREET C JOB NAME CITY.STATE AND ilf'CODE JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE We hereby propose to furnish materials and labor necessary for the completion of: o .. .� r .51 ;. u ;« .. � ► t c�.is . fi t XZ� c rt ..� 0 .XZs'1�._p� f�c' '�..a�.�� ,'+,:�"n...'" _�...�1.�'�►. ,..�".�t<.1+,r' `*�. � ��tE .ile c� k A Finance Charge of 11/2%per month will be made on accounts 30 days overdue. This is an Annual Percentage Rate of 18% ell WE PROPOSE hereby to furnish material and labor—complete in accordance with above specifications,for the sum of: ,-, J, 11 f.. 1tJ `-'. f� A. %ra T dollars(S t , ayment to be madefas follows: , i All material is guaranteed to be as spekifled.All work to be Completed In a sub. I 1, stantial workmanlike manner according to specifications submitted, per standard Authorized t l Practices. Any alteration or deviation from above specifications involving extra Signature costs will be executed only upon written orders,and will become an extra charge over and above the estimate.All agreements contingent upon strikes,accidents or Note:This proposal may be delays beyond our control,owner to carry fire, tornado and other necessary in. surance.Our workers are fully covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within days. ACCEPTANCE OF PROPOSAL The above prices, specifications and condi- tions are satisfactory and are hereby accepted.You are authorized to do the work 1 as specified.Payment will be made as outline above. Signature_ 10.1 ,.+t Date of Acceptance: Signature