Loading...
HomeMy WebLinkAboutBuilding Permit #545 - 14 STONINGTON STREET 3/11/2010 BUILDING PERMIT OF NORTH 9 1%.1%.9-D M°t TOWN OF NORTH ANDOVER 3? = ° O APPLICATION FOR PLAN EXAMINATION Permit NO: Date ReceivedATED ��SSgcHus�'�y Date Issued: - a IMPORTANT: Applicant must complete all items on this page LOCATIONPhn _ Gp G�/, ljh PROPERTY OWNER yta Print MAP 210 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 Alter No. of units: Commercial Reair, replace Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Ident' is ho_n.Yleas ,Type or Print Clearly) OWNER: Name: ��R yh Phone: Address: CONTRACTOR Name:_ J3x/ �l»19�/h'1X/ Phone: 9��' �� w/gs Address: Supervisor's Construction License: Exp. Date: Z JJ 2- Home Improvement License: loz S4 Exp. Date: ARCHITECT/ENG INEER /�' Phone: Address: /�1�- Reg. No. 2 FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ / Ol. j40 FEE: $ Check No.: l Receipt No.: NOTE: Persons contracting with a regis I•e contractors do not have access to the uar and Signature of Agent/Owner Signature of contractor 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 INTERDEPARTMENTALSIGN,OFF - U"FORM . . DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature j COMMENTS ,. HEALTH.. Reviewed on b Signature COMMENTS Zoning Board,of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board De'cisior:, Comments r � Conservation Decision: Comments Water& Sewer Connection/Signature& Date Drivewav Permit DPW Town Engineer: Signature: m 41 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 I. DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use k ❑ Notified for pickup - Date Doc.Building Permit Revised 2010 I 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 t ❑ Building Permit Application ❑ Certified- Surveyed Plot Plan. LiWorkers 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) o 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 i must be submitted with the building application Doc:Building Permit Revised 2008 � c Location No. Date �oRTM TOWN OF NORTH "ANDOVER ` Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ s�CHust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 12 l 22647 Building Inspector " FORTH �QO�iCAA✓ f LOS IVA6T VAL F T6 l _Town of Andover No.svj z - o Z A K E = dover, Mass. �• I� � > > C OC HIC HK ADRATE D PP�\y�y S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System a THIS CERTIFIES THAT...........4-Awto/ .....:..414A.'e-- BUILDING INSPECTOR rl ............................................................................ Foundation has permission to erect...............;........................ buildings on ../V �Q.v�. :. .. 1 Rough ...... ....... . .. .... ... ....................... . to be occupied as........44�, ti!--. w ; , 'f�NG4er1.�.r� /-� ........................... Chimney provided that the person ting this permit shall in eve respect conform to the terms of thea application on file this office and to h � ��. . .. . pp e �n Final 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 PERMIT EVIRES IN 6 MONS Final UNLESS CONSTRU N STARTS ELECTRICAL INSPECTOR Rough ...................... .......................... ..........T....................................................BUILDING. ..INSPECTOR Service Final Occupancy 'Permit Required to .Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street Burner SEE REVERSE SIDE Smoke Det. Massachusetts - Department of Public Safety Board of Buildin�ff Re-ulations and Standards Construction Supervisor License License: CS 15768 Restricted to: 00 ALAN R SMALLMAN 33 GROVE ST - TOPSFIELD, MA 01983 Expiration: 1/12/2012 (7,—uimiisii ncr Tr#: 13455 ' �e T�arrvynoouc��i � �ataae�Zuaelr Board of Building Regulations and Standards i HOME IMPROVEMENT CONTRACTOR Registration: 102550 Expiration.. 7/2/2010 Tr# 271368 Tripe: Individual s ALAN SMALLMAN } Alan Smallman 190 MIDDLETON RD ! Boxford, MA 01921 Administrator i q 1 Alan Smallman Building and Renovating Contractor and Construction Supervisor with the State of Massachusetts. Massachusetts- Department of Public`Safety Board of Building Regulations and Standards- Supervisor license, . e ' . Ikense:.Pt 15768 ' icte b ;33 GRO ;TQPSFIgI 83 Expiration: I/1=012 C'ununlwsiuo` .. Tr1. 13455 ; 4 p ��:• „by �j4.t I it rl� - = a` 41 •-+ e�.: ,,r S ,fat t' � ' r. � oxBoxford, .., B 306 Box ord Massachusetts 978 887-618.5 P.O. DATE(MM,10D/(YYY) =M CERTIFICATE OF LIABILITY: INSURANCE 10/13/2009 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Mathias Insurance Agency, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 200 Sutton Street, Suite 160 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. North Andover, MA 01845 978-688-5531 INSURERS AFFORDING COVERAGE NAICN INSURED INSURER A. AI Alan :Smallman : INSURER& S fet PO BOX 306 INSURER C: Boxford, MA 01921 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD INDICATED.NOTWITHSTANOING 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. "NSR POLICY EFFECTIVE POUCY EXPIRATION LTR INSAD TYPE OF I SURANCE POLICY NUMBER DATE M D LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,QQQ X COMMERCIAL GENEfTAL LIABILITY PREMISES Ea ocKtN1chu urence)_ $ CLAIMSMADE ©OCCUR MED EXP(Any one person) $ 10,000 B BPOOO11040 10/01/09 10/01/10 PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ -1.000.000 GEN'L AGGREGATE LIMIT APPLIES PER: � � PRODUCTS•COMP/OPAGG $ POLICY PRO. JECT LOC AUTOMOBItELIABILI7V COMBINED SINGLE LIMIT Z 000 ANY AUTO (Eaaccldent) $ i i00 0 ALLOWNEDAUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per Pin) B HIREDALITOS 6206962 :07:/06/09 07/06/10 BODILYINJURY $ NON•OWNEDAU'I OS (Peraccident) PROPERTY DAMAGE $ (Perauadent) GARAGE LIABILITY AUTOONLY•EAACCIDENT $ ANYAUTO OTHER THAN EA ACC $ AUTOONLY: Af.,G $ EXCESS:VMBRELLA LIABILITY EACH OCCUHHENCE $ 1.00 Q QQQ X OCCUR CI CLAIMSMADE AGGREGATE $ 2.000.000 QOQ ! CU00000896 10/01/09 10/01/10 $ B DEDUCTIBLE $ x RETENTION E 10,000 - $ i WORKERS COMPENSATION AND UORYUMR H• EMPLOYERS'LIABILITY WC 009755460 :10./15/09 10/15/10 E.L.EACH ACCIDENT $ ANY PoiUI'HIE/OR�PANINEWEXFCAITNF. 500,000 A ""'c wMeMseR ExCLUDFt» E.L.DISEASE•EA EMPLOYE $ Syes,describeunder : OD OOO PECIALPROVISIbNSbelow E.L.DISEASE-POLICY LIMIT 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDERCANCELLATION ,SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION ! - DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTI IGATE HOLDER NAMED TO 711E LEFT,BUT FAILURE TO DO SO SHALL Alan Smallman PO BOX 306 IMPOSE NO O IGATI N OR LIABILITY OF ANY KIND UPON THE INSURER.ITS AGENTS OR REPRESENT AT S. Boxford, MA 01922 AUTHORIZEDR R TATIV r�f ACORD25(2001/08) 0ACOR 8fnTORATION 1988 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations k JV 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): •- ;1 Address: .3.3 �rvtlf �f. City/State/Zip: 20,&z"IF ,_I , .1J Phone#: Are you an employer? Check the appropriate bog: Type of project(required): 1.❑ I am a employer with_ .3 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• Q Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for in any capacity. workers' comp. insurance. 9. ❑ 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.❑ Other comp. insurance required.] *.`,ny applicant that checks box 41 m:;also 811 out the section below showing their workers'compensation policy information. I 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 is providing workers'compensation insurance for my employees Below is thepolicy and job site information. // Insurance Company Name: AX 60 Policy#or Self-ins.Lic.#: `tJG 049 ,��f'�(�p Expiration Date:— Job Site Address: City/State/Zip:-A/."02 OR�/� 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 certijy u der t p and penalties of perjury that the information provided above is true and correct Sipnature: t Date: le Phone#: � � d 0 /' to IF, Official use only. Do not write in this area,to be completed by city or town official 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.apartrnents and.who iesides therein, or the occupant of the dwelling hbuse of another who employspersons 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 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 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 anddate 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. It'addition, an applicant thdtfmusf submit mtilti�le,permittlicense 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 Investigations 600 Washington Street Boston,M,A.0.21.11. Tel. # 617-7274900 ext 406 or 1-877-MASSAFE Fax# 617-72.7-7749 Revised 5-26-05 rw.masss..gov/dia Alan Smallman Building and Renovating Contract bo * ESTIMATE 3/9/10 Mr.&Mrs Wakelin 22 Chestnut St. West Newbury,Ma.01985 All quotes include stock and labor unless otherwise specified. Patch in underlayment on existing kitchen floor and level as much as possible. $1,025.60 Patch in underlayment on bath floor and level as much as possible. Replace tub framing and prep walls for finish.Install new vanity. Plaster walls and hang new dropped ceiling $3,285.00 . Insulate outside walls using 1"hi-R insulation board.Replace all interior trim. Re-hang existing kitchen cabinets and counter tops.Replace all trim. $2,265.00 Patch in floor in existing laundry area.Insulate outside walls using Hi-R 1"insulation $2,586.00 board.Plaster walls and hang new dropped ceiling.Replace all interior trim work. Electrical allowance for work in bath and laundry area.$1,500.00 to include Vanity light, fan light combination,one GFCI receptacle,and all proper switching.Laundry area to $1,500.00 have one GFCI receptacle and one overhead light with proper switching. Insulate floor in crawl space where insulation was removed using 6"kraft faced $gg6.00 insulation. Install new linoleum on kitchen,bath,and laundry room floors.Allowance is$5.00 per $2,960.00 square foot. NOTE*** Quote does not include plumbing work.*** NOTE***Price may vary due to existing conditions! *** Estimate Total: $14,507.60 Please note: Correction of any unforeseen problems, such as inadequate insulation, rotted areas etc., will all be an additional charge, and billed on a stock+time basis. Estimate includes removal of debris. *Protect yourself and your home...by using licensed and insured contractors.* Work is scheduled by date of estimate acceptance. Contractor has full Liability and Workman Compensation coverage. Certificates are available upon request. Contractor is filly licensed and registered Home Improvement Contractor, I P.O. Box 306 Boxford,Massachusetts (978) 887-6185 33 �rDVP �' Imo' Alan Smallman Building and Renovating Contractor Mr. &Mrs.Wakelin 14 Stonington St. North Andover, Ma.01845 PAYMENT TERMS 1/3 Start $4,835.86 1/3 Partial Completion $4,835.86 1/3 Completion $4,835.88 P.O. Box 306 Boxford, Massachusetts (978) 887-6185 i