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HomeMy WebLinkAboutBuilding Permit #490 - 14 WOOD AVENUE 5/1/2018 BUILDING PERMIT Of NORTH '9 t�t�eo ,6• ti0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION x Permit NO: Date Received ` ' 060 ��SSACHUS���� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATIONt3�. flJ {-Yet Print PROPERTY OWNER �- FOt/�C� L s 3 - Print MAP NO: —7-3 PARCEL: 6 Z 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 Alteration No. of units: Commercial epair, replaceme 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) OWNER: Name: 'C+1oes4-me,f Sovr-ce- L L C Phone: 97? -290 -?3o/ Address: �! ���h LJ�s� ,�e Esser 10 O I cr 2`! CONTRACTOR Name: CGS ;u-v►,�+C=Phone: 9 k -76E-—70/S Address: ES,(-ex MA D t�2 a Supervisor's Construction License: Exp. Date: 7//6 /zooq Home Improvement License: � _ Exp. Date: Z//6 /-Zoo? ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �s, coo - &0 FEE: $ Check No.: Receipt No.:Q09 Q NOTE: Persons contracting with unr istered contractors do not have access to the guranty fund Signature of Agent/Owner Signature of contractor 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 R ` NOTES and DATA— For department use ❑ Notified for pickup - Date ..............................._..._...-........._.........................._........---..._..................................._......__........_....__............._........._...._......._._...........-_...._..........................._.._._................._..._.............._......................................................................................._.... --...__......................................... i Doc.Building Permit Revised 2007 r 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 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 FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 u 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 i 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 j ❑ 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 Location )0 C( °No. Date v MaRTM TOWN OF NORTH ANDOVER F �w A Certificate of Occupancy $ • 01 •srr�. 4 � Mus t� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ f TOTAL $ Check # `Dy t 20958 ....rte Building Inspector NORTH Town of Andover 0 No. y90 -_ _ T!� � � i � 8 LAKE 0 Y dower, Mass., COCHIC ME K 0RATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT...... ........... BUILDING INSPECTOR ............ ................. . ........................ .............. Foundation .Y.......W . ..........Jt.3 has permission to erect........................................ buildings on f4'-'-e ... ................................ Rough to be occupied as.... ..... .� &44 k.............. i10 Chimney provided that the person accepting­%is periii's-h-a*111-in every respect conform t.a- hetermsof li; application----. .. .- ---...o...n.-file. .--ii n- 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 UNLESS CONSTRU TARTS Rough ............................. Service BUILDIN PECTOR 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 FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Paychex, Inc, 12/17/2007 8:59' 02 AM PACE 4:3/003 Fax Server i+d Ls 6fR8J r "s PAN- 0ATE(MM/0DIYY) 12/17/07 .. . .. PYdRs7 tCEA THIS CERTIFICA m I$ISSULM AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTWICATE PAYCHEX AGENCY INC. HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 1175 JOHN STREET ALTI �C3M v AFEQ15Rg I lE§BELOW. V� A E WEST HEINRIETTA,NY 11586IES J c*4",r A GUARD INSURANCE COSTELLO CONSTRUCTION REMODEL14G INC INC9 OIC WISE AVENUE c Cwrr ESSEX,MA 01929- I CJMPAN'J THIS IS TO CERTIFY THAT T14E POLICIES OF IWSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ADOW FOR THE POLICY PERIOD INDICA'rED,NOTWITHSTANDING ANY REQUIRRMIENT,TERkl OR CONDITION OF ANY CONTRACT OR OTHER C(y„UMENT WITH RESPECT"TO'WHICH THIS CERTIFICATE VA.Y BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, I!XGL .tiIGPiS AND CONDI"1 I0MT OF OUCH FL LILIES,,0,11TS SHOWN MAY HAVE SEEN RE-kAY Ff)PY PAID CIAIMS- TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE I POLICY EXPIHATH)!1 LIMITS LTR' DATE(MMVD/YY) DATE(MMiDD1Y' - -- CiE GOMME rABILI E �.. G_E_r:Cf'vL.fY3_GiTE:RATE , 171 COMMERCIAL GENERAL:.IA311JTV � i ------ — PFODUCTS-COW."OAG-G Ls— Pr. PFAI_&AOV INJURY I$ (3WNEii"S&I:ON I HAL i iJFi S P iOl 1 �------ -.1 ' � i EACH Ol"CUFHt_NCE— �S FIRE DAMA%(Any one lir@) S MED LXP Oriy one perevn S I AUTQWIOBILE LIABILITY .��r- -�— AINY AI ITO i i COMIMNED SINGLE LIMIT S ALL OWNED AI-IT05 SCHECL LEZ'AUTOS I I EDGILY INJURY (Perparsnn) I HIRED AUTOSI — -------- I - ' E010,10 INJURY 1$ NON-OWNED AU70S (Per as:icern) ----.._..------- ! PROPERTY DAMA0Z j S OARAGELIAVILITY � IAUIUONLY-toALCA) RII 5 ANY AUTO r---------------- ------ --- (Y HEH THAN ATI TO ONLY. ----------.—..----- i _ EACHACCIDENT 'u _ I A3GRE(3A.TE Is_ EXCES�� -- }----'----7-- -'—�-- ---- --� S LIAHILJT'f ------r---. ------- _� i I E ACH OCCLIRRENr� l I UMPELLA FORMAWRE-- ----_---- ~ ATE OTHER THAI)U1+16RELLA FCRI! i ---- — _.---- ..------ ---- _ i WORKER'S CrJNIPENSA'I ON ANO N'C 7ArV• nl• I A S E NFL.MRS'UABILITY i fONV LI,,jTsT I ER f EL EACH'f GIDENT S 100,000.0_0 I THE fPbPRIETJFJ n PARINER9EY.E',UTIVE L.„_,,,J hICL (�r'1WC'811339 j 10!01107 I 10/01/08 ItL UItitAFE PULICY'LIMII �..--_500.1?OJ.GG-----i '`'o^EFSlwE: I Jl 1 E KuEL D;CEA:E-EA EMPLOYEE �5 100,000.00 -_- OTHER I I I I DESCRIPTION OF OP&RATIONSiLOCAT04$fVEHICLE9SPECIAL ITEMS ......�....................., ............ eL IUHIC4 +4 SHOULD ANY OF THE ABOVE DESPRIBED POLICIES BE CANCELLED BEFORE THE INVESTMENT SOURC;E, LLC EXPIHATIJNDATE THEREOF.THElSSUING'iAi'ANtWILL ENDEAVORTOMAIL 14 WOOD AVE. 30 DAYBVlR17TEN NOTICETO7HE CERTIFICATE HOiDER14AMED TO THE LEFT. NORTH ANDOVER, UA 01835 __._- BUT FAILURE TO MAIL SUCk NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILRY OF ANY KIND UPON THE COMPANY,ITS AGENTS 09 REPRESENTATIVES. , AUT ZED REPRESENTA IPE ..:.���.: :�_. :.. . .�.....>,. ... ....� :.. ;: ..... . ... '>�a�r��i�.�i�s�a���ICIN ate: �:•i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street ` Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Tie 'bl Name(Business/Organization/IndMdual): ! . Address: City/State/Zip: ES_ce,�-.. VL�-0Y7,-`-f f Phone.#: 5 7,P— 76 oP -7 01,f Are you an employer?Check the appropriate box: am 11�'I a employer with 4. ❑ I am a general contractor and I Type of project(required):, employees(full and/ part-time)." have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. [�JR odeling shipand have employees These sub-contractors have no a� Y 8. ❑Demolition working for me in any capacity. employees and have workers' co insurance.$ 9. E]Building.addition [No workers'comp.insurance comp. required.] 5. ❑ We are a corporation and its 10.El Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their 11.[1 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.[]Roof repairs employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who subant 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 state whether or not those entities have employees. If the sub-contractorshave employees,they must provide their workers'comp,policy number. I 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.Lic.#: 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). 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. Ido hereby=aMs-andpenalti of perjury that the information provided above is true and correct Simature: Date: Phone#': 6 : %7 '76 P- 7 1� 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." i 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,eptity,employing employees. However the owner of a dwelling house having not more than three apartments and;who m'.esides 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"ever state or local licensing agency shall withhold the issuance or renewal of a license or permit to,bperate-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-contractors)name(s),address(es) and phone number(§)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 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 permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permittlicense applications in any given year,need only submit one affidavit indicating current policy informmation(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 Cormionwealth of Massachusetts Department of Induste al Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4300 ext.40,6 or 1-877-MASSAFE Fax 4 617-727-7749 Revised 11K22-06 www.mass.gov/dia 14 Wood Ave,North Andover Updates to include: Kitchen and stove, dw, sink $5,800 Bathroom $5,750 Floors carpet $2,500 Paint interior $550 Minor vinyl patch on exterior $400 Total repairs $15,000 I i a p / 1/7 U/O�YtAYL0421U2�G O�✓ 46Q�ILOP6 00.-35,000 cf enclosed space i 040POuildtAg Regulations and Standi ds i 1A-Masonry onlyi �onstructiQn:Supervsar License '1G-1-2 Family Homes Failure to possess:a current edition of the , M Q9 T 15 JO !•. Massachusetts State Building Code is cause for revocation of.this hceiise:• � . € � , ��� `- `� � 89 J®I#N�CNISE AVE ESSEX,-MA 0929 rG'a�' tniii�iP6nei• ' I • � Lie �arnnrao�zcoea„/l� �✓/��/ . License or registration valid for individul use only Board of Building Regulations and St before the expiration date. If found return to: andards Board of Building Regulations and Standards HOME IMPROVEMENT.CONTRACTOR` One Ashburton Place Rm 1301 Registration '1456,42" Boston,Ma.02108 Expiration 21612009 Tr#, 127801 sTypQt PCIVale Corporation COSTELLO CONST+REMODELlf'4 INC. SEAN COSTELLO 1 Not valid without signature 89 JOHN WISE AVE Adm ESSEX,MA 01929 inistrator _. .,.< j;: FAX NO. :9787687015 Dec. 17 2007 11:39AM P1 FROM :costello j i i ii Costello Construction & Remodeling, Inc- 89 John Wise Ave. Essex,MA 01929 Office Pklone/Fax(978)768-7015 www.costel toconstruction.us I 1 DATE: FAX: TO: ✓ ��- i FROM: o �,A # of pages including this one Message R : 1 q1, a c{ /-�•.J r `fZ, .c'r� o�-�- 610 n,d A—VoV /7r�r e-11 r � This fax is only intended for the above named recipient. If you have received this transmission in error,please contact the office at 978-768-7015.Thank you. i FAX NO. :9767697015 Dec. 17 2007 11:40AM P3 FROM :coste l l O 507 I`•+6 130 P-01 PEC 17-200`i ,57 hl M ASSURAM=` AcmCER'TIFICATE_OF LIABILITY INSURANCE ►Nwouwa (las) -5191 THE FAX (731) 7~ Z;O THIS CER11WCAT�gi6SURDASAMA'tiTEROFI ONLY AND CONFERSOIl11A .v'. Na{On ! "Man Ip9Nreneo Agmeey, ?Nne. N0IWH"UPON Gl�RTifCATE' :N `F ,•,. NOLDKR.THIS TIEICATE 410T AM 0. 453 South Ava. ALTER THS Mhriba ll, NA 02132 Kimberly Wood I1N9URlRSAFF'OROINGCA1fERAiGE NWGM:•'�=�. `� uiaurt{D stUla roi: n� g.'Inc. wauwk. 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ORT;4 AN10r�F' uR C 1846 WTIA9A'Q 19MILFtUCNttO1tIC9 WALL HPOW 9OO9NOUY MUA94M OF wr A-40"1NA CwMIT.rn holm to R9v1 o"TATtbd• FROM :costello FAX N0. :9787697015 Dec. 17 2007 11:39AM P2 i ::���1'i'Pfmmv �bi l��/i'LtafJaa�ua�d °'•bard of Building Reguiallous and Staisdatdt .onstmmon Supervisor License License: CS 88882 BirlhttatA� .7/tb/16?5 Eoihdio%i i-krum09 Tr8 15780 SEAN A COSTELLO 89 JOHN WISE AVE ESSEX,MA 01929 Comroi"rsfotmr �iM? �riu9w✓iFunu44'#N// c�.;'�?'itASR['�[de�d Board of Buiidiag Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 145642 Expiration: 2/1812009 Tr# 127801 Type: Private Corporatlon COSTELLO CONST+REMODELING INC. SEAN COSTELLO 89 JOHN WISE AVE ESSEX.MA 01929 ,Administrator I� I