HomeMy WebLinkAboutBuilding Permit #261 - 140 WINTER STREET 10/14/2008 BUILDING PERMIT of r10RTF/A
TOWN OF NORTH ANDOVER c? - �°�,
APPLICATION FOR PLAN EXAMINATION
Permit NO: / Date Received
SSACHUS�
Date Issued:
IMPORTANT: Applicant must complete all items on this page I
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LOCATION _� , �' �, �' nM ' "
Punt
PROPERTY DWNER 't%P. \411 11 fes
ant
EMAP`NO; _f'AFtCEL ZONtNG'TDISTRICT:" Historic'Oistnct yes ono
. ep ,Mac l ine Sh p,Vilage yen
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building One family
Addition Two or more family - Industrial
Alteration No. of units: Commercial
epair, replacement Assessory Bldg Others:
' Demolition Other
:Septic Well 4 Floodplain Wetlands` ' 1N4tershed L)stric#
WaterlSewer
DESCRIPTION OF WORK TO BE PREFORMED:
`Lao,IL /aye w-` %7ic.2
Ne w VG h / Y TC.G✓j We i72 sri w ✓r ofc3 N i}— �GE�/L 1
Identification Please Type or Print Clearly)
OWNER: Name: Phone:
I
Address:
CONTRACTOR Name Phorie
Address:
Supervisor s Gonstructiori 9icense '` ": Exp: Date:'
.,Home Improvement'License.
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: $4Y, FEE: $ 5--5:7
el JCheck No.: �� Receipt No. /a'''
'
NOTE: Persons contracting with unregistered contractors do not have ac ess to the aranty un
gnature of Agent/Owner Si nature ofi 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
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
a?
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 DEPARTMVT`-Temp'Du°rnpster on situ .,,yes-.
.rao
Located at'124''Main.Street w _ .
Fire t) paitment:�ignatureldate T
..COMMENTS'
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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
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
❑ 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
❑ 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2008
j
Location
No. Date Id- Mil`
N°RTM TOWN OF NORTH ANDOVER
►o s
_ Certificate of Occupancy $
AP
Building/Frame Permit Fee $
Foundation Permit Fee $ -
Other Permit Fee $
TOTAL $
Check # A
x
2 ! 594
Building Inspector
c
NORTH
TO" of
i_ LAKE oy , dover, Mass.,
COCMIC KEWICK ��
TED
`s BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
BUILDING.INSPECTOR
...1��..,/!v'4-..........:.........�. . /
! J
THIS CERTIFIES THAT �I ?......::......:::::
:............................................................. Foundation
has permission to erect.......:................................ buildings on....., �...... ih. +-....d -....................... Rough
to be occupied aS �[ /n OwtdG -Q •i�h �4f� �/ Chimney
p .. ....c..�r..��.acro.G.�....�?.�,�,��..,�:........�:�.....�.......................�•T..^�.......... .... �'l
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
PERMIT EXPIRES 1N-'6 MONTHS
ELECTRICAL INSPECTOR,
UNLESS CONSTRU N ST S 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.
!ward or °illi u �
�u((ding(law't
HpME IMPROV �. tuns and+(::arl•rr- _
Re atro "' EMENT Cp • RA
n' 110 l.
Ekprratron 479 �„
16/20/2008 a.
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,
M4 02111
i" www.rnass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/individual):
Address: .2 y,� lYh-•-'' S' /
City/State/Zip: �(_c �-/ _ Phone#: J2 .���'��iZj�p'
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and 1 .6. ❑ New construction
employees(full and/or part-time).* have hired the sub-contractors
2,k I am a sole proprietor or partner- listed on the attached sheet. $ 2• ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition
[No workers'comp. insurance 5..,7 We area corporation and its
required.] officers have exercised.their I0:❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.7 Plumbing repairs or additions
myself. [No.workers' comp. C. 1.52, §1(4), and we have no 12.❑ Roof repairs
insurance required.] t employees. [No workers'
comp. insurance required.] 13.0 Other
*Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.
f Homeowners who submit this afeldaVit indicating tile#aft u'oing at;work ataJ thenhireoutside contractors niust submit a new aTI1d8VI[IndlCfltlns such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
1 am an employer that is providing workers'compensation insurance for my employees. Below is theoli andjob site
information.
p ey
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 u to$1 500.00 and/or -
p one-year imprisonment,y p t,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.
1 do hereby certify and pains
and piaraldes of perjury that the information provided above is true and correct
Siartature: ✓ Date: Aa—,-V.,0
Phone#: �^zk' Af20, gor-!7 7
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 apartmentsland who resides therein, or the occupant of the
dwelling house ofjn�.ter- h flimplopys persbnNtb\dg,,ih ittplfioce;*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 1vithhold the issuance or
reset l'o a.tJten,9e or per este a business + o coiistt uaf o lilingS n the co4nmonwealth for any
applicant who has not produce 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 anLLC 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 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 Deparpmpnt's addressktelephone and fax number: y`•e.`- _y`` •,:'.�
The Commonwealth of l ussettsr,,l �
Department of Industrial Accidents.
Office of Investigations
600 Washington Street
Boston, MA.02111
Tel. 4 617-7274900 ext 406 or 1-877-MASSAFE
Revised 5-26-05 Fax 4617-727-7749
www.mass.gov/dia
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Note:This drawing is an artistic WILLIAMS
interpretation of the general
appearance of the floor plan.it is
not meant to be an exact rendition.
Page 2 of 5
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DEMO-
44.772.00
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LSUPPLY PERMITS.
2.STRIP ENTIRE SECOND FLOOR WALLS AND CEILING TO BARE FRAMING.
3.REMOVE WALL AND CEILING INSULATION.
4.STRIP ALL EXISTING WINDOWS OF EXISTING WINDOW TRIM AND CASINGS.
5 REMOVE ALL DOORS AND CLOSET DOORS INCLUDING JAMBS.
6.REMOVE FLOORING TO SUB-FLOOR.
TREMOVE AND DISPOSE OF ALL BATH FIXTURES IN EXISTING BATH. j
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8.REMOVE EXISTING BATH VANITIES AND COUNTER.
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9.UTILITY ROOM TO REMAIN UNTOUCHED EXCEPT FOR ENTRANCE DOOR,
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I 10.REMOVE ALL ELECTRIC BASE BOARDS.
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FIMSH BEDROOM-FRONT LEFT GUEST
I LINSTALL NEW WALL AND CEILING INSULATION.
12.INSTALL 1/2 INCH WALL BOARD AND APPLY SKIM COAT PLASTER
13.INSTALL NEW 6 PANEL PINE ENTRANCE DOOR COMPLETE WITH 2 1/2 INCH COLONIAL
CASING AND LOCKSET.
14.INSTALL NEW RAISE PANEL CLOSET DOOR COMPLETE WITH NEW JAMB AND CASINGS.
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15.INSTALL NEW WINDOW CASINGS.
16.INSTALL NEW MATCHING PINE BASEBOARDS.
I TINSTALL NEW 5/8 INCH PLYWOOD UNDERLAYMENT.
18.CLOSET SHELVING NOT QUOTED.
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*OWNER TO SUPPLY FINISH FLOORING
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FINISH BEDROOM 2-BACK LEFT GUEST
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19.INSTALL NEW WALL AND CEILING INSULATION.
20.INSTALL NEW WALL BOARD AND APPLY SKIM COAT PLASTER.
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!Continue to the nest page..
Page 3 oF5
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2I.INSTALL NEW 6 PANEL PINE DOOR UNIT COMPLETE WITH CASING AND LOCKSET.
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22.INSTALL NEW RAISE PANEL CLOSET DOORS COMPLETE WITH NEW JAMBS AND CASING.
23.INSTALL NEW WINDOW CASINGS.
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24.INSTALL NEW PINE BASE BOARDS.
25.INSTALL NEW 5/8 PLYWOOD UNDERLAYMENT.
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26.CLOSET SHELVING NOT QUOTED.
*OWNER TO SUPPLY FINISH FLOORING
FINISH MASTER BEDROOM
27.INSTALL NEW WALL AND CEILING INSULATION.
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i 28.INSTALL NEW 1/2 INCH WALL BOARD AND APPLY SKIM COAT PLASTER.
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29.INSTALL NEW 6 PANEL PINE DOOR UNIT COMPLETE WITH PINE CASINGS AND LOCKSET.
30.INSTALL NEW PINE WINDOW CASINGS.
31.iNSTALL NEW 6 PANEL CLOSET DOOR UNIT WITH CASINGS.
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I32.INSTALL NEW PINE BASEBOARDS.
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33.CLOSET SHELVING NOT QUOTED
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34.CLOSET POLE NOT QUOTED
35.INSTALL 5/8 INCH PLYWOOD UNDERLAYMENT.
j *OWNER TO SUPPLY FINISH FLOORING
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FINISH BATHROOM
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36.REMOVE EXISTING CLOSET AREA.
37.FRAME AROUND VENT WORK.
38 INSTALL NEW WALL AND CEILING INSULATION.
39 INSTALL 1/2 WALLBOARD AND APPLY SKIM COAT PLASTER.
40.INSTALL NEW 6 PANEL PINE DOOR UNIT WITH PINE CASING AND NEW LOCKSET. j
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Continue to the next page.. i
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Page 4 of 5
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41.INSTAL NEW PINE WINDOW CASING. I
i 42.INSTALL NEW PINE BASEBOARDS.
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43.SUPPLY AND INSTALL NEW TEDD WOOD LUXURY LINE VANITIES APROX 7 FT. OF CABINETS
INCLUDING ON TALL LINEN CABINET.QUOTED IN CHERRY.
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44.INSTALL ONE OWNER SUPPLIED TUB.
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45.INSTALL ONE OWNER SUPPLIED SHOWER VALVE.
46.iNSTALL ONE OWNER SUPPLIED TOILET.
47.INSTALL ONE OWNER SUPPLIED LAV.FAUCET.
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I 48.SUPPLY AND INSTALL SWANSTONE TUB WALL INCLOSURE UNIT.
49.SUPPLY AND INSTALL ONE SWANSTONE VANITY TOP WITH ONE BOWL AND 4" SPLASH.
50.1NSTALL I I/2"FIBER ROCK UNDERLAYMENT GLUE AND NAIL. i
51.SUPPLY AND INSTALL SUN TOUCH FLOOR HEAT.
52.INSTALL OWNER SUPPLIED TILE AND GROUT OVER RADIANT HEAT.
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ani-file installed v6th borders or on a disgonal Neill be an additional charge
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i 53.SUPPLY AND INSTALL ONE PANASONIC EXHAUST FAN.
54.SUPPLY AND INSTALL ONE MARBLE THRESHOLD.
FIMSH-HALLWAY
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55.INSTALL CEILING INSULATION.
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56.INSTALL 1/2 INCH WALL BOARD AND APPLY SKIM COAT PLASTER
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57-INSTALL 5/8 PLYWOOD UNDERLAYMENT.
58.INSTALL PINE BASEBOARD.
*OWNER TO SUPPLY FINISH FLOORING
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ELECTRICAL- i
59.SUPPLY AND INSTALL THE FOLLOWING-
18- 15 AMP RECEPTACLES
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Contnue to the next page..
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Nee 5 of 5
Egg
2 -20 AMP RECEPTACLES
2-GFI FOR BATH
12-SINGLE POLE SWITCHES
2-3 WAY SWITCHES
6-LIGHT FIXTURES -WIRED AND INSTALLED-SUPPLIED BY OWNER
12-RECESS LIGHTS
4- BRK SMOKE DETECTORS
3-BRK SMOKE AND CARBON MONOIXIDE DETECTOR COMBO UNITS
2-FLUORESCENT CLOSET LIGHTS
1-PANASONIC EXHAUST FAN
28 SQ FT RADIANT FLOOR HEAT
10-ARC FAULT BREAKERS
• OPTION I -OWNER PAY SUBS AND MATERIAL DIRECT-TOTAL JOB-$39.649.00
OWNER PAYS-
ELECTRICIAN -.$5020.00 FIXED
PLASTER-$350.000EST.
PLUMBER-$1500.00 FIXED i
TR4SHMASTER OR DESIGNING KITCHENS-$5000.00-FIXED
DL%MPSTER-$650.00 EST
OWNER PAYS EST MATERI AL.-
PLYWOOD UN-DERLAYMENT$650.00
BLUE BOARD-$480.00
6 PANEL PINE BOARDS -$800.00
6 PANEL BI FOLDS -$400.00
SW:-ki'vSTONE VANITY TOP-$500.00
WINDOW CASING-$250.00
DOOR CASING-S 160.00
BASE BOARDS-$176.00
CEMENT BOARDS-$75.00
DOOR LOCKSETS -$200.00 i
INSULATION-$300.00
MISC. GLUE,NAILS.SCREWS.JOINT COMPOUND ETC. $500.00 j
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DESIGNING KITCHENS LABOR AND VANITIES- I
LABOR-$14.300.00
VANITIES-$3.350.00
PERMIT-$638.00
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Thank you for the opportunity to quote this for N-ou!
SUBTOTAL.^ _ �
$44,77_ 00.
TAX (5%). $0.00
Accepted Bv: Accepted Date:
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