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HomeMy WebLinkAboutBuilding Permit #264 - 141 ROSEMONT DRIVE 9/27/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO:fyw Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION l LI ( Print PROPERTY OWNER � '4<r3o`,J Unit# i Print MAP NO: `�$ PARCEL: S`( ZONING DISTRICT: Historic District yes -fte— Machine Shop Village yes -ro— 100 year-old structure yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building A26ne family ❑Addition ❑Two or more family ❑ Industrial �eration No. of units: ❑ Commercial repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ® Septic T ll '` ` 3` F]oo�dplaix ® Wet ands`' p �W to ers` heclDi ' ` �' ® �. ji � T DESCRIPTION OF WORK TO BE PERFORMED: er�.e,J< ^F5i� q I (Identification Please Type or Print Clearly) OWNER: Name: efPhone: Address: l `4\ CONTRACTOR Name: �� �� ,l'`A Phone: °� �- C 19 ra ®�- Address: �5_ Q2 -� 'c:re•i j 'r--a-.)- Supervisor's Construction License: CS S 'I1 Exp. Date: �� a Home Improvement License: I-.) 6'�, c Exp. Date: I i tr ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ lot o n FEE: $ �7 Check No.: 394b Receipt No.: 0-463-3 NOTE: Persons contracting with unregistered contract do not have access to the guaranty fund ;Sianature.of`Agent/Owner Sig____Lure o 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 1 CONSERVATION Reviewed on Signature COMMENTS i i HEALTH Reviewed on Siqnature COMMENTS I Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments j 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 i COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: i 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.$10041000 fine NOTES and DATA— For department use i ® Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi 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 V®TE: 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: Doc.Building Permit Revised 2008mi Location /7! / Gr-z~v,-v 7 No. r/ Date l �aRTh TOWN OF NORTH ANDOVER 3? �. '• O F 1 L� D } Certificate of Occupancy $ Mustt� Building/Frame Permit Fee $ `•' Foundation Permit Fee $ Other Permit Fee $ - TOTAL $ Check # sr,65 2463 J Building Inspector t AORTH Town of 0 '. No. o , lover, Mass., • '� 1 O LAKE COCHICHEWICK 44 \IV RATED pP� �G3 BOARD OF HEALTH Food/Kitchen ERMIT T D Septic System BUILDING INSPECTOR 0..... 1.�......THIS CERTIFIES THAT........... !ti.. 5 ........................................................... ... Foundation has permission to erect........................................ buildings on ...1.41............ A.IWO.!!!�... ......... ......... Rough �,1� Chimney to be occupied as0-0-.6old `f �..... � 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 1x17 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU Rough ""t............ ...................................................................................... 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 S O D E Smoke Det. d off ice f ,. NpMF Regis t iMPR O a' T�ppi�t+o� � lot) Be :/ STq 6V Q? J "11��9i2s6 2gC,T galah 1k, /CpiNd_f fid% 291.1 l 3. TE , r lN "90924 \�\ Updersecre Boar d c,t'Qui: DCP;Ii7rnc.ar \' uc i�irrJ Onattiau�+;�uhiic•'safi t� CQ'9str . , ; tao++ License: CS 54718 `uper•UisOr Ci, t:in� }[fx e JAMES M 5APplET TESTA N QN ST .r E7-01V LMA 0'1845 EXAirati�n: 618120j2 rte: 29825 e Y y 'PLACE CLEARANCES. FRAMING DIMENSIONS AR'E_A4 TO ICOMOUSTIB4S (in 1ncf5es) 10" �EARANCE TO CEILING 25 i NON-COMBUSTIBLE FLOOR p COMBUSTIBLE FLOORING 0 BEHIND APPLIANCE 1/2 i ' s SIDES OF APPLIANCE 0-1/81/2 1019 APPLIANCE LOCATION 22"r-- 5591 2"r-- 5591 f� FF 42"[10671 - NOTE:THE REAR STANDOy -A MAY NEED TO BE REMOVED WHEN VENTING `Adjust framing dimensions for interior sheathing(such as sheetrock) O G AT 45e "Add 12 inches for rear venting with one 9011 elbow. A j BC. CLEARANCES TO COMBUSTIBLES 25" 1 IQE p El wg w D O F 1 +H D 0 D 36" A B C D E F G H p^ in. 51 42 1 7256-5/8 See Section D. 22 17-3/4 8 l� !1/2" mm 1296 11067 118291 1438 1 Mantel Projections 559 451 203 0" MANTEL LEG/WALL PROJECTIONS MANTEL PROJECTIONS O Note: INTERIOR WALL Measurement is TO CEILING taken from top ,e T7 TOP VIEW of the opening, 1 21 NOT the top of it 10 32 he fireplace III E ^ G H �� OT J25 I(�If L7 5 n 1P ' I i 6 L1 15 FIREPLACE OPENING to t3 u MANTEL LEG OR WALL PROJECTIONS OO 2-1 11 to If A minimum is_,then B maximum is_. A in. 2-7/16 3-7/16 4-7/16 5-7/16 6-7/1617-7/16 mm 62 $] 113 138 164 189 TOP EDGE OF T"TS FROM E OPEN NG B in. 1 2 3 4 5 mm 25 51 76 102 127 PRODUCT LISTING CODES Product information provided is not complete and is subject to change without notice.Product US ANSI Z21.88b-2008 installation must adhere'strictly to instructions accompanying CAN CSA 2.33a-2008 product to avoid risk of fire and c°L un— UL307B potential injury. Additional information can be found online at www.heatnglo.com H E AT&IG LIO- A brand of Hearth&Home Technologies Inc. Lakeville,MNUL oauaiED No one b0dis a better fire Phone:888-427-3973 952-985-6000 Web:heatnglo.com GS/HNG/6000C_0311 Please consult the manufacturer's H EAT&G Lam. installation manual for all,details and (ooOC No one builds a better fire requirements before rnaking•a final design layout decision. Gas Fireplace MODEL FRONT WIDTH BACK WI DTH HEIGHT DEPTH VIEWING AREA Actual Framing Actual Framing Actual Framing Actual Framing 6000C 41 42, 28-1/2 42 39-7/8 40-1%8 21 22 35 x 24-1/8. VOW, 0� r✓!T`,�'� / [7 1/2 14-1 4 C 24]'—' `-[362] 21 M Cit" r-F-- Or -TDP t [533] �c,J�/'Y 8-1 1 6 1'2t C [216671 E2971 ---------------------------------- rj" Go Our b TOP VIEW C�OT� WDi2-SE 6956 w1-rt� �� W1 u- C&;5b1 34-5/8 bf,0 ' 1�,v 40 [879] L. v �J?�j✓ [1038]381 33-1/2 [8511 [851) 3 O E� [918]8 41 [1041] �1 FRONT VIEW O OGAS LINE [[1152] (al 7 [2-7/8 ESS O 39-7/8 [1013] 6-7/8 J2C-114 [683] 8-1/2� [216] I� 9 11/16 I'[246]il LEFT SIDE RIGHT SIDE kdditional information can be found online at www.heatnglo.com L The Commonwealth of Massachusetts Department of Industrid[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 Legibly Name(Business/organization/Individual): : Address: City/State/Zip: © o er ll'lA Phone#:_I ,1 Are you an employer?Check the appropriate box: _ 1•❑ I am a employer with 4. ❑ I am a general contractor and I Type of project(required): e oyees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2• I am a sole proprietor or partner- listed on the attached sheget.t 7• remodeling ship and have no employees These sub-contractors have 8. ❑Demblition working for mein any capacity, workers'comp,insurance. [No workers com .insurance 5. 9• ❑Building addition ' p ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 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 wehaveno 12.[]Roofrepairs insurance required.]t employees.[No workers' comp,insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 7 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew 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 workerscompensation insurance for my e inmployees Below is the policy and job site formation. 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 G. 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 maybe forwarded to the Office of Investigations of the Da for insurance coverage verification. fP J ` Ido hereby certify u thepains andpenalfiq o perjury that the information provided above is true and correct._ Si nature: Date: 'hone#: :7 Y— z - a Offrcial use only. Do not write in this area,to be completed by cify or town offrcial. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.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 apartments and who resides 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"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 insurancd 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(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 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/licerise 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. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related for any business or commercial venture (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, please do not hesitate to give us a call. The Department's address,telephone and fax number: Aepa b utt of Industrial Accidents Office of InVestigations 600 Washington Street Boston}MA.02111 Tel.#617-727-4900 ext 406 or 1-877 MA.SS,AFE Revised 5-26-05 Fax#61.7"727;7749 WWW.mass.jZavjdia. 'TESTA Building and Remodeling 5 APPLETON STREET NORTH ANDOVER , MA 01845 HIC Lic. 120296 Expires 11/19/11 (978) 682 2023 CSL Lic. CS 54718 Expires 6/8/12 Proposal July 18, 2011 Proposal Submitted To: Theresa Peterson Home Phone: (978) 975-9811 141 Rosemont Street North Andover, MA 01845 Job: Remodel Livingroom Obtain building permit Complete removal of all demolition and construction materials generated by Testa Building and Remodeling and its subcontractors. DEMOLITION : Remove old Fire place and build new walls to accept new gas fireplace unit. PLASTER : Hang %" blue board on the ceilings and patch walls. Masonary : . Install dry look stone on new walls Fire place and installation of fire place by others. Electrical by others i A finance charge of V/2%per month(18%per year)will apply to all accounts over 30 days past due. In the event collection activity is required the customer shall be responsible for all costs associated with collection,including reasonable attorney's fees. I propose hereby to furnish material and labor complete in accordance with above specifications,for the sum of: $4875.00 Four Thousand Eight Hundred and Seventy Five Dollars One-third to start, one-third after insulated , one-third upon completion. Authorized signature_ I reserve the right to cancel this contract if n t accepted in_30_days Signature 1 Signature DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES