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HomeMy WebLinkAboutBuilding Permit #446 - 145 BOSTON STREET 2/12/2009 BUILDING PERMIT D;NOR14ORTIy "tio TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATIONto Permit NO: � Date Received 9 CDRw TED �SSACHUS�� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION 14J� &.5 s Wo(+k Andover IYA o I gq5 PROPERTY OWNER Ki Co le and P'V6er &tdulzAi Print MAP NO: / 'L17,6 PARCEL: . i' ZONING DISTRICT: Historic District yes no 0 Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New BuildingOne family Addition wo 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: baA!o0(n remodel Identification Plese Type or Print Clearly) OWNER: Name: NiCOL2 and Pe-Ter WU15h I Phone: 979- &e2 a�57 Address: A5 5 , N f b y M CONTRACTOR Name: W i ISOtl UOQdtWCKi nQ Phone: Address: acaUeS . Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: 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: $ 12- , 600 , 00 FEE: $ l 7 �! Check No.: '?O - I I Receipt No.: 0--L C Ae- NOTE: Persons contracti g ith unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner ature of contractor Location & Jh S7— No. srNo. Date 101 NORTIr TOWN OF NORTH ANDOVER 3? �� OL F49 S ' Certificate of Occupancy $ 44 . -• ° • ��s"••°'E<t'' Building/Frame Permit Fee $ /H swCHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2 ! 825 Building Inspector 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 COMfjAENTS 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 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance orspecial 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 Wilson Woodworking Invoice nVOIce 11 Jacques Rd Tyngsboro, MA 01879 Date Invoice# 2/9/2009 2493 Bill To PETER REDULSKI 145 BOSTON ST NORTH ANDOVER Terms Due Date 2/9/2009 Description Qty Rate Amount DEMO BATH ROOM FLOOR WALLS&CEILING 12,000.00 12,000.00 PLUMBING INSTALL NEW 3 OR 4 PIECE WHITE FIBERGLASS TUB. REMOVE BASEBOARD HEAT AND RELOCATE UNDER VANITY. (HOMEOWNER TO BUY AND INSTALL TOILET AND 2 SINKS WITH 2 FAUCETS.) VALT CEILING INSTALL SKYLITE(NON OPERATING) ELECTRICAL RUN 2 NEW CIRCUITS FROM PANEL INSTALL CEILING EXHAUST FAN WITH PROVISIONS FOR 2 LIGHTS OVER VANITY (HOME OWNER TO BUY 2 LIGHTS OVER SINK) INSTALL INSULATION TO CODE HANG 1/2 INCH GREEN BOARD,MOISTURE RESISTANT GYPSUM BOARD INSTALL 3/8 SUB-FLOOR,AND TILE AT$6.00 A SQUARE FOOT FOR SUPPLIES AND LABOR VANITY TO BE SUPPLIED BY HOMEOWNER($300.00 ALLOWANCE) PAINTING TO BE DONE BY HOMEOWNER INSTALL NEW WINDOW,DOOR AND BASEBOARD TRIM. PRIMED AND READY FOR PAINT. FINISH PAINT TO BE DONE BY HOMEOWNER Thankou for our business. y y Total $12,000.00 Page 2 ORTH '9 o'" Of NAndover , O V" Ja. 04 o dover, Mass., COC MICKEMCK �. SRATED PP� �� BOARD OF HEALTH Food/dCitchen PERMIT T D Septic System BUILDING.INSPECTOR THIS CERTIFIES THAT............ ... A-14P. .......... ... .. ............... ........................................... ...Foundation fin 1 IN has permission to erect........................................ buildings on.........(.1�..........so.. ..... ..... �............ Rough ..........................:........................... t0 be occupied as......... .. ....�i�... .I..... ..R............. Chimney provided that the erso§Cce in this ermit shall in eve respect conform to the terms of the application on file in P P P g P every P 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 CONSTR TS 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 Nall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. 0011TM TOWN OF NORTH ANDOVER p0 OFFICE OF I. a BUILDING DEPARTMENT *> 4S# 1600 Osgood Street Building 20, Suite 2-36 ;,b• :�'` North Andover,Massachusetts 01845 SSACMUst< Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please phpt DATE: ►NA.ru IZ I` zoo 9 JOB LOCATION: NS 8Q5 -Orl S+. 1> Number Street Address Map/W HOMEOWNER N i C 0( 9 Gt U IS t t. q— 15/-/Y Name Home Phone Work-Phone PRESENT MAMING ADDRESS I Y S 05k S� 6(E A oue r- rnl- c) I R4 - City Town State Zip Code Then f " curre�exemption or homeowners was extended to include owner ied to two units or less -occup dwellings and to allow such ho meawners to an individual for hire who engage does not a license provided . Possess ,p that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE GZ ` A APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homeownus Exemption 110AR.DOF \PPF:\LS 688 954.T CU.NSERVA'rION 688-9530 ITEAU111688-95.10 PLANNING 688-9535 6 j , a The Commorc wealth of Massachusetts Department o , P .fIndustrial lQccidents oflnveviigoations 600 Washington Street � Boston t. , MA 02111 Workers' Compensation Insurance.AffidaBuildelrs/Contracto An Iicant Information rs/Electr�c�ans/piumbers Please. Prinf Leaibiv Name (Business/Organization/Individual): fCOIl t Address: 1 q 5 i as, City/State/Zip: Nor&') A nd O ve r } Phone#: X 78- Co X57 Are you an employer?Check the appropriate box: l.❑ I an a employer with 4. ❑ I am a QA Type of project(required): ..neral contractor and I employees(full and/or part-tirne).* have hired the sub-contractors 6. New construction 2.❑ 1 am a sole proprietor or partner- ship and have no employees listed On the attached sheet t 7• ❑ Remodeling These sub-contractors have working for me in any capacity. workers, comp. insurance. s' ❑ Demolition [No workers' comp. insurance 5. ❑ We are.a corporation and- 9 ❑ Building addition required'] ofncers have exercised.their 10.❑Electrical repairs or additions 3 I an a homeowner doing all work right of exemptioner M ` p GL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. IS2 > §1(4), and we have no insurance required.] t employees. 1 2.[No workers' ❑ Roof repairs comp, insurance required.] 1.3•7 Other *Any appiicant,that checks box#1.must also fiil out the section below showing their workers'compensation Polk}'information. Homeowners l chs this box a,%tde.ait indicating tttB� af-dutftg .Ei%;er;;&,tu(hell him outsi&rontraciorS III SLLOfi11t!i nCw atntiavit inai=t ng scch, XContractors 1ha1 ehcck this box must arra hot an additional sheet showitt_the name.op t}c sub am an.employer that is providinear. raetors and their workers`comp,pof icy information. I g workers'compensation insurance for a !a information. mPeeS. Below,iY s the policy and jab site 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 fine up to $1,500.00 and/or one-year imprisonment,as well as civil penalties in thefoto re imposition a STOP WORK ORDER 1and a fine of up to S250.00 a day against the violator. Be advised that a cop),of this statement may be forwarded to the Office Investigations of the DIA for insurance coverage verification. of I do hereby cert,under the pains and penalties of perjury Thai the Informationrovtd P ed above is true and correct La • �� Dates: �ho 6 a Official use only. D�not write in.this area' to be.completed by city or town ofr- ciaL Town: Permit/License# Authority(circle one): d of Health 2. Buii�ing Department 3. CitylTownClerk 4. Electrical Inspector 5. Plumbing Inspector r Person: Phone; Information 2nd 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 incluciirt.g 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 ap artTnents 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 a r local licensing agency shall withhold the issuance or renewal of a license or permifto operate it.business or to construct building 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 cont meting authority." Applicants Please fill out the workers' compensation affidavit compZ-eteiy,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es) and phone numbers)along with their certincate(s)of insurance. Limited Liability Companies (LLC)or Limited Liability LLP Partnerships(LLP)with no employees other than the mem bets or partners,are not required to carry workers'.compensafion insurance. If an LLCor 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:. Tne,affidavit should be returned to the city or town that the application for the permit or license is being requested, a not the Department of Industrial Accidents. Should you have any questionsa.�rege Tding the laza, or if you re uimd to obtain q "workers' compensation policy,please call the Department at the nm-rnber:listed below. Self=insured companies should enter their self-insurance license numb—on the spproprietz line. City or Town Officials Please be sure that thea ` v' Enda tt is complete and panted legibly. 'Phe.Departrnent 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 permitricense number which will be used as a reference number. In addition an applicant that must submit multiple permit/heense applications in art > PP ant PP given e « � � 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 sta meed 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, Vtrhere a homeowner or citizen is obtaining a Iicensct or permit not related to any business or commercial venture (i.e. a dog license or permit to burnleaves etc.) said person is NOT required to complete Phis 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 fw, number: az t The Comrnonwtalth of Massachusetts Department of lmdustrial Accidmts Office of Investigations 600 Washington Street Boston; SIA x2111 Te1. # 617-727-4900 e)-t 406 or 1-877-MASS.4FE Revised 5-2645 Fax 4 617-7-7-7749 WWW.mass-govldia