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HomeMy WebLinkAboutBuilding Permit #489 - 1459 TURNPIKE STREET 1/3/2007 TOWN OF NORTH ANDOVER pORT1� APPLICATION FOR PLAN EXAMINATION 3?0� Permit NO: ` Date Received mol . Date Issued: r P ��ss4CHU IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER I't Z V! ®C! be Print MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building &One family ❑ Addition ❑Two or more'family 0 Industrial 0 Alteration No. of units: epair, replacement 0 Assessory Bldg ❑Commercial 0 Demolition ❑ Moving relocation 0 Other ❑ Others: 0 Foundation only DESCRIPTION OF WO TO BE PREF RMED Identification Please Type or Print Clearly) OWNER: Name: /J(_P:VLA/ Al/ Phone: CL f79 4f3 0 3 6a Address: jq ;-j� e s - - CONTRACTOR Name:- Phone:®//V Address: /'� /74(// Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: r ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$115.00 PER&F. Total Project Cost :$ 9LOO FEE:$ ;�;l Check No.: / Receipt No.: Page I of 4 I I I TYPE OF SEWERAGE DISPOSAL � Tanning/Massage/Body Art ❑ Swimming Pools 0 Public Sewer ❑ Well ElTobacco Sales ❑ Food Packaging/Sales ❑ Permanent Dumpster on Site ❑ Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guars fund Signature of A ent/Owner Signature of contractor �'�✓ g g � Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ tamped Plans ❑ 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 s r FIRE DEPARTMENT - Temp Dumpster on site yes no Fire Department signature/date 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 i Building Setback(ft.) Front Yard Side Yard Rear Yard Required Provided Required=Provides Re uired Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA— For department use t Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT WORM05 Created JMC.Jan.2006 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 oInteriorFloor Plan Or Proposed Work Addition Or Decks ❑ Building Permit Application ❑ 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 P P Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) !, 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 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:BPFORMOS Page 4 of 4 Location f ��"f ' -' No. Date NORTH TOWN OF NORTH ANDOVER Oft .•° 3? •• O0 Certificate of Occupancy $ �'�s'•^°•Eta Building/Frame Permit Fee $ SACHUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #�5 19909 Building Inspector � �10RTIy Town of 4 over No. ~ A dover, Mass._ COCMICMEWICK y1. 7�S RATED BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..........a 11.111.et✓..uov............................ ..'.. .................................................... Foundation has permission to erect........................................ buildings on....!..`ii..0.........714% ...... ......... Rough to be occupied as.....V.1. .....1.41K �t �t.: .�..!�!►. �.. ...... Chimney . . . ... ....provided that the person acceepting this permit severy respect conform to the terms 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 IN 6 rs ELECTRICAL INSPECTOR. UNLESS CONSTRU 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. FROM <FR1>0E0 26 2006 17:1e/81r. 17:13/Ho.7600000e67 P 2 SIDING Hi-Tech Window & Siding, Inc. �.�' �•, MA Reg.#118836 1,3 Washington Street,Haverhill,MA 01832 �l MA LIC.#016201 www.windovn-sidinv.com e---,-� MEMBER Date: / 7 / �� 31)) �• �-- Consultant: Job Name: �i V► k C Telephone 7' `� -g36 0 t �y 0 Job Address: <ST I—WA Town: CONTRACTOR agrees to start described work ordor about weeks after final fittings and complete desaibed work in about working days. CONTRACTOR shall not be held liable for delays due to causes beyond our control. The f011owing work includes all labor and materials needed to complete your job in a workmanship like manner. W.� (� Combination Job-Siding With Other W PV.0 Coaled Alum. 0 Aluminum Building and Elec Permit Fascia Trimer h alt f Fascia Treatment Siding Removal .1 ft S sSoffd Trim Fascia golor Co'Preparation Package Window and Door Trim Full Custom j M None Accessory Package C.70shutters Location t vAOfr Underlayment [] Gutters Siding 0 Downspouts Soffit E21of RemNove D�eebries 0 Lock.Elec.Meter Center Vent Fully Vented Non-Vented Location VIReplace Visable Rot Vented as Needed Energy Savings/Bug Guard tarter Window And Door Casing Color 4 Ctutorn Forted JAAss Full Custom Formed n ��.,,,�,�qqa� k;.A;'i"r4 6:-•ya-A%F F'f.� �:6.w $.* I� Blind stop Ca:prq None COIOC f Location /✓fG �:: •' ,. Vi�li ht Blocks Vi Der Vents W Electric Outlet Blocks Vinyl Exaust Vents Shutter Color 1 Amount Vinyl Faucets Blocks C5 Vinyl Gable Vents Location 4' < F,�,. ONUM -. ....:.::. :.... }..e.. w z;oiw� x' Gutter Color pouts Color aa:. . ......:; Q Hi-Tech 3/8 Cff Other j/r Location P LocationIrk Qe...-.;_.>: id 111514 11 A C4107 y < dA ,,- b /(e. Complete House Q Garage U /ON IM 47 4Cv /h))Ab INSh: s •: '3�s„'yy`%('PY'y�,%'*:x,., 1{ '' Color (/(- J'd� / 47ec ,ol a4 does- CGS14 ,m. Brand SProfile cWte' oak F r%__ 7o Mega Q Krlbah to Nnange .•.,: ... ,5 Caen o►Clteett © Master cart .. .. .:o.... n : . Corner Post Color Total le siment a00 [] Wide Insulated Wide Non-Insulated 113 Deposit -� D U [� Regular Insulated Regular Non-Insulated 1/3 Paymont At Halfway Point it. , 00&— r 113 oo--- 1/3 Balance Day Of Completion A500 -� 11ou may cancel this agreement If it has been signed by art y thereto at a place other than the address of the seller,which mey be his main office or branch thereto,provided you not Hy the seller in writing at his main office or branch by ordinary mail posted,by telegram sent,or by delivery,not later than Midnllght of the third business day following the signing of this agree- menL Sea the attached notice of cancellation form for an explanation of this right. An interest charge of 1-1/2%per month(1896 per year)will be added to any amount unpaid after 30 days from invoice date. Date of Acceptance In the event of default In payment of this order or any pan thereof and the account is referred Signature to an attorney for collection,the purchaser a ees to pay reasonable attorney fees. (Hkxneow er) I/We give Hi-Tech permission_kr obtain 4D neressary permits. Signature (HiTech) Signature The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' d 600 Washington Street Boston,MA 02111 wM www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information H/ Please Print Legibly Name(Business/Organization/Individual): c° Address:— / d3W / -S �l i �-f`� -d p✓ S J� City/State/Zip: A. L(. Phone.#: 9e,0 R` 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 I employees(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 sheet. 7. ❑Remodeling ship and have no employees These.sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' insurance.# 9. ❑Building addition [No workers' comcomp.insurance P• required.] 5. ❑ We are a corporation and its 10.[1 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 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 submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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-contractors have employees,they mustprovide 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.#: C�; C d' ���� Expiration Date:_ ( G f_ Job Site Address: /J?�T /o itA111It t' %r/ 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. I do hereby certify der the pains and penalties o perjury that the information provided ab ve i's rue and correct. Signature: Date: Phone 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 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 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(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 perrnit/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 pernut 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, MA 02111 Tel. #617-727-4900 ext.406 or 1-877-MASSAFE Fax#617-727-7749 Revised 11-22-06 www.mass.gavfdia ....... ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYY ) TM. AUG 3 06 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION R B KIMBALL INSURANCE AGENCY INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P 0 BOX 1390 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR HAVERHILL MA 01831 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# AgercyLic#:MA 1780220 _. NSURED INSURER A: American Home ASurance Company HI-TECH WINDOW&SIDING INSTALLATION INC. INSURER B: NAUTILUS INSURANCE COMPANY CIO ATTN:WILLIAM CHASE II INSURER C: COMMERCE INSURANCE COMPANY ---- -- 143 WASHINGTON STREET -- __...__._.... HAVERHILL MA 01832-5418 INSURER D: UNDERWRITERS@LLOYDS LONDON INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING 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. INSR ADD'LI POLICY NUMBER POLICY EFFECTIVE 1 POLICY EXPIRATION LIMITS LTR INSRD TYPE OF INSURANCE DATE MM22M DATE MM/DD/YY GENERAL LIABILITY NC509239 NOV 23 05 NOV 23 06 EACH OCCURRENCE.. $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILIT� .P-.REMISES.IF_e.orr��e�a)_____.__.. $.__._ .._ 300'000 CLAIMS MADE X OCCUR MED.EXP(Any one person) t$ 5,000 i __ .. B X BI&PD DEC)$500.00 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GI AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG. $ 2,000,000 POLICY PROJECT LOC AUTOMOBILE LIABILITY 06MMVS6572 JUL 10 06 JUL 5 07 COMBINED SINGLE LIMIT (Ea accident) li$ ANY AUTO ALL OWNED AUTOS I BODILY INJURY (Per person) is 250,000 SCHEDULED AUTOS —..----- --- - - C HIRED AUTOS I I $ 500,000 BODILY INJURY (Per accident) NON-OWNED AUTOS I - - - --- PROPERTY DAMAGE �$ 100,000 (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: Arr $ EACH OCCURRENCE $ EXCESS I UMBRELLA LIABILITY OCCUR CLAIMS MADE AGGREGATE $ $ $ DEDUCTIBLE RETENTION WC STATU- �( OTHER WORKERS COMPENSATION AND WC8947853 JUL 6 06 JUL 6 07 ;TORY1MLiS_J_.. __..... .. EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ 1,000,000 A ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 1,000,000 It yes,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 SPECIAL PROVISIONS below i OTHER:CPP--PROPERTY-OFFICE QMF0510867 NOV 23 05 NOV 23 06 PER BUILDINGS SCHEDULED AMOUNTS D MECANTILE-SHOP-CONTENTS& AND COVERAGES STOCK !AFFORDED HEREIN DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS MANUFACTURE'S REPRESENTATIVE AND DIRECT SALES INCLUDING AN OFFICE WITH SHOWROOM- VINYL SIDING SALES AND INSTALLATION REPLACEMENT WINDOWS-DOORS,DECKS AND OTHER ASSOCIATED PRODUCTS AND CARPENTRY RELATED TO RESIDENTIAL HOMES AND BULDINGS HEREIN. CERTIFICATE HOLDER — CANCELLATION JOHN CONSTANTINO DBA ~ ZIOGIOVANI @AOL.COM SHOULD ANY THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE E THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 CONSTANTINO BUILDERS AND ELECTRICIANS DAYS WRITTEN SO SHALL IMPOSE NO CERTIFICATE OBLIGON OLDER D LIABILITY MED TO THE LEFT.BUT OF ANY KIND UPON THE 226 LINCOLN AVENUE,HAVERHILL,MA.01830 INSURER,IT'S AGENTS OR REPRESENTATIVES. TEL: 978-374-4647 FAX:978-521-6655 AUTHORIZED RE RESEN TIVE / 46�vlalcolrn D. Kimball Jr. Attention: JOHN COSTANTINO Gi v" TION 1988 ACORD 25(2001/08) Certificate# 1372 ©ACORD CORPORA on fr,m 73L)H,4 ANT 17VRWIN 69LLt7LE8L6 ZZ :ZZ 900Z/Z0/60 7/ C •f 9 l f )1 y� :,. ✓ a.. y #.f.a s"t� flA r d p`v.v ttK .y&'t r� S , '' t,.t r ✓M TOOfIt)/IOsftlMR�46 t?����0�1�011{(/ �1t% 1t s'`'r:;xt ,� air t x� 4 '� r,. r si ft� F d f ` t � }•} trd,,- � � fr,�,+�� Board of Building Reguladons and Standards •,r�s r r Qr �, 4T s°°^'� �r � _�1 t l x �*,+ ,,, tet+.t- tt i.. 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Y t BOARD OF SUIL.YIRGGMATIOW o Uaea CONSTRUCTION SUPERVISOR %u. �� - •` t t *f x rt' 1 Ix� rr {' E t•f f .i.,.,t: a i% Nunbd 11-1811947 �018201 _ "t t 3!' t � "i� t _ u 4 ` ' �t +;4 k t r � z '+fi 4t. .{.Sea1'+afi• ..1�+d t krM1.: t rr;v t; rt, ttF *Yt{j +a ti 4.p t 4tt!s y y� # �BI ��.r{�l�l7 7 Tr.no: 10010 n •i s•#'s- rpt a e+a i. � ! �� t 4 y4� 11 i �d � ra } s' i,��.� ^ xyt v ' " y ✓e: •"1 a r } - t 1 tr '!' t y�� 'N - �t P. T �(,� +,u#.i} '' WILLIAM P CFIAS ' ~ .: 15 KINGSBURY a" HAVERHILL, MA commissioner I tea t�5 j ray: • ]y t��gt +n e 4 r 1-..%5 F.. h' ..i .. -.". ...a.-:..s''�r'.Y..!S;..l}'tNr&t4J.. ♦t�N !