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Home My WebLink AboutBuilding Permit #486-13 - 149 BERRY STREET 12/24/2012 E Of OORTM BUILDING PERMIT 3i�.�d``, « �e� TOWN OF NORTH ANDOVER0 to APPLICATION FOR PLAN EXAMINATI N 4 b Permit NO: �� Date Received `0 .r. 4aqq+` �AATeD `11 Date Issued: �Z �� 1SSACHUS�� IMPORTANT:Applicant must complete all items on this page LOCATION /y9 /�Pr/�,y S-rg e eT Print PROPERTY OWNERAg goo Co Te- Print MAP NO: PARCEL:"ZONING DISTRICT: Historic District yeno !Machine Shop Village ye( no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building '�l One family ❑Addition ❑Two or more family ❑ Industrial MAlteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other ❑Septic Li Well L) Floodplain ❑Wetlands 0 Watershed District ❑Water/Sewer �,i► sh OFF &sew"z; 6#mc- A000i 4,10-11 Ikox"t..ae l2ooc� Identification Please Type or Print Clearly) OWNER: Name: /3990,1 .,. .s4ck* 6ol'e Phone: of 78'-8y6-3y 7.; Address: 5Weer- Aloe /1Do✓�s^ CONTRACTOR Name: Phone: q18- dLy- �17sy — ,04n)e-l 6R0ss&*a Address: 23 enc% /yl,# Supervisor's Construction License: Exp. Date: C S - css.�os8 9-i3 -o�oiy Home Improvement License: Exp. Date: l 5"1 7 I D � - � —,?o 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 Co t: $ 6 Doo FEE: $ 12- Check No.: Receipt No NOTE: Persons contracting with unregistered contractors do no*,`,�-access to the guaranty fund Signature of Agent/Owner �'s.j_ ti �� Si4�-,ature of contractor �.s r TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued,- IMPORTANT:Applicant must complete all items on this page LOCATION. Print _- PROPERTY OWNER Print 100 Year Old Structure yes no MAP NO: PARCEL:. 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 ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other FS eptic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District` ater/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor r Plans Submitted ❑ Plans Waived ❑ CPrilfied Plot Plan 11 Stamped Plans ❑ Location No. —1 .Y Date `2-�-2 • ' TOWN OF NORTH ANDOVER 46 s s Certificate of Occupancy $ Building/Frame Permit Fee $3j Foundation Permit Fee $ Other Permit Fee $ � TOTAL $ Check# 26055 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 I CONSERVATION Reviewed on Signature COMMENTS I HEALTH Reviewed on Signature COMMENTS e I 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 Tow ]Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 NlaiTStreet. Fire Department signature/elate 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 I DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine I NOTES and DATA— (For department use U Notified for pickup - Date s t Doc.Building Permit Revised 2010 Building Department The foliawing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits o Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products IIS NOTE: All dumpster permits require sign of from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit a Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract ❑ FI oor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract ❑ Mass check Energy Compliance Report o 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 subm;ated with the building application Doc: Doc.Building permit Revised 2012 Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost 26,000.00 m $ - $ 312.00 Plumbing Fee $ 39.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 39.00 Total fees collected $ 490.00 149 Berry Street 486-13 on 12/24/12 Finish basement no bedroom The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Name (Business/Organization/Individual): 499a 5569.+ cr SmucT,--7 Address: a City/State/Zip: A"�" A,# 0 16 V Phone#: 9'78 - aV- 117ss Are you an employer?Check the appropriate box: Type of project(required): 1I am a employer with f 4. E] 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 8. ❑Demolition workingfor me in an capacity. employees and have workers' Y P h'• $ 9. F]Building addition [No workers' comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.0 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.❑ 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 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: 7-A�L7Ru(ls � e �e,^ 7surft•rca_ EOi¢.i Ca "� ,Ps Policy#or Self-ins.Lic.#: 4 k u d - S"B y 6/P—�2 /02 Expiration Date: Job Site Address: /yy Agery SiVr-j- City/State/Zip: AA9,-A /l�Da��r MA 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 cern under the pains andpenalties ofperjury that the information provided above is true and correct SigLiaturel Date 7? " /7-/a Phone#: 7 S 40"-. 4/7S 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#: .r r ��j�QfYX�ffK:tsWZ a..- Dan Brosseau office 978-664-4759 po box 266 fax 978-6641748 North Reading,Ma. dan@brosseauconstruction.com . proposal proposal submitted to- phone- date- Aaron Cote 149 Berry street North Andover,Ma. 11/30/2012 basement renovations build out basement according to plans' to include the following- framing of walls ,installing strapping on ceiling, framing around duct work Insulation around exterior walls of basement install blueboard and plaster on walls and ceilings install finish trim mouldings,doors, Install tile flooring paint all walls and trim work, install cabinets in bar area, install'r4 bathroom includes labor,materials ,disposal of all job related trash and building permit fee all of the above work to be completed in a substancial and workmanlike manner according to the job specification s for the sum of— Contract Price Twenty six thousand dollars $26,000. Payments of contract Price shall be made as follows- deposit of $6500. When rough inspections completed $6500 when plastering work is completed $6500 when job is completed $6500 ACCEPTANCE OF PROPOSAL- The above prices,specifications and conditions are satisfactory and are hereby accepted.you are authorized to do the work as specified.payment will be made as-outlined owner Contractor F NORTH own of a :n _ over o to r No. - �` h ver, Mass Dec. 2 26 IZ o " I COCMICNl WICK A. AoRATEo PPa��S S U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System A1�,,� BUILDING INSPECTOR THISCERTIFIES THAT .... .dl�:::.:..........:. ............ ...................................................................... . . has permission to erect Foundation p ........................... buildings on ....t.. .. ........... i.'l.. .. ... .................. � ... Rough /�f.�,��—^ /fes to be occupied as ... V.11.l ........... LIL.�J..::.••�':•�•••..... �.... .... ..�•-�•�.rn..... � Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in 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 CONSTRUCT ST TS Rough Service ............................................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. SEE REVERSE SIDE i Ad ,M1 � ��,.c��'"��,:r��'°-�,' �'•�n.�,.N�'"r`,.'�.�... er"..','^a+..,.,.,,'�ina`",M1,..;n'^ �� 'g-...4 .f rte' �•'J��tt;axy`ai>�``��,-aE�Lsa..�a�.,. ny,L. n _.{s�'� � ,K m� ..- ...-,... _._..„. j' u ,.. �� fJ-4'i4..-_ •. I AV Sr i *J l.J � 1 -+�;. �F},k�� d8u?C,ny '(� •' � ill � � w Tl Pa 1w t' C Xv vlift ��, tii Aix �� •1 o ' ^ ET 00 — �� : oOer Ql v it e 131 cc OL ? € n 6 F''ir•+lA AN •� s— i(] APPROVED BY SCALE: � � ==• I DRAWN BY DATE: 11-15 -/.? + �a tea DRAWING NUMBER 73: CHARRETTE PRO-FORM 920PF PRINTED ON 920H CHARPRINT VELLUM y.....� i 3L� to 10 IL Ss a f Lazy K+e ►$ Jw- ay 1 5A kms4e.- k W w 3 b a :i Size ;Lv ,� i`.� Icer I ........... .. -.....,.,- 41.4111.11-1– »w . r v Sam 1 Sic-re-0 ! ate• _ ;'yi j# F i � G�.�� • t r IuH;J a y ' taW�`' Gdjr r Wi{, 1`'o I��w* ' ' "*ew. t�, 4 '3' ratr6,. ` ro�ki' u � -- ' I-111K 71 - ,Nj Y• 6f' C t I I Vn0 r• FRI tv 13 I le RA .�.� V e VAT SCALE: '/If ^ , APPROVED BY DRAWN BY DATE: DRAWING NUMBER 'tom-tet CHARRETTE PRO-FORM 920PF PRINTED ON 920H CHARPRINT VELLUM Adftk TRAVELERS WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) A POLICY NUMBER: (6KUB-5B4061 8-2-1 2) NEW-1 2 7_ INSURER: THE TRAVELERS INDEMNITY COMPANY 1. NCCI CO CODE: 11347 INSURED: PRODUCER: BROSSEAU, DANIEL J DBA T F WARD INS AGCY INC BROSSEAU CONSTRUCTION 403 FRANKLIN ST 23 WESTWOOD CIRCLE -MELROSE MA 02176 NORTH READING MA 01864 s Insured is AN INDIVIDUAL Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy period is from 08-18-12 to 08-18-13 12:01 A.M. at the insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers P4. Compensation Law of the state(s) listed here: MA x. w 0 B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ 100000 Each Accident o Bodily Injury by Disease: $ 500000 Policy Limit Bodily Injury by Disease: $ 100000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A 0 k D. This policy includes these endorsements and schedules: o SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE :4 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating } Plans. All required information is subject to verification and change by audit to be made ANNUALLY. 4 s� DATE OF ISSUE: 08-15-12 DS ST ASSIGN: MA OFFICE: ORLANDO INDUS AFF 161 PRODUCER: T F WARD INS AGCY INC 28F9X 001101 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: C 4155058 DANIEL J BROSS$AU 23 WESTWOOD CIRCLE i N READING MA==01864 + Gl / � • �� N "' Expiration Commissioner 09/13/2014 - aVii- t Qnsvtotr a�rsgdsi4efis HOME iMPROVEMEN7 CONTRAGIp` ut t; a c Registration LicctfSe or registsatiou valid for iodividul us4 only 154730 before 4lie:expiration date. If found return Expiration 4/2/2013 Tyi .' Ccc of Consumer Affairs and Bgsmess Regulatiou =" BR SS - flBA �. EAU COt�fjRH , 10 Park Plaza Suite 5170 E K i,ostoe;17.A-02116 DANIEL BROSSEAU . �; /j 240 PARK ST :' NORTH,READING NYA0-1864 —�--- � �- IJre�er'se�'ittx - - - ;x.' blot va" without signature