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HomeMy WebLinkAboutBuilding Permit #436 - 15 MIDDLESEX STREET 2/2/2009 BUILDING PERMIT of "°oT" TOWN OF NORTH ANDOVER c� APPLICATION FOR PLAN EXAMINATIONq;� 70 Z �. Q Permit NO: Date Received '114°°RwrEc#I �SSACHUS�� Date Issued: '® IMPORTANT: Applicant must complete all items on this page LOCATION lfJ �` C Print PROPERTY OWNER R tAIKJM ZIOLJ Print 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 eratio No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well i Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: r 'eC,�end lf1=4f ar ux>q L ,- 5' Z& Identification Please Type or Print Clearly) OWNER: Name: Gew L.a(,v Phone: Address: 4 Irck CONTRACTOR Name: hs G- 4g/W Phone: ce72 3 S� 2l�ct Address: _ l2 <nr Sahlz , otcl c < '2.j Supervisor's Construction License: Z ` ` 3 Exp. Date:. ZJ& Home Improvement License:. a 'Z Exp. Date: 2 l<<1 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. OLl Total Project Cost: $ ��ob � 4 6 4`" JFEE: $ S{ Check No.: ��3 Receipt No.: I NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 'Ig unat re of Agent/0wner - S.ignature_of contractor 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 x'Photo Copy Of H.I.C. And/Or C.S.L. Licenses opy 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 Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL h 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 FOJZM DATE REJECTED DATE APPROVtD PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature 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 DPW Town Engineer: Signature: g g 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 areasq. 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 �pRTH c ovm 0Andover , 0 K E ©` y dover, Mass., • COCMICMEWICK ORATED �Pa` "♦y '9S ti BOARD OF HEALTH Food/Kitchen PER IT .T D Septic System BUILDING INSPECTOR THISCERTIFIES THAT......... ...... ........ ................................................ .................................................. Foundation has permission to erect................. ..................... buildings on ...Ir..........M8A.�„... ••••••••�.•.w.. Rough tobe occupied as.............C..I..f ....... . ................ ................................................................................ Chimney 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 y�Z PERM1 T' EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUT TS Rough ............................................................................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place o'n the Premises — Do Not Remove Final No Lathing or D■ y wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. 2 4 6 8 10 12 t 14 16 18 20 22 24 S L 3�� 26 28 30 0 ,:.. . II 2 IgCO3/� it ti 0 oS 4 1. y VQA I " 11q�2T� 1-2- 3��� s x(12 -7qwAjI 8 �XlCw SiL2 Ba-rT7rIl I 10 al — — — P°'� �''�Iler I � � �xq��s/g di Z 12 ��� X 18 V\/ 19 Cr 0-7 p C U 14 Ll �6 9 0 �I I M I og O O 0 16 c in 18 v U E U v Cq N 20 Scale: '/,"= 1'0"(Each square=3") a � Iq i Location��a �!-��llL�-�` �J- No. Date " 14ORT" TOWN OF NORTH ANDOVER 3? •.. • o AL Certificate of Occupancy $ CH S<� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 1�3 2t $ j3 Building Inspector a F R A N K FRANK HOWARD CARPENTER&BUILDER H o w ILo iesidence 15 Middlesex St. N.Andover,Ma Dec04,2008 689-9275 Kitchen Contract: 1. Obtain Building,Electrical & Plumbing Permits 2. Demo existing Kitchen down to the bare studs 3.Install necessary framing for new cabinet plan 4.Electrical includes 10 -6" round recessed lights w/standard switching,wiring for undercabinet lights(supplied by owner)wiring for appliances,wiring for convenience receptacles 5. Plumbing includes waste and water piping for sink,Dishwasher hookup. Icemaker hookup, gas piping for stove(sink& faucet supplied by owner)lnstall one toe kick heater 6.Install new insulation to exterior walls 7. Secure existing subfloor using 2" screws,install 3/4"x 2 1/4" red oak strip flooring sanded and finished with three coats of urethane $.Install /2 blueboard and skim coat plaster,smooth walls and ceilings 9. Install cabinets supplied by owner I O.Install appliances supplied by owner 1 I.Install new interior trim 12. Install ceramic tile backsplash,tile allowance is 4.00 sq ft.(tiie to be installed in a rectangular pattern 13.Remove all debris as needed. 14. If it is possible install microwave vent to outside �1 S Labor&Materials , 14,865.00 v V 512A MAIN STREET, BOXFORD,MASSACHUSETTS 01921 VOICE: 978.352.7604 FAx: 978.352.7604 All materials is guaranteed as specified.All work to be completed in a workmanlike manner according to standard practices. This contract does not include materials and labor for unforseen conditions arise after the work has started. You the buyer,may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction.Cancellation must be in writing. We propose hereby to furnish materials and labor-complete in accordance with above specifications,for the sum of 14,865.00 Payments to be made lows: , l�� First payment of 50 0 it ;Si cond payment of6 OQO.QO at start of demolition, Third payment of6,000.00 after rough inspections,Balance to be paid upon completion. Acceptance of Contract:: The above rices and specifications are satisfactory and are hereby acce ted.You are P P rY Y P authorized to do the work as specified.Payment will be made as outlined above. Signature Date IXIY f) Signature Date/11 ��a Work to be started February 2009 completion 6-8 weeks after start 512A MAIN STREET, BOXFORD,MASSACHUSETTS 01921 VoicE: 978.352.7604 FAx: 978.352.7604 �s Ike Conruno>izwecalth of Massachusetts I,K l Department of Industrial Accidents ; .1 [UU rx Off1ce of Investigations ash in aton Street Bomton , MA 02111 ` rv►+n't''-ar:ass.gov/daa Workers' Compensation Insurance.Afflclavh: Builders/Contractors/Electricisas/Piumbers An Iicant Information Please. Print LeaiblF� Name (Business/Organization/Indivi dual): w Address: 672— �- � City/StatelZip: FAou an employer?Check the appropriate box: I am a employer with 4. ❑ I am a general contractor and I . Type of project(required): }oyees(full and/or pari-time).* have hired the sub-contractors 6. 7 New construction 2. 1 am a sole proprietor or partner- listed on the attached sheet $ 7• �odeiinQ ship and have no employees The subcontractors have working for me in any capacity. workers' comp. insurance. S' E] Demolition' [No workers' comp. insurance 6. ❑ We are a corporation and its 9. ❑ Building addition 3.❑ required.] officers have exeroised.their }6 ❑ E}ecuical repairs or additions I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 162, §1,(4) and we have no insurance required.] t 'employees. [No.workers' 12❑ Roof repairs comp, insurance required.] 13•❑ Other *Any appli:ant that checks boa#1.must also fill out the section blow showing their workers'compensation poiic} inionnaiion. t.. Homeowners who submit•this aludevii indicariaL uiey er5 uuiii `�:;:r;; ld then ni ode contracior6 rnusi submit a nem,amciavir indiWtirc sech. 1conttactors thal check this box.mui attached an additionsl sheet show sin_the nares m O utsi of the a. -Ontozctors and their woticer`c40mp.Policy information. !am ann amployer that is providing workers'compensation insurance,for np)a Lo ees. Below is the oft information. em y p cY and job site Insurance Company Name: &f&o0A e� .r— _ r �-1 Policy#or Self-.ins. Lic.#: 7/99 Expiration Date:.lob Site Address: City/State/Zip- Failure Attach s copy of the workers' compensation policy deciamtion page(showing the policy number and expiration date). .Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to fine imposition of criminal penalties of a fine up to 21,500.00 and/or one-year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. Be advised that a cop},of this statement may be forwarded to the OfDER a investigation of the DIA for insurance coverage verification. I do hereby,certify under the pains and penalties of perjury; thw the information provided above,is true and correeL SiQrtatur�: Phone 4,,: Official use onip. Dn nol write inthis area, to be compieted b3;city or town of ciaL City or Town: PermWLicense 4 ti 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 a fid 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 iegal entity,employing employees. However the owner of a dwelling house having not more than three ap artments 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 d--med to be an employer." MGL chapter 152, 625C(6)also states that"every state o r local licensing agency shall withhold the issuance or renewal of a license or permitto operate it business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence off compliance with the insurance coverage required." Additionally, MGL chapter 152, 625C(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 till out the workers' compensation affidavit compi-eteiy,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 fir LLP does have_ employees, a policy is required Be advised that this afnciia.vit 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 th:city or town that the application for the permit or license is being requested,not the Department of industrial Ac: idents. Should you have any, questions regarding the la o, or if you are required to obtain a workers' compensation policy;please call the Department at the n�t�rber:Iistwd beloti; Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the.'afndavit is complete and printed legrbiy. 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/iicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under".lob Site Address"the applicant should write"all locations in (city or town)." A copy of the affidavit i.davit 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 Iicenste,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 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 tail. The Department's address,telephone and fax number: The Commonwes:lth of Massacchusctts Department of T-rndustrial Accidents. Office of Lavesfigations 600 Wad-i imgton Street Boston; MA X12111 TeI. 4 617-727-4900 C=406 or 1-8:77-MASSAFE Revised 5-26=05 Fax 4 617-727-7749 ���.mass.govldia /ze �a9r+nzovu�rva/�i u��/ aaaaiacaelda Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registr ph;, 101824 yyy Expi�ratiott :629/2010 Tr# 267228: yA Type Private Corporation FRANK How iCAPrBUtLD',ER I Frank Howard "'y "j 512A MAIN STREETi� Boxford, MA 01921 Administrator af- � 0-A Blfll LdtNG Q#>t9 ; Lloerse Cf7E�STRUCaw TIQN SPRC7jSQR `042443 k 1W 041 W]2b 8 3 1'485 0 1"RANK L HQWAFtb z, , 512A 'x WIN S"C r ca ComniissTon� Massachusetts - Department of Public Safeth Board of Building Regulations and Standards Nw Construction Supervisor License License: CS 42443 Restricted to: 00 FRANK L HOWARD 512A MAIN ST BOXFORD, MA 01921 Expiration: 9/3/2010 -(,4)JI Tr#:.2348