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Home My WebLink AboutBuilding Permit #244 - 15 NADINE LANE 10/6/2008 BUILDING PERMIT o` o oT 6'�ti TOWN OF NORTH ANDOVER �? b.41 * _° APPLICATION FOR PLAN EXAMINATION +� op Permit NO: v Date Received "0q,Too 'P"�.h �SSACHUS�� Date Issued: Z16�L �D IMPORTANT: Applicant must complete all items on this page 4P / r ,LOCATION Prin# PROPERTY OWNER,: S,97,4nl ,, Print MAP NO:G �6_ PARCEL- .ZONING DISTRICT:S/ �2 Historic District yes Machine-Shop Village eyes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One famil Addition Two or more family Industrial Itersio k> No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other ;`Sep#ic Well, Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: IAIS74/I knee (tea llS /ivis dAlF Identification Please Type or Print Clearly) OWNER: Name: 5Phone: Address: t2 ,E /S Roo Sc/e,-1-, 0.3072 CONTRACTOR blame: ,412y.- l_In/ 'Phone:. 7?/- eS-zl-o Address: yW�L<�r Supervisor's Construction License: Exp, Date: a Home Improvement License: /1767`J Exp. Date." d 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: $ E(,00 (gyp FEE: $ / pa Check No.: 3 Receipt No.: -7 1 z NOTE: Persons contracting w' unr st red contractors do not have access to the guaranty fund ignature of Agent/Ow er Ignature�of contra— ct -.-��- 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 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: Located 384 Osgood Street FIRE'DEPARTMENT Temp Dumpster on site yes no Located�,at 124Vain,Street1 fire Department-signature/date 'COMMENTS ' t i I 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 9 9 9 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 Iva Jz- Location No. 4-1 V Date M 6 lal MOR,►, TOWN OF NORTH ANDOVER O:�•.•o :•1ti0 3? •. • O O ♦ s • ; , Certificate of Occupancy $ Building/Frame Permit Fee $ K Nus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 7,oS Check # L [[ 2 , J72 Building Inspector NORTH To of And®ve r No. C% 0 LA 0 over, Mass.,- COCHICHEWIC T ED 1p""' CO BOARD OF HEALTH Food/Kitchen PERM11T T D Septic System t ILDING INSPECTOR '�qlv Ale � AI��.THIS CERTIFIES THAT......sc ;. ............ .........e....?.. 4.. ........................................................................................ Foundion has permission to erect........................................ .buildings on ../s .............................. ....... ..... Rough Chimney to be occupied as.................... ...... �...... ..... ...... ......... provided that the person accepting this permit shall in every respect conform Cth��ie terms of 6�e% pplication on file i Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, AfteratiYalind 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 UNLESS CONSTRUCTION STAR ELECTRICAL INSPECTOR ZAR � Rough Service ........................ .............. .... !�7 ......................... BU DINGFinal 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 j Smoke Det. Ul 6N rte:k-t- f LIIVIL— VV< f� f t LVV I IVa v VVI f f i t/tV f This AGREEMENT-is between: MaIr-1 - J2 i"JAe-(J/ PROJECT: / L/�j► (Coraraiaor's flame) (tdama r ® y lt/ RPh ( raetor's Address) (Address) (City,state, Zip) (City,State,Zip) (tetepnone) sags:tcd�f v^ ■ ■Contractors'State License Board which has jurisdiction to investigate AND complaints against contractors if a complaint.is filed within three years �5,,OGri ,�y� e V,.,, D1 �,/e/\ ■Vt V 0 Vt{l0 V 0 Q PaOV �NRVV�t. 0 W Wtitnt� /-�-`' `-'r ' ( m )/ /I/ //---(Illi contractor may be referred to the Register of the.Board whose. -address-(Garstnmia-residents-osify;consbR your-yellow-Pages-for the ,..: iriyJui oiaicr ia.i�wivai.ivovia[c cii,arioc lnrmvairw artRur JOwnerg AWFPsF) fUMILM Road,Sarxamanto,•California 95827.or.mailing,address:.P:O-,.Box ? 26000,Sacramento,CA 95826'. /r a to l/ O (City,State,Zip) A Construction Funds: The name and address of the construcfion fund holder is: me ano Brancliress ot ETInK,5avings and Loan Associ ation,Escrow,Agent,JointControl or otner Consumon Funa Rower) v.tast.rrFravrr ur wrruar.[vr wm ru«aarr wr ru[rur a-rid,«ra[arars to;Or rsuw[arry[,urrrFrrc[a,uFr[rrr aero frrvjoii irco[,rrury awvo,rrr a V.workmanlike and substantial manner a (J//d kilt[ [.JG /.S rt ra/✓rc.P -P-dyK Td41 JAI b CfP mr� (DPsrir[0Pthe 1brnYa tr.t)P-Dr}rmllntPr'lhi;'cnw-srl! /JS U�C.�t r iii Y f/�DLlrf G Na IA&t Z"11 �t9�rvloQ/� C'r/ �/f7lA v O Gr/h f.-- /S Q �2i'i r/�/y fir '/P�c7'—GaX� �'A& e (hereafter-allad fhn nroit.:r'n boon tha folfowing dasrrihe-cl Donerfv Lit J i"/7[/ f= N LAi✓� C.Property Lines: Owner shall locate and point out property lines to contractor.Contractor may,at his option,require owner to provide a licensed land aUiveyor's r7rapof propai j. D.Payment: Owner will pay contractor the sum of$ 0 U in installments as follows: Ll/4 yrt L.✓6i-lf l f GL t✓rTl (Insart7ntat Contr."ictprim) E.Time for Completion of Work: Within 30 days after the execution of this agreement,owner will have the job site ready for commencement of air s or tdrr u ser ad[tvr ytvo ws sts as tw cvr ntc«r tvtiCo to Un[nt tcrn v vrvtn.Cv«v rn.An a[mr Wrr m rct rw drv«.nru nrr r v va a of the rrutivo airia Ohm oumpwva I'm Quite 3d working days after commencement subject to permissabie delays. to r irvutx m■>r.t■uiiiir tt iv rttr-munr.„ntf tanuiiii.n..nn ii tr.trvr-t.rr..ri.in mr.r.a;ur.�:av inr- , ,t ntwt nun nu..taumnt.t ■■ . Contractor's License No. V ! Date: 6E Firm Name A /SL14 L2l/i 16A."I S (Contractors Firm Name,ff Any) (Owner Sign Here) a _ x (r hritractnf ry Agent$irgn Hare) (ff gore than OrtP.Owner,WAind Owner Sign Here) . cPREW:FT2> Board of Building Regulations and Standards Construction Supervisor License ' i License: CS 61679 ..... Expratn x 217/2009 Tr# 9290 Restriction. 00 ��' MARCL RI.NALDI� 44 WAVERLY PLAC'E-,,. MELROSE,MA 01274 Commissioner Board of Building Regulations and Standards v HOME IMPROVEMENT CONTRACTOR �k Registration ..117679 Expiration:. 11/3/2008 Tr# 125719 Type: DBA NISHLA MARC RINALDI 'fN 44 WAVERLY PLACE-= I MELROSE,MA 02176 Administrator r' h I s The Commonwealth of Massachusetts Department of Industrial Accidents �d WILL i 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: yyC-/aVY,-- 1� L City/State/Zip: f s rJ c C 1 a w;Phone#: Are you an employer?Check the appropriate box: Type of project(required): l.❑ I am a employer with 4. ❑ I am a general contractor and 1 .6 ❑ New construction 2.eployees(full and/or part-time).* have hired the sub-contractors l am a sole proprietor or partner- listed on the attached sheet. 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10:7 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 we have no 12,❑ Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13.0 Other }Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. Homeowners who subutii.iitis affidavit indicating they are dai:;g all work and hien hire outside contractors must submit a new affidavit indicating such. lContractors 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 workers'compensation insurance for my employees. Below is the policy and job site information. 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 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. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signa ret�� 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 compietely,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 permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permittlicense 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 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: 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 Revised 5-26-05 Fax# 617-727-7749 www.mass.gov/dia