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Home My WebLink AboutBuilding Permit #145-2017 - 176 CHESTNUT STREET 8/15/2016 BUILDING PERMIT of NORTH ;w- LEO j 6 'Y 1 �l� TOWN OF NORTH ANDOVER �2 �a APPLICATION FOR PLAN EXAMINATION Date Received l�"� Permit No#: � �-y'°�R�*Eo Date Issued: �66 SSACHUSE ORTANT:Applicant must complete,aU items on this page LOCATION. I C+ E r-4Vr 671- � P int PROPERTY OWNER b�V+ D i ILA-12k� Print 100 Year Structure yes no MAPPARCELot'12—ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building XOne family ❑Addition ❑Two 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 PERFORMED: AS >� 9 Identification- Please Type or Print Clearly OWNER: Name: DAY 1 E ►G/�- -I%t.( P9,9(d Phone: Address: Q` 1' Contractor Name: S i`EPkletA A , 51 LIZ Phone: 9'J Y . J Email: 5 5 11 k R.en,-,yw�,DW r7 a nv i l Lo Address: + - I'dvi;Q Supervisor's Construction License: C-5 ^ 0 9 $ 533 Exp. Date: II - J 3 - Home Improvement License: 1 '1 to I lb Z Exp. Date: *7 - 2-5' - ARCH ITECT/ENGI NEER S -ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ 6S00, 0 0 FEE: $ _�& .___ -_ Check No.: Receipt No.: ��3 NOT Persons co ae ing with unregistered contrac r do not hqAe access to the guaranty fund -- C�J'-1. 1 - - - ---- --- -- --- -- - c..------------- ----- -- --- - f Location No. — � �� Datet • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ — Foundation Permit Fee $ "� Other Permit Fee $ TOTAL $ '� Check# Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody Art ❑ Swimming Pools ❑ well El Tobacco Sales El Food Packaging/Sales 11Private(septic tank, eta ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF a U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ 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 !dater & Sewer Connection/signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on 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, rust 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 Call Email Date Time Contact Name Doc.Building Permit Revised 2014 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 OTE: 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 a. Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/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 OTE: 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 4, 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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:Building Permit Revised 2014 00 R TFj Town o _ 6 ndover O No. 146 .141 1z y , �h ver, Mass, 17 (0 A- COC HIG HI wKM 1• 7d A�R-ATEO 1•P��.(5 lS U BOARD OF HEALTH P E I T D Food/Kitchen Septic System THIS CERTIFIES THAT .... 1....... . � ... ....... !rtl ,,, �+v ► BUILDING INSPECTOR .. ....... ................. ................ ��L Foundation has permission to erect .......................... buildings on .. ..... . .... .S4I�!!M.l1..%................ to be occupied as . ....... ..r . .tp.. t.44— ..�,,,,r Chimn . u Rough provided that the person accept ng this permit shall in every respect confd m 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 RoughhVIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST TIO AT Rough Service ........ ........... ........ ........ Final BUILDIN INSPE TOR GASINSPECTOR Occupancy Permit Reguired 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. Terms and Conditions • Contractor agrees to furnish all necessary labor, tools, equipment and materials to complete the work outlined in the scope of services. • Contractor shall provide copies of a valid builder's license and proof of liability and worker's compensation insurance prior to commencement of any work. • Contractor agrees to complete the Scope of Services in a timely and professional manner in accordance with the specifications set forth by the architect and engineers, and in compliance with state and local building regulations. • Contractor agrees to clean all debris from construction only and to keep the job site in a clean and workable condition at all times. • Any materials, products or labor not specifically mentioned in scope of services is not covered under contract and will be paid for out of allowance fund or billed to homeowner (monies denoted in bold next to categories are included in overall price and will be drawn from to pay for materials and installations) • Homeowner (not lender) is ultimately responsible for payment upon completion of services and receipt of invoices. • Anything not specifically mentioned in above scope of services will be billed at$65 per hour,plus materials. • All materials/labor supplied by Silk Renovation/Restoration are warrantee for lyear from date of completion. Stephen Silk 16avid&K4ren Perry Stephen Silk Renovation & Restoration North Andover, MA 01845 MA License # CS-098533 HIC License # 176182 (978)886-0447 CONTRACT: To:David & Karen Perry ReA 76 Chestnut St., N. Andover, Ma 01845 Date: July 29, 2016 SCOPE OF SERVICES: Mudroom: • Remove/replace 4 existing windows • Install new entry door w/side lights • Install new french door unit • New trim to match existing • Insulation and drywall as needed Total: $6500.00 The Commonwealth of Massachusetts z . Z Department of Industirial Accidents I Cong'essStreet,Suite 100 ' Boston,MA.02114-2017 www mass gov/dia sY• Workers'Compensation Insurance Affidavit:Builders/Contractors/Eleetricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. _Applicant Information Please Print Legibly Nate(Business/Organization/Individual): Sj�4� S{W4 9*44 VV.4-:j1 a(A 4' 4,4�R D V- t bel Address: City/State/Zip: iA /.N.0 00 qN- to 6. Phone#: I?ed - k 9(o - d 4 Ll 7 Areyou an employer?Checktlie appropriate box: Type of project(required): LQ I am a employerwith . e Ioyees(fall and/or part-time).* 7. F1 New construction 2.�I am a sole proprietor or partnership and have no employees working for me in 8. Q Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3 Q I am a homeowner doing all work myself[No workers'comp..insurance required.] 10 FJ Building addition 4.F]I am a homeowner and will be hiring contractors to conduct all work on my properly. I will ensure that all contractors either have workers'compensation insurance or are sole 11. Electrical repairs or additions propiletors withno employees. ' 12:[]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.'[]Roof repairs These sub-contractors have employees and have workers'comp.insurance. 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[]Other 152,§1(4),and we have no,employees.[No workers'comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. T Homeowners who sul Egthis affidavit indicating they are doing all work and then hire outside contractors must submit anew 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-c6r&c6s 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 acid jab site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: YJ ob Site Address: t-7(/ �c5Tq� Attach ST- City/State/Zip: t.J0_-<l"190�CR tach a copy of the woxkers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A,copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains �annddp_enalties ofpefyury that the information provided above is true and correct Signature ✓'r Date: l - Z 2 0 i t+ 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): i 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,ox 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 commonNKealth 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 certificates)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 Depax tment of•flidustrial 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 dr 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 permit/license number which will be used as areference 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 permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA.02114-2017 Tel. # 617-727-4900 ext.7406 or 1-877-AIASSAFE Fax#617•-727-7749 Revised 02-23-15 wwwmass.gov/dia /03/2016 12:34PM FAX 7815817866 PANTANO VONKAHLE INSLTRAN 0001/0001 SILKSTR OP ID:RR CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 08102/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: It the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Commonwealth Ins.Partners LLC NAME Pantano/VonKahle Inc N 25 Newport Ave.Ext AU a Exe,617.847.0005 617-847-0006 N.Quincy,MA 02171 E-MAS A/c No; Commonwealth Insurance ADDRESS:VVkreV@aol.com INSURERS AFFORDING COVERAGE NAfC 0 INSURER A.TRAVELERS INS.SERVICE CENTER INSURED Stephen Silk DBA INSURER 0, Renovation&Restoration 33 Perley Road INSURER 0: North Andover, MA 01845 INSURER D: INSURER r;: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OFINSURANCEPOLICY EFF POLICYEXP POLICADULSUBR YNUMBFJt MMID MM/DD LIMIT$ A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE T OCCUR 6801 D513216 04/22/2016 04/22/2017 PREMISES Ea occurrence $ 300,00 MED EXP(Any one Person) $ 6,00 PERSONAL&ADV INJURY $ 1,000,00 OENL AGOREGAYE LIMIT APPLIES PER: GENERAL AGGREGATE S 2.000.00 POLICY❑JEST F LOC PRODUCTS-COMPIOPAGG 5 2,000.00 OTHER: $ AUTOMOBILE LIABILITY COMBINFaU SINGI.F.LIMITS ANY AU70 BODILY INJURY(Par persan) $ AUTOS ED RUTH ULEO BODILY INJURY(Paracddenl) S HIREDAUTOS A OSNON-OTEO (P_e $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIA9 CLAIMS-MADE AGGREGATE $ DED I I RETENTION 5 $ WORKERS COMPENSATION - AND EMPLOYM UA9ILITY STATUTE ER ANY PROPRIETORIPARTNERIEXE-CUTIVE YIN NIA E.L.EACH ACCIDENT $ OFFICERrMMeEA EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yeik descnta under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICYLIMIY $ 095CRIMON OF OPERATIONS 1 LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schadula,may ba atmGhed d more apace la required) This certificate is hereby issued as evidence of existing insurance coverage. CERTIFICATE HOLDER \ CANCELLATION /�✓`' \ 1\ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN David&Karen Perry J ACCORDANCE WITH THE POLICY PROVISIONS, 176 Chestnut Street f North Andover,MA 01845 AUTHORISED REPRESENTATIVE 01888-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACO RD Massachusetts Department of Public Safety a i Board of Building Regulations and Staridards License: CS-098533 Construction Supervisor i STEPHEN A SILK J 33 PERLEY ROAD NORTH ANDOVER MA 01845 r"/ zc; CA—, Expiration: Commissioner 1111312017 ��e V'6YJr77rQircrtp,Q'/�.o�C/tl�.a�sac�u�ell.� _ Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR egistration: 176182 Type: piration: 7/2512015; DBA STEPHEN SILK RENOVATION&RESTORATION STEPHEN SILK 33 PERLEY RD NO.ANDOVER,MA 01845 Undersecretary