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HomeMy WebLinkAboutBuilding Permit #570 - 179 ANDOVER STREET 4/29/2009 BUILDING PERMIT NORTIi o�+,, TOWN OF NORTH ANDOVER o? °`'`- *' '° °�, APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received �gssgT.°us Fi CH Date Issued: L IMPORTANT:Applicant must complete all items on this page LOCATION 1 -75 6Lax S+ Print PROPERTY OWNER NJ } p j 5 t C C G w �--- Print MAP NO: AL—PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no i 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 Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: i S + -foo Id ntification Please Type or Print Clearly) OWNER: Name: Phone: e3(� 40 ViT Address: 7 l OJO c,r s� CONTRACTOR Name: Kit C04sfi 34y, Wl( Phone: ci)8- go�t-08�y Address: PC) &N S-11 L„4k�,W M, olwo Supervisor's Construction License: ?o 13 5– Exp. Date: 21 5-1 1 i Home Improvement License: )L4116 Exp. Date: i 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: $ �I�)� FEE: $ Check No.: � Receipt No.: ( 5�� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor Location /-7 I AA 1 0 Y,t:j z S No. 0 Date f �aRTM TOWN OF NORTH ANDOVER s t * � Certificate of Occupancy $ } Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check ,/)I/ 2t9u3 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 CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS � t 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 124 Main Street Fire Department signature/date COMMENTS t 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 I i I i i ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 s 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 Ii ❑ 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' i New ConstructionFami Sin le and Two ( g 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 ' i I The Commonwealth of Massachusetts kj ! Department of Industrial Accidents Office of Investigations 600 N� ashington Street Boston MA 02111 www.massgov/dia . Workers' Compensation Insiwance Affidavit: Bailders/Contracto A licant I rs/Efeetricians/Pfambers nformation Please Print Legibly ( 1 bly Name(Business/0rganization/[ndividual): J©Se_` 4 In Address: Pro City/State/Zip: Phone#. . Are you an employer?Check the appropriate box: I. 1°am a employer with � 4, ❑ I am a general contractor and I Type of prefect(require: 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.t 7. ❑Remodeling ship and have no employees These su.&contrat tors have 8. Q Demolition working for me in any capacity, workers' comp.insurance. [No workers'comp.insurance 5. 9• (❑ Building addition ❑ We are a corporation and its required.) officers have exercised their 10.❑Electrical repairs or additions 3.[1 I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. o•worke ' [N rs comp. c. 15 - insurance required.]t P 2, e i s. [ and or have no 12.[] Roof repairs re9u ) .employees. [No workers' 13.JZ Other SAN comp. insurance required] "Any applicant flier checks bozo f!I must also fill out the section below showing their workers'compensation policy information, r homeowners who submit this affidavit indicating they are daring all work and than hire outside contractors must submit a new afr1davit indicating such. $Contractors that check this box must attached an additional sheat showing.the name of the sub-contractors and their work rs'camp•policy n fauns en. I ant an employer that is providtng:workers'compensation insurance for np employees; Below it the policy m1d job site information. / Insurance Company Name: 1-1r Policy#or Self-ins.Lie. Expiration Date: 6 '2- o Job Site Address:_ �.7 S City/State2' . Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration dated . 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 u er th airs and penalties of perjury Mat the information provided above is true arrear correct Si tire: t Date: Z � Phone#: —?I61-2` ti— cia1 use only. 1)o not write in this areq to be completed by city or town ociaL ff City or Town: Permit/License# 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#: Liberty Mutual Group Liberty P.O.Box 9090 Mutual. Dover,NH 03821-9090 Telephone(800)653-7893 Fax (603)-245-5330 June 19,2008 I i RE: Certificate of Workers Compensation Insurance Insured: JOSEPH HILL DBA HILL CONSTRUCTION PO BOX 561 WAKEFIELD, MA 01880 Policy Number: WC2-31S-336141-018 Effective: 6 /25/2008 Expiration: 6 /25/2009 Coverage afforded under Workers Compensation Law of the following state(s): IIIA Employers Liability (Limits Sole Proprietor/Partner Coverage Election: Bodily Injury By Accident: $ 100,000 Each Accident is covered by the workers' Bodily Injury by Disease: $ 100,000 Each Person compensation policy. Bodily Injury by Disease: $ 500,000 Policy Limits ' JOSEPH 1111.1. As of this date,the above-referenced policyholder is insured by Liberty Mutual Fire Insurance Co under the policy listed above. The insurance afforded by the listed policy is subject to all the terms,exclusions and conditions, and is not altered by any requirement,term or condition of any or other documents with respect to which this certificate may be issued. This certificate is issued as a matter of information only and confers no right upon you, the certificate holder. This certificate is not an insurance policy and does not amend,extend,or alter the coverage afforded by the policy listed above. If this policy is cancelled before the stated expiration date,Liberty Mutual will endeavor to notify you of such cancellation. AUTHORIZED REPRESENTATIVE LIBERTY MUTUAL INSURANCE GROUP f This Certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as i4afforded by those companies. cc: Insured: Producer of Record: JOSEPH HILL HUB INTERNATIONAL NE LLC DBA HILL CONSTRUCTION 299 B,=1.ILARDVALE ST PO BOX 561 WAKENE"W, TN4A 01880 WILMINGTON, AvIA 01887 6/19/2W8 V4ORTH TO" Of 4Andover V" No. 00 dover, Mass., • O — LAKE �. Co V 7�S RATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.... .N. ... ............... ..... .....!!N........................................... ...................... Foundation has permission to erect..................................... buildings on .... .71..........AftWAV40.1...... Rough to be occupied as.......... ................................. .. . !f . . . . .. . . A ..................1 ..... ................................................. chimney provided that the person acce n this permit shat in every respect conform to th arms of the application on file in P P P g P Final this office, and to the provisions of the Codes and By-Laws relating to the Inspec ion, 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 11 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU STARTS Rough ................... ................ Service S_ ................ECTOR Final Occupancy Permit Required to Ocmpy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry wall To Be Done J FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. - Burner Street No. SEE REVERSE SIDE Smoke Det. 4LLO cTOE — HillW� wo��o ��� rta 5C�ULF -i`+-h s5-�P , s o w E Ivo uw dP' Roofing • Gutters L' K!r Tv 0 i�-TT ? L otAlZ BI rCONSTRUCTION P.O. Box 561 Mo i K - SLAC-K— , Wakefield, MA-01880 _ OA-L- 'I'o C o"J F tf-" You . . (781) 224-0683 Fully Insured `-1161. 414'�- _ Lic.#070135 Reg.# 124918 -- PROPOSAL SUBMITTED TO PHONE DATE Z14- 1z36l STREET Q JOB NAME n p CITY t STATE ZIP JOB LOCATION We hereby submit specifications and estimates for: 'To sof P c,1I t ooh s i ncl,,. .y bur+ -Ta ,5� �l 3' 04, C e A i c, . '-e'A W-,4, C"'-q f c c a'V( W"i r- ult dUv� roos r1o � a.� , ,. a�l vc.Ikey t, �0 1� -�1-1 >?� w.11 6. f,ItJ o' r t• oy.. fcN.a •.,� l-oo<t G.1t0., � w�.�t c. lv ••.,►,v+..ti, wAk ^la �tiytal� q t� c+✓,�C� W t7a�st�,, La>�w,c�x: >0 yew- Price includes removal of all job related debris. `Please note:All items in attic should be covered during roof tear-off. We Propose hereby` to furnish material and labor, complete in accordance with above specifications,for the sum of: q e.J ? O 0 J ' r IK�fti,'ti� (a lt'SI�J VJ 0 644— f 3S 104.15 dollars ($ 1,L/ I Payment to be made as follows: r 0 rdcv� ...K Note: This proposal may be withdrawn by us if not accepted within 3 v days. Acceptance of Proposal: The above prices, specifications and conditions are satisfactory and hereby accepted. You are authorized to do work as specified. Payment will be made as outlined above. Signature ,/! ?z/L Signature Note: Unpaid bills over 30 days subject to 1-1/2%finance charge per month(18%annual). white - customer yellow- return copy pink - contractor Massachusetts- Department of Public Safety Board of Buildimt, Re�-ulations and Standard. Construction Supervisor License License: CS 70135 Restricted to: 00 JOSEPH W HILL Y PO BOX 561 '' WAKEFIELD, MA 01680 �--G-- � -` Expiration: 2/5/2011 j ! nna�i,�i wrr Tr-4: 11341 Board of Building Regulations and Standards lug HOME IMPROVEMENT CONTRACTOR Registration: 124918 Expiration: 9/1112009 Tr# 260016 4o.- 4t, Type: Individual Joseph Hill Joseph Hill 6 DRURY LN. WILMINGTON,MA 01887 Administrator . i it 1 May 17 , 1989 North Andover Historic District Commission 120 Main Street North Andover, MA 01845 Mr . Robert Nicetta Building Inspector Town of North Andover 120 Main Street North Andover , MA 01845 RE:Michael Bider, 179 Andover Street, No. Andover, MA Dear Mr . Nicetta : Please be advised that the above captioned property does not fall within the boundaries of the North Andover Historic District Commission. In view of this fact no certificate of appropriateness is required , nor any review or jurisdiction of this property necessary relative to performing alterations , additions , etc . Sincerely id J. Mi cci Chairman, orth A over Historical District Commission