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Home My WebLink AboutBuilding Permit #698 - 181 JOHNNY CAKE STREET 4/30/2007DESCRIPTION OF WORK TO BE PREFORMED: g 1 o c. k 'To e '(Z eQ' A -e a T �'fz d Qj q 2(43 e Identification Please Type or Print Clearly) OWNER: Name: Pao\ o :X-ri C 4) N.n o Phone: ci-7%- 6%I Address: 1'-6 i otic n -e- L e CdNTRACrtC?RName .g sw Phone Address: ,. u _7-7 . apery sci Canstru.-tion L ic6n a .:C Date ." r -_ ; Hirnprpvemr�r�tL�cense. t rr 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: $ r 7 S� FEE: $ -50 1 Check No.:��v Receipt No.: 90 1 S^ NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor, J Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS TE REJECTED DATE APPROVED CONS ERVATI��A'I�C2'� COMMENTS_Mhc 4 OR DATE REJECTED DATE AP ROVED HEALTH ❑ �; �C COMMENTS- 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 ❑ I Zoning Board of Appeals: Variance, Petition No: Planning Board Decision: Comments Conservation Decision: Comments Zoning Decision/receipt submitted yes 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 MGL Chapter 166 Section 21A —F and G min.s100-s1000 fine No Doc.Building Permit Revised 2007 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 a 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 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 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 o Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products 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 2.2007 Location No. Date v' NORTh TOWN OF NORTH ANDOVER F A ` Certificate of Occupancy $ • °� ...mss... >' + ,�� Building/Frame Permit Fee $� "us Foundation Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #,- 20'i 20'i 5 5 - U Building Inspector o v � O O z F CA w a .yy `°c nrui F= W .E � °o w � a c9i A o1 o w o cG U G w _ o r�G c w 9 W o 1: cm G � oc a: w W rA cn o cn E 5c .cam 0 0 O y C : 0 Ci �CCUL A `m C o 4•. 10 O z 5 C* O y o� W LLI 19 LLIW U) mf�nc 03 CA .yy `°c nrui F= W .E 0.. C. "o ca m • GoCL CZ m� _ a `m's ago4- 5 C* O y o� W LLI 19 LLIW U) TESTA Building and Remodeling 5 Appleton Street North Andover, Ma 01845 (978) 682 2023 Proposal April 9, 2007 Proposal Submitted To: Kim and Paolo Incampo 181 Johnny Cake Lane North Andover, MA 01845 Job: Home Phone: (978) 681-0353 Work Phone: Job Description: Obtain building permit Complete removal of all demolition and construction materials generated by Testa Building and Remodeling and its subcontractors. CONSTRUCTION: Support the exsisting sun room . Dig out under the sun room and put in a foundation and frame a knee wall to re support the room. Frame out a garage door opening and clap board to match exsisting siding. Install a stone retaining wall along the back yard. Prep the drive way for hot top. NOTE: NO ALLOWANCE FOR PAINTING.,STAINING OR HOT TOP A finance charge of 11/2% per month (18% per year) will apply to all accounts over 30 days past due. In the event collection activity is required the customer shall be responsible for all costs associated with collection, including reasonable attorney's fees. 1 propose hereby to furnish material and labor complete in accordance with above specifications, for the sum of: $25,750 Twenty Five thousand Seven hundred fifty dollars One-half to start, one-half upon completion. Authorized I reserve the right to cancel this contract if not accepted in_30 days Signature Signature The Commonwealth of Massachusetts Department of Industrial Accidents 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): Te :s;+ 'a �j � � ,�,t � Q_tMcy4 r„ k ;w - Address: S A p o I .c, + Q v 5 -J- City/State/Zip: !yo -�/� v' t_ /)njo Phone #: 517 F- 6 9 a- -- 3 Are you an employer? Check the appropriate box: l . ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors >.. ®.I am a sole proprietor or partner- listed on the attached sheet. t ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance required.] ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other _.,y appu�au, u]at cnccKs oux s I must arso nu out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing ail work and then hire outside contractors must submit a new affidavit indicating such. *Contractors 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. I do hereby certify der the pains and penalties of perjury that the information provided above is true and correct. Si nature: Date: t -0/0 ? Phone #: t 9"? f - 6 F �,- __),a1 -I. 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 #: Building and Remodeling 5 Appleton Street North Andover, Ma 01845 (978) 682 2023 Proposal April 9, 2007 Proposal Submitted To: Kim and Paolo Incampo 181 Johnny Cake Lane North. Andover, MA 01845. Job: Home Phone: (978) 681-0353 Work Phone: Job Description: Obtain building permit Complete removal of all demolition and construction materials generated by Testa Building and Remodeling and its subcontractors. CONSTRUCTION: Support the exsisting sun room. Dig out under the sun room and put in a foundation and frame a knee wall to re support the room. Frame out a garage door opening and clap board to match exsisting siding. Install a stone retaining wall along the back yard. Prep the drive way for hot top. NOTE_ NO ALLOWANCE FOR PAINTING -,STAINING OR HOT TOP A finance charge of V/2% per month (18% per year) will apply to all accounts over 30 days past due. In the event collection activity is required the customer shall be responsible for all costs associated with collection, including reasonable attorney's fees. I propose hereby to furnish material and labor complete in accordance with above specifications, for the sum of: $25,750 Twenty Five thousand Seven hundred fifty dollars One-half to start, one-half upon completion. Authorized I reserve the right to cancel this contract if not accepted in -30— days Signature Signature ; Bo�"coo u� ung egu atio9K an , am I", HOME IMPROVEMENT CONTRACTOR ` Registration: 120296 Expf _ �jjQj .1;1/19/2007 -13A TESTA BUILDING II< REMOA>�1It.G JAMES TESTA v j 5 APPLETON STRJ; N.ANDOVER, MA 01845 Administrator J J ING REGERVISOR O OF N SUP BOARD 1 VB ticense: O54 � pumber: GS 1 06Ip911965no..145:0 Birthd2�� Tr. R i Expires: �08120p8 �.f Re�trlcted: 00 M TESTA JAMIEBETON ST 18gg Commissroner ' N ANppVERI;AA 0 - t _ - Wx `S' - V) t 2 (j) (4- o -) Z -a T + o .- ? (V i o e-) 0 ol '7 No K MA Date ..� ......... 11 pry` .eo ,• 'BYO TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .� �. �� !.' ...?°� �>l .................... has permission for, gas installation.. in the buildings of . ht e. Z4 -p P ........................... at�......... ., North Andover, Mass. Fee. 7! ..... Lic. No./ .?.`is .. -...4-:. � ` ....... GAS INSPECTOR / Check # t110 7266 i 41 N I MASSACHUSETTS UNIFORM APPLICATON FOR PERNIlT TO DO GAS FITTING (Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations /c1? �.� Owner's Name New _X" Renovation El Replacement ❑ Permit # Amount $ r,11_91 Plans Submitted (Print or typa) Name_ Address __ , Ak!-� A4gF S'/-- / Name of Licensed Plumber or Gas Fitter Check one: Certificate Installing Company ❑ Corp. ElPartner. Firm/Co. INSURANCE COVERAGE Check one:,,. -- I have a current liability Insurance policy or it's substantial equivalent. Yes w No If you have checked Yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑ Other type of indemnity Bond Owner's Insurance Waiver: I am aware that the.licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 1:3 Agent 0 I herehv certifvthat ail nfti.. .,«a • , -11. -.-U kUl ciiLcrcu) in aoove application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusett tat Gaffs Code andC japter 142 of the General Laws. Title City/Town OVED (OFFICE USE ONLY) Signature of Licensed Plumb Oy Titter ED-131umberf k0 Gas Fitter icense ` Number OrMaster In Journeyman d ri rk U 6y n m dZ y O p W FW w a GC7 H x w a z W dp CG a w F x a Q Z W Q r F d W tO� > w F rU� a rZ F W W x > o W x Z x 3 C4 Q t O O w C4 p r: H SUB-BASEM ENT c U a u z > B A S E M ENT 1ST. FLOOR 2N'D. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7 T R. F L O O R STH. "FLOOR (Print or typa) Name_ Address __ , Ak!-� A4gF S'/-- / Name of Licensed Plumber or Gas Fitter Check one: Certificate Installing Company ❑ Corp. ElPartner. Firm/Co. INSURANCE COVERAGE Check one:,,. -- I have a current liability Insurance policy or it's substantial equivalent. Yes w No If you have checked Yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑ Other type of indemnity Bond Owner's Insurance Waiver: I am aware that the.licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 1:3 Agent 0 I herehv certifvthat ail nfti.. .,«a • , -11. -.-U kUl ciiLcrcu) in aoove application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusett tat Gaffs Code andC japter 142 of the General Laws. Title City/Town OVED (OFFICE USE ONLY) Signature of Licensed Plumb Oy Titter ED-131umberf k0 Gas Fitter icense ` Number OrMaster In Journeyman N r The Commonwealth of Massachusetts' Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers nniirant Tnf....__4:__. Name (Business/Organiza6on/Individual): Address: !� _`��.- City/State/Zip: Jai � ir--c---' e on #: �� ✓� 2r �aJ Are you ag.employer? Check the appropriate box: 1 • ,r am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet I s and have no employees working for me in any capacity. NO workers' comp. insurance required.] M 3. ❑ ream a homeowner doing all work myself. [No workers' comp. a insurance required.] t These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL C. 152, § 1(4), and we have no employees_ [No workers' COMP. insurance required.] * -.ny arplicant that che&.s boy: #1 must alst} irll out the Becton below Bb^ Homeowners who submit this affidavit indicating thev wz^^ -�� • L � b t• on-ers, compensation policy information. #Contactors that check this box must attached an addi t are doing all work and thea hire outside contractors must submit a new affidavit indicating such. ti' are sheet showing the name of the sub -contractors and their workers, comp. policy information. "am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11 -El Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other 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. I do hereby cerci nder the pains andpenalfins ofperjury that the information provided above is true and correct Date.: Official use only. Do not write in this area, to be completed by city or town official City or Town: Issuing Authority (circle one): 1. Board of Health 2. Building Department 6. Other Permit/License # 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector Contact Person: Phone #: Information an d 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 perrson 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 completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their cerdficate(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 maybe 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 tovm that the appiicatioz for the permit or license is being requested, not the Department of Ind�ustrrial Accidents. Should you have any questions regardigg 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 permit/license number which will be used as a reference 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 beenn 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 perinits 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 lndustriaJ Accidents Office of hvestigations 600 Washington Street Boston, MA 021.11 Tel. # 617-727-4900 ext4Q6 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-72.7-7749 v mrw.mass.- aov/dia