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HomeMy WebLinkAboutBuilding Permit #111-2017 - 190 CHICKERING ROAD 8/8/2016 NORT}a '9 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#• 7- Date Received �'"�R„rEo ` gSS�cHus�c Date Issued: IMPORTANT: Applicant must complete all items on this page ©. �d C/Al t r �,LOCATION L/Z� L.�JI(.G I� � Print PROPERTY OWNER JAVA Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes o 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 .tl ;. Floodplan� ®1Nef�an.ds� Wa-e e D V. •❑ FE r # -�,, _, - -. �� ®I titer/,Sewers - DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Tgrve Phone: Address: 224 Contractor Name: �/rG0,9tq ✓v�/ Phone: 97� - �Sr- Z�7 Email: Gv�r ..@ Co4w s r e /,V4-/'' Address: ?d- ( o SSC ► //Zc� 7��2Ru-'= Supervisor's Construction License: e5 Exp. Date: Home Improvement License: 3 7 2 Exp. Date: ARCHITECT/ENGINEER Phone: -" Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$$12y5.00 PER S.F. Total Project Cost: $ ��'i!,D '� FEE: $ �/ Check No.: ® Receipt No.: NOTE: Persons contracting with unregistered contractors do pot have access Co4e guaranty fund 41 j . ��. ' t ��� F .tlt4,'`4Ycwr ? _. �. .4 �-:e IQ 5`°.a-.��®� •. -. � - Location 4/ No. Date i • - TOWN OF NORTH ANDOVER ' Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ C�� Other Permit Fee $ . _ TOTAL $ 'f Check# 53 Building Inspector' . 30695 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans .0 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 o U FORM R; PLANNING Cox DEVELOPMENT Reviewed On Signature_ i COMMENTS i 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 DEPARTiME'•N Temp-.Dumpsfier on site*x.'yes�,. .,� Locate124 Main►Street " wfi3�i' �. t _ . � � -rr � 'F it lreluepartmentsignature/date *e4 . �"le`'+Pr s'7�LCO MMENTS- j!R fA2R a'�-.F•"1('a(/a.�' ..{/ .�"'-4vt 4 ♦ ♦ rf. d71•,..� 1- 1 ♦t..Ste..x!•!•�'Fys 1.•: .!\ .,> L •'t` ,x ii 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 N® MGL Chapter 166 Section 21A—F and G min.$10041000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pmnit 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 4 Building Permit Application 4 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 Permit Building P Application 4 Certified Surveyed Plot Plan 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) 4- Building Permit Application 4 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 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 itORTH Town . of 2 �: _ aAndover No. LANE h ver, Mass, A IL *2 COC C."K M.I[.[ Sm y7. ATE PP � S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .......+ 164.4*...1`.'l.S�,K. `-- ,,,,, BUILDING INSPECTOR .... ......................... ........... ... ��� • . �. Foundation has permission to erect .......................... buildings on .............. �.� .... .A.. Rough tobe occupied as .........'.'�y��. .......................................................................... . Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Y4 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST ION Rough Service Final BUILDING IN.44 CTOR GAS INSPECTOR Occupancy Permit Required 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. )e;pc> 7)AAcz-;F- A4+ ep lei ,77e -3 44� IqA— 66P -- 722 OF � S fie- _/AL 0— -- 7- _ Ll a5c 0)aC�'or�'1cr Cgs m _ Jahr _ S - The Commonwealth of Hassgehusetts Department of Industrial Accidents F d X Congress Sheet,Suite 100 'd Boston,MA 027X4 2017 S R ,Y Workers,Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE'MED WITH THE PERIYDT'i'Il�TG AUTHORITY. . Applicant Information • Please Print Legibly Name(Business/organization/Individual) ���/�G'rtG•c. C/� ��G/Gtth� Address: Az Sae`W City/State/Zip: one Areyou an empIoyer?Checktl"ee appropriate box: Type of project(required): 1. I am a employer with .17 i employees(full and/or part-time).* 7.. []New cozistruction 2.01 am a sole proprietor or partnership and have no employees Working for me in 8. E]Remodeling any capacity.No workers'comp.insurance required.] 9. ❑Demolition I Q I am a homeowner doing all work myself,[No workers'comp..insurance required.] 10 n Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11. Eleotrical repairs or.additions proprietors withno employees. 12:[71 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.-0 Roof rep airs These sub-contractors have employees and have workers'comp.insurance.; 6.0 We are a corporation pad its officers have exercised their right of exemption per MGL c. 14.F]Other dl��sYiA/l-- 152,§1(4),and we have no,employees.[No workers'comp.insurance required.] F FXo ff 9" *Any applicant that checks bdx#1 must also'fill out the section below showing theirworkers'compensationpolicy information. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tConiractors 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. Ifthe sub coriiractors Tuve employees, ey must provide their workers'comp.policy number. Iain an employer that is providing workers'compensation insurance for my employees.'Beloit/is the policy acid job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Z �;`�2-/6 4_' Expiration Date: � ``T (Z U114 Vr 2.0 Job Site Address: Mo /1,dTypWWct{ Attach a copy of the woirkers' 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 and penalties ofpetjury that the information provided above is True and correct Date: Si afore: 3 2c Phone#: 3 Offacial 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 them•employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract bf hire, express or implied,oral or written." An employer is defined as"an individual,partnership,asso ciation,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enferprise,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 common-y�ealtlx 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 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 fok confirmationofinsurance 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 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 burn 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 TeX. # 617-727-4900 ext.7406 or 1-877-MASSAFE Fax#617-•727-7749 Revised 02-23-15 wwwmass.gov/dia Massachusetts -Department of Public Safety Board of Building Regulations and Standards construction Supervilsor License: CS-050281 WILLIA"J ZANI� 806 SALEM RD DRACUT MA 0126 uul� Expiration - Commissioner 10/15/2016 ��e--(rrjam�rtancuecr�l�a�P/G�cra�cr�u:telt. Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR egistration: 180372 Type: j xpiration .11/10/2016 Corporation _ - M1 WILLIAM J.ZANNONI INC=, WILLIAM ZANNONI ft' 806 SALEM RD g � ,T DRACUT,MA 01826 Undersecretary I, MetLife Auto&Home® Homeowner Operations Field Claim Office Attention:Claims P.O.Box 6040 Scranton,PA 18505 (800)854-6011 Ift July 18, 2016 North Andover Building Inspection 1600 Osgood St, Suite 2035 North Andover, MA 01845 Our Customer: Scott Granowitz Claim Number: JDG14066 DU Date of Loss: July 15, 2016 Dear North Andover Building Inspection: Pursuant to M.G.L. 139 § 313, please be advised that a property loss at the address referenced below has =_ been estimated to have damage to the dwelling or other structures that will exceed one thousand dollars. —_ Please let us know within ten (10) days if there is a pending or existing lien against the property as -_ provided by M.G.L. 139 § 313, or if there is an intent to initiate proceedings to perfect such a lien. Loss Location: 190 Chickering Rd Unit 213d,North Andover, MA Sincerely, I Don Gemmell Metropolitan Property and Casualty Insurance Company Claim Adjuster (800) 854-6011 Ext. 7434 Fax: (866) 947-3698 Email: dgemmell@metlife.com i MetLife Auto&Home is a brand of Metropolitan Property and Casualty Insurance Company and its affiliates,Warwick,RI. MPL MA-REGDEPT Printed in U.S.A 0698