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HomeMy WebLinkAboutBuilding Permit #803 - 198 MASSACHUSETTS AVENUE 6/9/2010BUILDING PERMIT q\ TOWN OF NORTH ANDOVER.•:_�`'a APPLICATION FOR PLAN EXAMINATION '' ~ Permit No: Date Received TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration [i No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other x F SptcG�ell ,A©odair WeX �.. £`v M�-z�.t'%$' i9 "SzG< h.-•-# 5" gr Wxetlands "`"''W. �� 3i t r k-'w",i �w"�" a Y 'Syi a ti t SheC� astrlGt d' {�lYe �..� t3 e x,4 -�. a.^.;�4 .E�''}:J, _"`�-$`he't:fj .mom s+$ .hTy•l•t`���?R�h, `i k` -'n #.meq,.- f w��.'""i'fir Y".''f'' ;,r .3. DESCRIPTION OF WORE( TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: C LASSiG - ZOAL f T-RuS l Phone. ARCHITECT/ENGINEER J-!;e4C,�/PZ--(t,/ 1%C�,gr�hone: Address:& h- Vim, -rr FF (�. five/ , ,( 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: $ `� 0, FEE: $� Check No.: S( l Receipt No.: NOTE: Persons contracting w�nl^ �tered contractors do not have access to the guaranty fund r' 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- ackaging/Sales Private Private (septic tank, etc. Permanent Dumpster on Site t THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING '& DEVELOPMENT COMMENTS _. CONSERVATION Reviewed on Signature t - COMMENTS HEALTH Reviewed on Siqnature 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 '1 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 ❑ Notified for pickup - Date Doc.Building Permit Revised 2010 _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 o Building Permit Application L3 , Workers Comp Affidavit o Photo Copy Of H.I.C.--And/Or C.S.L. Licenses ❑ Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o- Building Permit_ Application _ o . t Plan Workers Comp Affidavit i ��, o Photo Copy of'A rd C.S. icenses Copy- 0f Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprin r Plan And Hydraulic Calculations -(If Applicable)- Li pplicable) ❑ 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 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 o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract L3 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: Building Permit Revised 2008 Location / / /�`� ' �" �'"' s: No. Date f NORTH TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # 232b5 Building Inspector z E IE _N .05 L N O N C W cm CD cc cm m 0 CD c �C N CD t w O Z O O L _ O O V Z co CL O y 0 C cm o 'OC y O O �E CO cm CD 0 co O 0 0 ca �Q c C� J 'D �O. O D C Z O V h O C: _cc C. LLI ul U) 19 W LU 19 W 0 C y Q 0 H i� dCt o a ;oao H CD NCD C _ w o a w Cc:co V co U- 00 o c a ..a w x00 " V)w `° O o c43 N co w W = = c 2 cn Q o cn E IE _N .05 L N O N C W cm CD cc cm m 0 CD c �C N CD t w O Z O O L _ O O V Z co CL O y 0 C cm o 'OC y O O �E CO cm CD 0 co O 0 0 ca �Q c C� J 'D �O. O D C Z O V h O C: _cc C. 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LJ m A � z msso�xoOo�� c`SaFm o� =:I ?D M b(y� Z n Z z O •7< f*1 5 y �ov�zoD�^ o o c z �D aXX� -0-J Ln o D\ zzC;M HOp m �zr7*0 c� o�sz�� � m�R•azz> z R.=,MR LA 0-0 D�z D 2:5��� . -10, � \ gN ti om � 1fm O °'e'"`n9 No. Pr°jecs:Proposed Office AlterationsRev. Dates: • 02/24/2010 Maclaren Associates LLC A.1 Dr. Muto & Dr. Gordon 03'24/2°'° a/ob/2°io architects planners 198 Mass Ave, North Andover, MA 11 main street atkinson, NH 03811 The Commonwealth of Mtfssachusetts Department o f jradustrial _,accidents Office of faVestigations 600 Washington Street Boston, 112.4 02111 wnnvm.as&-gov/dia Workers' Compensation Insurance�Affidavit: Builders/C �licant Information ontractors/Electricians/Plumbers Name (Business/organizatioti/Individual): Address: v City/State/Zip:_��_�� , �� 07 Phone #: Are you an employer? Check the appropriate box: L ❑ I am a employer with __ 4. ❑ I am a general contractor employees (full and/or part-time).* 2 • an a sole and I have hired the sub -contractors proprietor or partner_ ship and have no employees listed on the attached sheet r working for me in any capacity. These sub -contractors have workers' comp. insurance. [No workers' comp, insurance 5. ❑ We are a corporation and its required.] 3 • El. I am a homeowner doing all officers have exercised their work myself. [No workers' comp. in right of exemption per MGL c. 152, § 1(4), and we have no red re uit required-] employees. [No workers' comp. insuran Type of project (required): 6• ❑ New construction 7. modeling 8 • ❑ Demolition 9. ❑ Building addition 10 -19leetrical repairs or additions I I-[ Tlumbing repairs or additions 12.[] Roof repairs ce regw.red.] 13 0 Other t=Wi' piicant that chair tsor..�t must a?SO iii. out tee secem beios s^o; "^•. + e homeowners who submit this affidavit- tir weI mss' comp— ISO ome s� indicating thy' are do; - "Contractors aL' work and tires hire outside contractors T ist_submiC a new atnaavit indicating such. 'Contractors that check his box must attached an additional sheet showing the name of the sub contractors and their ,u it a n '- "`"` "'" 0"`P1Oyer u:at is providing workers' compensatio information. n insurance for my employees. Below is the policy and j b site insurance Company Name: Policy # or Self -ins. Lie. #. Expiration.Date: Job Site Address: Attach a copy of the workers' compensation policy declarationatr (sh City/State/Zip: Failure to secure coverage as required under Section 25A ofMGL P 152canO lead toe policy number and expiration date). $ne up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the forme of a STOP WORK ORDER and P criminal penalties of a Of up to $250.00 a day against the violator. Be advised that a copy of this statement may f forwarded to the Office a a fine Investigations of the DIA for insurance coverage verification. 7 A- L--- L- v ,�' "JJ' K"Uar me piuruand penalties OfPer%urJ' th4rt the information provided above is iFue and correct fiir— / l _ Official use only. Do not write in this area, to be completed by city, or town o fficiaL City or Town: Perraira-1cense # Issuueb Authority (circle one): L Board of Health 2. Building Department 6. Other City/Town Clerk 4. Electrical Inspector Contact Person: Phone #: 5, Plumbing Inspector Information an- d Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including t:]ie legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association o$ 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 ofanother who employs persons to do mamte3nance, 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 stateor local licen 'singagency shallwithhold the issuance or renewal of.n 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 ofpublic work until acceptable evidence of compliance with the insu=rance 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 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' comp =sation 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 sore to sign and date the affidavit. The affidavit should be return -=1 to the vies or town that the auvucaut3n for the permit or Ecevse :S being rea=-s*.ed, not the 3epa' to a tt OI Industrial Accidents. Should you have any Questions regardin-g the law or if you are required to obtain a workers' compensation policy, please call the Department at the numbe=r 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 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 13=7nits 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 Office ofInvesfigations would Irlce to than 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 andiag number...- . \ The Commcanwealth of Massachusetts Degar tent of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 021.11 Tel. # 617-72.7-4900 =,--t 4;06 or 1-8 77-MASSAFE Revised 5-26-Q5 Fv, f617-727-7749 )xrvm-.mass- gov/dia. 'Niasslichustus - Depill-tillent of Public S.Ife, Bom-d of Building Regukiliows and Standards License: CS 47660 Restricted to.: 00 WADIH E RAMEY.--, 25 GOLDEN OAKS DR SALEM, NH 03079 Expiration: I/1/2012 Tr#- 14130 Tuesday, June 08, 2010 5:26 PM Wadih Ramey 160345$'1706 P.01 OFFICE OF BUILDING II $Pr;(;TOR TOWN OF NORTH ANDOVER C0Pti§MUCI1®N, Y- . . 11"1:1.2 ;'0 MTN PROJECT LOCATIow NAME OF BUILDING:— 61:13 NATURE OF PROJECT: IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, - -81� �-.-� N ii A, i.0.� REGISTRATION NO., BEING A REGISTERED PROFESSIONAL ENGINEERtARCHIT'ECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL, DESIGN PLANS, COMPUTATIONS AND SPECIFICATI64S 'CONOERNING: ENTIRE PROJECT 'v ARCHITECTURAL. a STRUCTURAL a MECHANICAL FIRE PRQTECTION a ELECTRICAL ® OTHER (SPECIFY) _ FOR THE ABDVE (NAMED PROJECT FIND THAT, TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND 8 EfRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PISR100IC OASIS TO DETERMINE THAT THE WORK IS PROCEE1=DING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 7. Reark .+, for owformuxe to the deqIgn concept, Shop dryings, samples and oUw submittals which are GU mlitted by the corltraGV In accordance month the r9quire:r7►e;11tS of tho cons niction documents. 2. Reulew and approval of the quality oontrcl procedures for all coda -required controlled materials 3. 130 prewt at irtlterVS18 approprWe to ew stage of cep Wuetlon to homes, gen"ally famIllar witeft pTIVen and quallty of the vcrk and to d rine, in general, If there M La being parbrned 111 a "wnBr COnWbtwt Mh the cOnstriuciton documents. PURSUANT TO SECTION 116.2.2 1 SHALL SUBMIT WEEKLY, A PROGRESS REPC)RT TOGETHER WITH PERTINENT COMMENT$ TO THE NORTH ANDOVER BUILDING INSPECTOR. UPON COMPLETION OF THE WORD, I SHALL SUBMIT FINAL REPORT AS T)q THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR (70 PMCY. SU8SCRI AND,,Ms O BEFORE ME THIS ,..`.DAY OFLu � NOTARY PU SLI C MY COMMISSION EXPIRES � � � Z- � 2Z> � C7 MAY -24-10 08:21 PM MU-1-U—UUKLJIJN 'V r •rsw r w•rti r c Ramey Team Builders PMB 382 216 South Broadway Salem NH 03079 Dr Muto and Dr. Gordon 198 Mass Ave. North Andover Ma For the sum of S 24990.00 we propose to do the followings: Demo the proposed area as per pians, Install all Vactrical and HVAC and plumbing as per plans, Patch all areas(ceiling,walis and floors) as per pian. Install now carpet in the front lobby. Painting the propose area to match existing. Payment to work as follows: S 8000,00 up on signing the contract. $ 8000.00 after rough inspection 8990.00 up on oempletton, G wadifh y Date L Dr, Muta DaS Date Ph/Fax (603)4581706 em6il:wremey73@comcast.net lei 9 ` x------ cn Xe I I I I A 13daVO 10A I > Z m M 0 13dW 1�A x 0 C: lino z � r GANA 39 1NW > o 1 m > .Zpl m I _ H I 13daV3 a L9 moi\ Quo N � O O z ammt m. 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Dates: 02/24/2010 Maclaren Associstos LLC A. � Dr. Muto & Dr. Gordon 03'24'2°'° 04i06.2010 architects planners 198 Mass Ave, North Andover, MA 11 main street atkinson, NH 03811