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HomeMy WebLinkAboutBuilding Permit #1337-2016 - 2 UNION STREET 6/27/2016 I BUILDING PERMIT t%,FSLEPX" _. TOWN ®F NORTH ANDOVER �= h:', .. '' . APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received DRHjEEO) gSSACHUSE� Date Issued: I PORTANT: Applicant must complete all items on this page LOCATION PROPERTY OWNER 18 O 0 AI 4A ri 9,eY k, Print //// 100 Year Structure yesOnoMAP PARCEL: ZONING DISTRICT: `7"'Historic District yesMachine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition C/Two or more family ❑ Industrial 'fl Alteration No. of units: 3 ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other El Septic ❑Well ❑ Floodplain 0 Wetlands ❑ Watershed District 0 Water/Sewer nn / DESCRIPTION OF WORK TO BE PERFORMED: !J CL-4 / -00 o..,t it e A4-c Q e/(rt, t' G 4 C. Lt /2-e A-c-o We/t`� Identification- Plealp Type or Print Clearly OWNER: Name: Ayq a(sN A Af cl aey&Iy Phone: 3 3 9-Y Y o TZ 3 1 Address: V k O ov S4A./ 0 vet A/ Contractor Name: �o Al A-1 a e- 4,�(/Phone: 3 — 4/ O — 2 Email: &V iL e !c,`v 1N[ a i M Address: at, , pk Sf 1U nrd o vek GL1 t� Supervisor's Construction License: CS `102 �7F Exp. Date: 0�'19S_/ t C9 Home Improvement License: Exp. Date: 240102 01,�7_- j ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON.$125.00 PER S.F. Total Project Cost: $ ,90_00, O_AO FEE: $ r'0 Check No.: J �61 Receipt No.: N TE: Per s contracting with unregistere contraotors do not have access to the guaranty fund Plans Submitted ❑ dans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWER-AGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF e U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zor-ing Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Pltunning Board Decision: Comments Conservation Decision: Comments !later& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE,-DEPARTMENT - TemptDumpster on-site .y-es., L6catedjdt'-1.241Mb0tStreet Fire De artmerit.si nature/date COMMENTS. - i Dimension Nus giber 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) ® Notified for pickup Call Email Date Time Contact Name €......_......................_....._ ------–=------------ ------ — I Doc.Building Pennit 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 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 Pp 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 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 t I Location No. 3 7-2 G� ' Date i r • - TOWN OF NORTH ANDOVER 5 Certificate of Occupancy $ Building/Frame Permit Fee $ /6 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# '1 „ � Building Inspector17 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 93000.00 m $ - $ 108.00 Plumbing Fee $ 13.50 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 13.50 Total fees collected $ 235.00 2 Union Street 1337-2016 on 6/27/2016 bath and kitchen remodel first floor r 1 i XtAORTH Tt . .W" '. . Y . " ve" 'e 0 No. 1 ?61 _ ?, h ver, Mass �I 7 2�® o > > coc ICKIWICK 1. �d�AOR�TEO PPP`y'�5 1S V BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT BUILDING INSPECTOR ............. . .....dtj.G/!�F ........... e..•� t Y/c�1/... ......... ........... has permission to erect � uIW Foundation p .......................... buildings on ...... ............................:........ ............... Rough to be occupied as ....../..... ` ..... IMI. ............... ....... !. !!�..... Chimney provided that the person accepting this permit shall in every respect conform 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 Inspe n,Alterati nd 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 TIO Rough Service .. ..... . ......... ............ .... Final 1 B.UILDIN SPECT R GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. IKEA Home Planner Printout http://kitchenplanner.ikea.com/US/UI/Pages/Printouts/VPUISummary... ffi 2 union st - Plan View All measurement in inches Q r1aM A 0000-9351-3120 in 77 f 27 0 24 14 131161 14 !1 TTpl zz i m I, Q d B 111 24 2 of 5 6/20/2016 11:02 PM IKEA Home Planner Printout http://kitchenplanner.ikea.com/US/UI/Pages/Printouts/VPUISumniary... --�-- 2 union st bathroom - Plan View All measurement in inches 0000-9351-3133 4 i O O 9/16 !q !B 25 30 2 union st bathroom - East (Wall All measurement in inches 0000-9351-3133 32 ! i rJ i _ e2 i 32— — 2' 2 or 2 6/20/2016 11:00 PM TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street,Building 20, Suite 2035 *. North Andover,Massachusetts 01845 Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICAA.TtON Please print DATE: p� La ?Zl? 0156 JOB LOCATION: Number Street Address Map/Lot HOMEOWNER 4&WkeYl-IV v3 © 7a 3 f N me Home Phone Work Phone PRESENT MAILING ADDRESS X fftff`t�YV S-1- Ala City Town State Zip Code The current exemption for"homeowners"was extended to include owner occupied dwellings of one or two family dwellings and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one-or two-family dwelling,attached or detached structures accessory to such use and/or faun structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner.(780 CMR Section I IO.R5.1.2) The undersigned"homeowner"assumes responsibility for compliance with State Building Code and other applicable codes,by-laws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Departinent minimum inspection procedures and requirements and that he/she will com with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 8.2015 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 The Commonwealth of Massgchusetts f .Department of IndustrialAccUents 1 Congress Street,Suite 100 - Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/ElE le ctricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information ` Please Print Legibly NaMe(Business/Organization/Iudividual): .Address: R 1 /4- City/State/Zip: a/A✓ 114- O! 9 02 Phone##: 3 3 5 Are you an employer?Check&e appiopriate box: Type of project()Vequired): I.Q l am a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees Working for me in $.Remo doling any capacity.[No workers'comp.insurance required.] ' 9. E!Demolition 3..❑I am a homeowner doing all work myself.[No workers'comp-insurance required.]t ❑ 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. l will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole I L C1 Electrical repairs or additions proprietors with no employees. ' • 12..d 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.1 6.rWe are a corporation and ifs officers have exercised their right of exemption per MGL c. 14.❑Other e ees o workers'comp..insurance required.] 152,§1(4),and we have no..,ra _ [N p q ] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors niust submit anew affidavit indicating such. (Contractors that check this box must•attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have -eraployees. If the sub-contractors have employees,t i must provide their workeis'comp.policy number. X am' an employer that is piovidiing workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: I�c R Q-V e,le-2 (Ali) �7 Policy#or Self-ins.Lie.#: (,{ `,Z Expiration Date: 3 -.S) - 119 /O�p— Job Site Address: a4 u ti c`�"V S City/State/Zip: �n 1/ iq/e V'1 A_yWo Attach a copy of the workers'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 fol warded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify under the par s a penalties of perjury that the information provided above is true and correct. Si nature: Date: f 4 1,90 Phone#• Z3 3 9 — Z(V0 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`o liire, 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 enferprise,and including the legal representatives of a deceased employer,or the receiver or trustee of art 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 anotherwho 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 b6 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=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 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 or if you*are required to obtain a workers' compensation policy,please call the Department•at the number listed below. Self-in"sured companies should'enter-their self-insurance licenso 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 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 Tel.#617-727-4900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia ` CERTIFICATE OF LIABILITY INSURANCE DATE(M20/201 YYYI Tk6coOERTIFICATE 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:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: QUARANTELLO INS AGCY INC PHONE FAX 91 HUTCHINSON ST (A/C,No,Ext): (A/C,No): E-MAIL REVERE,MA 02151 ADDRESS: 75YPL, INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERS INDEMNITY COMPANY OF AMERICA CREATIVE CONSTRUCTION SOLUTIONS INC INSURER B: INSURER C: INSURER D: 22 FEARLESS AVE APT 2 INSURER E: LYNN,MA 01902 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. INSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIDMYYYY) (MMIDDIYYYY) LIMITS GENERAL LIABILITY ACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE F__1 OCCUR. PREMISES(Ea occurrence) ff::: MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY [:J PROJECT ❑LOC PRODUCTS-COMP/OP AGG $ I AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE.AUTOS (Per person) HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION ANDX WC sTATUT OTHER EMPLOYER'S LIABILITY Y/N UB-2E81723A-16 03/31/2016 03/31/2017 LIMITS ANY PROPERITOR/PARTNER/EXECUTIVE E] N/A E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE i$ 100,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below 500,000 DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION BOGDAN ANDREY KIV SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED 2 UNION ST. IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENT VE NORTH ANDOVER,MA 01845 0 *� ""-- ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved.