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HomeMy WebLinkAboutBuilding Permit #275-14 - 201 DALE STREET 9/25/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: � Date Received Date Issued: I ORTANT: Applicant must complete all items on this page LOCATION �� , ZE ST /, Print PROPERTY OWNER/ '.f iv�E ,�?i Print 100 Year Old Structure yes MAP NO: u 7 PAR CEL:0-Y-3 ZONING DISTRICT: Historic District yes Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Buildingne family ❑Addition ❑Two or more family ❑ Industrial aeration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: ,�i7e�,lGY�.N j��i¢Pldu3 �.' ���G;?le� %x��rt�/J Drd.s�✓,tz��/��� le oe T Identifi ation Please Type or Print Clearly) OWNER: Name:T, Phone: 'ZSR" Address: e;P/ y- CONTRACTOR Name: te"r 1141-1 Phone: Address: �y3 iet1, / Sl• f�/ryG,, 0-41 Supervisor's Construction License: ef-12WIe— Exp. Date: 23 Home Improvement License: ��3/�S� Exp. Date: 4, / ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$/12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �� FEE: $ Check No.: /OCA Receipt No.: ' ,6 01 NOTE: Persons contracting with unregistered contractors do not have accesh 6o th gu Ir fund Signature of Agent/Owner Sig _ature of contracts 1 11 Plans Submitted ❑ Plans Waived 0 Certified Plot Plan ❑ Stamped Plans /e Location No. ��� Date • - TOWN OF NORTH ANDOVER 5 End • Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# Building'lnspector Plans Submitted ❑ PlansWaived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE_OF SEWERAGE:DiSPOSAL Public Sewer ❑ Swimmin Pools ❑ Tanning/Massage/Body g Art ❑ Well ❑ Tobacco.Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc.. ❑ Permanent Dumpster onSiteEl i i 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 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments r Water & Sewer Connection/Signature& Date Driveway Permit 1 `DPW Tow . Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -TempDumpster on site yes no— Located-at 124 Mair Street Fire Departinent signature/date' COMMENTS 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 ® Notified for pickup - Date s I Doe.Building Permit Revised 2010 Building Department The fol;owing 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 o Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract a 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 ❑ 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 New Construction (Single and Two Family) Li Building Permit Application o 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 apt),-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm-tted with the building application Doc: Doc.Buhding Permit Revised 2012 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 8,866.00 m $ - $ 106.39 Plumbing Fee $ 13.30 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 13.30 Total fees collected $ 232.99 201 Dale Street 275-14 on 9/25/2013 Bedroom Renovation NORTH Town of .. t E -.4" Andover O :z-. ver, Mass, �� 3 .(� COCNICKl WICK 1' S U BOARD OF HEALTH Food/Kitchen PERMIT T LD y Septic System THIS CERTIFIES THAT ���:'! ,(fivG� BUILDING INSPECTOR ... ....... ....................... ........................................................... a o/ &/6 Sr Foundation has permission to erect .......................... buildings on ............................................................................. Rough to be occupied as ... �1.': ° V.............Q...,-,, „ `; bar. .`r.'............................... 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 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 CONSTRUCTION STARTS Rough Service ........... .. __ ..... .............. BUILDING INSPECTOR Final 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. SEE REVERSE SIDE Smoke Det. --'^� OP(D:BR ,�cc�►Rrc�. CERTIFICATE OF LIABILITY INSURANCE DATE(M111191209120 2 �•--� 1 2 THIS CERTIFICATE 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poliey(ies)must be endorsed. It SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). ONTACT PRODUCER Phone:978-688.7000 CAM., Durso&Jankowski Ins Agcy LLCPHONE FAX 198 Massachusetts Avenue Fax:978.688-7001 AIC No Exti: _ _____(AIC,No): North Andover,MA 01845 f-Mna. _ Durso&Jankowski Ins.Agcy. ADDPRORESS: _ . ER CUSTOMER 10 7{:PREV I-4 INSURER(S)AFFORDING COVERAGE NAIC# INSURED Ace Home Medics LLC INSURERA:Main Street America Assurance 14788 57 Harold Parker Road . Andover,MA 01810 INSURER B:Guard insurance Group INSURER C: INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELO`N 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 ratAY 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.....___ .._ADDL:'SUBR ... - .._ _. POLICYEFP POLICYEXP-...... LTR TYPE OF INSURANCE i POLICY NUMBER MMIL&P YY MMiDD,YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 'DAMAGE 10 RENTED A X COMMERCIAL GENERALLIABIL:TY MPT9681C 12/15,12012 12115/2013:PREMISES(Eaoccurrence). 5 _ 5500,00 CLAIMS-MAGE = X OCCUR SMED EXP(Any one person) S 10,00 PERSONAL&ADV INJURY S 1,000,00 GENERAL AGGREGATE S 2,000,00 GENT AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP!OP AGu S 2,000,00 ' RO- _ _ �. POLICY : Pr LOC S AUTOMOBILE LIABILITY COIABINED SINGLE!IM;T S (Ea acodent) ANY AUTO BODILY INJURY:Per pe,1sun' S o ALL OWNED AUTOS .. ... -._. _._ .. BODILY INJURY IPer accident) S SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) MON-011.'NED AUTOS :S S UMBRELLA LIABi _ _ OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS-MP,DE AGGREGATE S DEDUCTIRI.E S - RETENTION $ S WORKERS COMPENSATION _X ,T CST lU- _ T AND EMPLOYERS'L1A81LtTY $ ANY PROPRIETORJPARTNEWEXECUT1 IN ACWC353169 09129/2012 09/29/2013 E.L.EACH ACCIDENT S 100,00 OFFICER'MEMBER EXCLUDED? 11 i A� - _ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 100,00 11 yes,describe under DESCRIPTION OF OPERATIONS heioa,�r E.L.DISEASE-PDLICY LIMIT S 500,00 DESCRIPTION OF OPERATIONS,1 LOCATIONS t VEHICLES (Attach ACORD 101,Additional Remarks Schedule;if more space is hectuired) carpentry- CERTIFICATE HOLDER CANCELLATION NORTH13 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 384 Osgood Street North Andover,MA 01845 AUTHORIZED REPRESENTATIVE G 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD a Office of Consumer-Affairs&Business kegufahan, ME IMPROVEMENT CONTRACTOR " tration 153185 TYpe. piration 11/8/7014 DBA MATYPREVITE HOME MEDIC. MATTHEW PREVITE 57 HAROLD PARKER ROAD ANDOVER,MA019i0. ; Undersecretary 1Viassachusetts -Department of Public Safety Board of Suitding Regulations and Standards Construction Stipch ism . License:CS-900212. MA W S mtkviii, 59 HAROLD! r e °�`�.t'..•-^ - riga�' Expiration Commissioner 03/23/2014 The Cotnfnonwealth ofMassachusetts Departinent oflndustr•ialAccidents Office of Investigations 600 Wastrington Street Boston, MA 02111 www mass.govhlia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Orgahization/Individual): Address: /F.5 ,/div Sj City/State/zip: -/ Phone#: Are you an employer?Check the appropriate:box: general contractor and I Type of project(required): - L ED<n a employer with _ 4. ❑ I am a g x have hired the sub-contractors 6 �Zemodeling; Ne constructionemployees(Rill and/or -tune).' 2.© I am a sole proprietor or partner- listed on the attached sheet. 7, ship and have no employees These sub-contractors have 8. []Demolition working for me in any capacity: employees and have workers' cam insurance.t 9• EJ Building addition [No workers camp:insurance p• required.] 5. [] We are a corporation and its 10.El Electrical repairs or additions 3.ElI am a homeowner doing all work officers have exercised their l l.M Plumbing repairs or additions myself,[No workers'comp, right of exemption per MGL 12.[Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13•[1 Other comp.insurance required.] *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 must submit a new affidavit indicating such, tCoutractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or tint those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy aumber, I airs an employer that is providing wot'lcers'cvrnpensation insurance for my employees, Below is the policy and,job site information. Insurance Company Name-, Policy#or Self-ins.Lic. JK T 57, 'o q Expiration Date: Job Site Address: ��' � E sl• City/State/Zip: -Attrseh-a-copy f t-heAvorAerr-s—eompensahon policy-declaration-page-(shoving-Ilse-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 I� fine up to$1,500.00 and/or tine-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. I do hereby cerd r :der ep rr a4lefialdes ofperjury that the inf©rrtration provided ab ea is ue and correct Signature: Date:'f �! 9 tL Phone#: ' Official use only. Do not write int tis area, to be comp etc by city or town official City or Town: Permit/License# Isstdng Authority(circle one): : 1.Board of Health 2.Building Department 3.City/Town Clerk 4,Electrical Inspector 5,Plumbing Inspector 6..Other Contact Person: Phone#: Aamp ONO. 1 ' cza:!�78-404--524 Offs _9784207-0226 Aiortit �adints A� r-$x;ws-207-0329 :Qt rami:�«rT�, Mstk Aude ... ` ' t 20f bale t. ;~3IC Lic. t]53965 CMr'tifta Y 3 LLC, � lott#tAtrdovrr iai��01945 Construction Super,Li G.tr10021 C. ti 8 i. s93 11;,97&25"95'} 1~stanatc lA$rcemetlt J" 206013 Hate;.August l;2013. Job Ltreatinzr: Aseg,G�frz} "tDale Strom 5 pr �HthAtt$ratx Ai.4Ol$d5 Clot E�imale/,igreemertr for.Sert+icet:. iMtisc.Intrtiar ttstti F,ssatior Renctvadnns ttv.{an5lructioa It front hcdtoom;we will:teinmaand replepc(Z)rusting casemeutt wiu(bwt Install intotior and CKtenur millasark to match. 4i 5[l arpaa lls•:remove exatru b ssebanrd in Ll1is ad Admrn strati m: s atiag;temuve sad st�lace wAlboard from(3)waits is frnnt3�edmom insulars these(3)wa S wr from In and re-install cot oniat Style,baseboard over existcng•hnrdvuond floorit4,remove andreplace'the sidiag aadhoase e fironi taeittg baitipant{appcax-1$'x 12';;aw iactuding trim};instal{new ceiling in hedroom:oorrdinate a Arts a ith , c9meo+kners elecuician.Other Casings in bedroom vrillrccnaiiiasthcy utt tly exist.Lkoposat is inchtaidc of uvc tnunicatoa withclients and su ers as%Val as ,admmistratirn cqa diaatioa etid su sirn o£antite. PlasterSang all ae u.xvaliboard over(3)wails In the bedtrrtn and over twztsling ceiling in bedrortn;;piaitet alt ne"allbrartt$month; 1650 idster aeitin a�7th.tea tote similar to first tri the seeand bedroom. ,775 the frons bednsoai into of m11 sew glestar, aiming afRalts.costing andtrltn;two coat finzn3t. t Prt 8 'mc&Pais ,. i WinAows �)rindersco.double tvxsemeru wiitdou73 with screen.Ltrty E glees.wiate hardware.nppro.�tmnte amt size 56-11--x 5=-1?;16" 'i50t driest stock size to m casut incnts prwidcd h}homrac,Ter).fhCnrai asst rosy ahangc due to size fluWorripttoas velecttotta.Prior brderin 'ue•wiU meet with Wlrr teverif measuitss and ons.Thie:lineitem inelud sales tax. 495 . uil&n Mataiials nlataoa,Itastbaard vuindcrw caning feat®Hers,aditeSiva and tither cetatei4.mity:materials mxx 2QU is t is 1 of•tld lxtills,windrow and relined detuis. 9s: . 3uildin Permit Fee . 411owance far lsaildin etmit l3asad oa Sl.?lSif#t10+tftatat t eosr, lel $gam :3drtiBnrwl 7'errirs and Conf riwu;cast of sw:nduwsAw upon window:ordir:,1�3 balance der upan stmt;l:3 batdrttY&0 310`10»ptlztian otplastzring.l 6 dee prior to ttsmp+tchDtr;balance dna upon camplerfWf.7'itcesp n.batrd on wend rrrna�zt xk',&tatlaaoit.4ddirrormi xvotk maybe rsgntred dna to eondirfims Oay a eminar see orymeficx changes ru the c aGa df art yr in tieP firPa'fi stint+ or nigdifirnnonof a7tirs/iarlxxat RAq'work rnur'und abavt Ghat dtsrrlbed here Ott be biltsa atxord rtgh..Pr poaat is,mttd r 9Udr?t s}rvnt s<rbrnauaL lye mm rak r p cones afu+r+ sorb:If ort do not want thea preturas shWVA pteasz initis!hers. . If 1-1/0 Afar*. Th&1,A- nrr v�etY moth fer the apportu itjr relrerfarn+work fit y+ouT h'once:if a are very gratef d rind hops to 6 e:able-to provide ya><eciiir vwr serroicas, n4enyvalGaveachaneetoreviewthe infarrnmirm.ple.a lel me.tcrcnsv3vinr nngkt+dadbav)nawouldliketoproceed. 1'Yrank ywn very nerrc*.dt waald be tree psiviltge ro carte A•�. ;inreretp, Moth"Prevae Are Home Afee&:LLC 7 h rrk you'Eery xutCh f©r sex r�`akan. We,gre4attr appreeia�teri'our business pxt#look font�urd#rJ prot'�y'c+u�titJr eptioxrrl quality,in aprof--sional,"ecrfy tin�e(y and efficient man er l7ur r her gv�t' ya ni salisf on. Aecepted:The above prices,specifications and C are satisfactory and are hereby accepted. Signa rc Date Ace.HorneMedics,. LLC is.authorized to do the work as Specified. Payment will be.made as.outlined S tmatiire - — bate above.