HomeMy WebLinkAboutBuilding Permit #258 - 201 SOUTH BRADFORD STREET 10/14/2008 BUILDING PERMIT o* rAORTF1
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
S e�
Permit NO: 0 * °4
Date Received
X1,9 °gwre°♦�`�,�9
Date Issued:
SSACHUSE
IMPORTANT:Applicant must complete all items on this page
Print
I' OERTY 0WEft � t r t :rt
Ptir�
MAP' It3� P L. 2,N11a1G D,1STrRICT his#wile D 9t 6t: � Sao
- -
dlainehnpllag fires ran
TYPE OF IMPROVEMENT PROPOSED USE
Res' Non- Residential
New Buildingne fam'
Addition Two or more family Industrial
Iteratio No. of units: Commercial
epair, replacement Assessory Bldg Others:
Demolition Other
pepticW11 Fto�odp
la9n., letlar�dsr9eteTsl�ed�isfrct
N$te lsewer
DESCRIPTION OF WORK TO BE PREFORMED:
Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address:
CO-N1 JR,ACTO"RNaThe-
Address: t 4 r f r _Al
- 19f
—�
apse isicr' Cbnglrucf on'Lldens , l _D.Efte� /
t i m e Irrp7p e�n16nt ease Exp Date'-
ARCHITECT/ENGINEER A 44 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: $ 1 , �"D0, FEE: $
l
Check No.: .0 Receipt No.: 4�) /`7Y/
NOTE: Person contracting with unregistered contractors do not have access to the guaranty fund
rater o1erounr �ga#ure of cotracto
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
Private(septic tank,etc. Permanent Dumpster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
, EALTH 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
Temo dura ,
S
� � y
tao .
La�catedf 12la7n: tret
'T'ee'Wft��eistr �e _
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
Doc.Building Permit Revised 2008
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
❑ -B-uilding 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
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)
❑ 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
❑ 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2008
moo/ r
Location OJT Yom.
No. Date f fid"
N�RTh TOWN OF NORTH ANDOVER
? �_ • O t
A
• + ;; Certificate of Occupancy $- _ —
.a
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # J
2 ; 5 -01 '1
Building Inspector
q
NORTH
Town of
0 0
No. Z ,�
o , �` dover, Mass.,/l� • ��• O�
O _COCHICEWICK A-
oRATED pP�`t��
BOARD OF HEALTH
Food/Kitchen
PERMIT T _ Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT............ .. ..*h ..........Z0.00
*.0. ....................................................................... Foundation
has permission to erect........................................ buildings on ....a pf.......�.....�r*.0/........�.�...�1l� Rough
h
to be occupied as.. ..... .P�;.r.....��.4k..... .........................�r,..,s. moi.......
Chimney
C e
provided that the person accepting this permit shall in every respect conform to the terms of the application on filen Final
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 CONSTRU ON TS Rough
. .... . ............
. . . ........... ...
Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
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.
{
SP 0.310x 1071,$ale#,,.N3f 03079 Now/#"•(60)4,ri8-2207
October 1,2008
Ms. Ronda Ziner
290 S. Bradford SL
N.Andover, MA 01845
Re: Deck Replacement Proposal
To follow is scope and pricing for the above referenced project:
A Remove and dispose of existing ding, Wings and posts dawn to frame
A Furnish and Install new Latitudes decking (color--redwood)to existing frame
wing Split-Stop screws
➢ Furnish and Install new ELK ralling system to existing deck(post caps to have
solar lights by Vlnylast)
A Fumish and install new Azek trim boards at perimeter rim, along stair skirts and
at stair risers
Total cost for this scope of work- $11,500.00
+# SU ADD== A9TA!MD MM AND .
D Permits
Thank you for the opportunity to provide out services.
Sincerely,
Jason Muise
Safari Construcilon Management
Jasoa Mail 4tCbar A: Perkbwv Jr.
Date; /0r r✓a& e:
see a juv&out diow..
r
o"7
Str4
4% n S4
ens peti• •�
Fxpfr Vie. �. isor a
✓qS,� I e � tr n. S 9� 4%ens ah a
7.qa Nq M f s roomy 23j2 19q e r s
Sy�� F(ygM �i, h,, �� I p70
227?
r
JUN_04-,2a0E+ 1 ,: THE BERMRD I ACi:N ,• 603 889 1722 P.01/01
ArcOM. CERTIFICATE OF LIABILITY INSURANCE
wRQouce TwS CERP.FlOA'TF;15#SS'UbG A$A M�€ATT�OF INFORMATION
`Y' Rt � A I X f ONLY AND CONFERS NO RIGHTS W-014 TH9 0BRTIPICATE
M[)I, g. T1416 cmriFicATE DOES NOT AMEND, EX11!ND OR
361 MAIM ST. ! ALTER THE COVE £8E ItFPf;?R{ O B� 6 pt]l.fGl S5
N"HUA, NR. 03060 �
__ _ �IiNEURERS i��l'o��ta�Cau�wal�IE 'NAIC#
_ ..t -
s1�t3 COtvrxRtse�xg2� t�IAl+iI�,G�'1! IxiC s IN3uwea$a �TER?t 3rit7RLD YNS�E �d �.._..
vp
axLzm, nm 03079
- I
Cgas
! THE POLICIES OP iNSURANwfi L16TED 8601N HAVE,3f?EN i UI!0 TO THE1NSWREG NAMEiU Ar317VE POR THE POLICY PCFRt0D INDr—ATED.NOTWITH5T00NO
t q�Y REtXJ "EM T,Trkkkl OR C=ITION Of ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT T'4 WHICH THIS CERTIFICATS MAY BE ISSUED OR
MAY PERTA!N,THE 114SURFANCE A"OR"D BY THE 0()l.,0tf S DESCf+.ISwO HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSION$AND CONDITIONS OF SUCH
Po,.tt`,tES AGSGRVAT1r!its+n's SI•iCKNN MAY HAVE,r*IZKI RED`UCEDl3Y PA.IP CLAIMS,
UNITS _.... f
P6 w s t M fitil{GT NUM9iz nA~
i �cENEW LIARILtrr I F'.rk CJCCL2Fd(sNCE I stQO.(®�(4�(C}1 �I
i 4JFAMEFTAALGENVjRR4 LLAUIL TY
CLAm4SMaAAE !OCCUR i M4L.I}W( 4rwp0¢on! 6 QQ
A; w 3��iN 1210�t1-
104,(12/08 04/12/09 ;!' I%4OKAL&AbV tfU*y s p t S
GENVRA: AQGKftATE 3 01}b 00
aEN'L AGGREGATE LIMIT A1'P.iC:$PEit.+ i PftCri3UG�S& COM?"FJR AGG i 000 '
fkSUCY1 ZCT LOC i
%U.`UMt?itLGLiAB w tTY '0?mINEOS INOLk 4041T i$
j AkP Alf i V
I ALL OWNED/J,fTO$ I !gtdmyIN•tUR'Y $
SCHGDULBO AUTOSi°"?^
j _`g�"""
S 1 1 H#RRO AUTCJS ( j BUL�ILYIN ltaRY � T�
j (••-.-4•�1 N0*OW%VOAUTQB 4CY'1[m{!
i,.._...,;. ....... 1 PROPERTY 15}MAGE
t � i t iRvacadontl
............. �.
I GAhAGE LIABILITY j Al TOONLY-EAAGClVVNY f
ANYAUFO I s7tMCFtTIiAN EA A=
Ai tT04NLY: AGG i
I YGCsSSrUM@R2LlP.LIAEr�tTr ," fcAGm OC•OURMtENCE L a
occUR I i,'LAttA6 AG@ ( !hC 44RfrQ►7[ I F _
'r..... OGDIlt'ilptf` I .�^...,,....._. �Fes_.,.•,.- ,
FrETENTHON S I
RKEA8 WMPjWTK)NANC TOtAY
NQMPLGYERS'LN9IJTY W'C28-2S-04169500 13.0/31/07 ! 10/31/08 �F_ .GACHAC:CIDENT b 00,000
f,ANY PRQPK4TMPAttTNfFVEXe0tPIvf
OGFiCfi7tM,fEA �St f.XCI.UUE6? 000 ;
' ' EA!?LOYt S 3G.x_T..;
:teas o�acntauntw i.
�r eGtAt PRdVWAONS aeW« V.I. DiSsAw.•POL.iCY LIMIT!S O o 0
OTHER
(
j DESCRIMONOFOPE:RATION51LC7CA'itONG-iYGh{SGL��}>rE,XfLU$K?NSAOCDF:1?BY k+NIX:RSEMAfiNT,*aP£PIAIPAHOviSl�,thMi
Rtl ATE H01OER CANC TION
PROOF Or Tb?5[J1arA1 GR FOR POLICY- SWOULQ ANY of THe ASOVE DESCROF..O POLICttES ISE CAWEuiED BEFQRE rm!t;XPtRFa•�4N
OLDER SE i OAIF T14FREl-`F. THE ISSUIND INSVKEk WILL f; AVOR TO MML30 DAYS WRITPCt•4 j
NOI tCLt.?'{I T-IF C:FRTIffCATr_MOLDER NA.Mt Y4 THE LEFT,FAJT FAILURE TO 00 SO Fit�A.l.l,
LVPOSf.NO OBLGAMN OR LLAKjTY OF ANY KING UPON THE;NSURER,ITS AGGArr:;OR
REPAMNTx•1 Ivi;',.
AUTHOFiiLE1f iF.AFC46NTATIV6
AC0I102S(2009148) --*Avow CoRpowtomisea
D .�
TOTAL P.01
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
h 600 Washington Street
Boston
, MA 02111
i" www.nzass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Eiectricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/individual):— G�, � 6
Address:.
City/State/Zip: `,�QILW AJ � 03'031_ Phone #: 60,7 7
Are),6u an employer?Check the appropriate box:
Type of project(required):
1. I am a employer with O 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6 w construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 1 7 Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
required.] officers have exercised.their I0:❑ Electrical repairs or additions
3.❑ I an a homeowner doing all work right of exemption per MGL 1 I.❑ Plumbing repairs or additions
myself. [No workers' comp. C. 152, §1(4), and we have no 12.❑ Roof repairs
insurance required.] t employees. [No workers'
. comp. insurance required.] l 3.❑ Other
*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 arc uoing all work a€td then hire outside coniraciors 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.
1 am ann employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:L q
Policy#or Self-.ins. Lic.#:_19Cjf(' � �1 G� �D� Expiration Date: !d 1 3) 01
Job Site Address: CPO y`, �, �� S�-, City/State/Zip: AYJQVe r MA
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.
1 do hereby certify er the ins and penalties of perility that the information provided above is true and correct
Sianature: Date: d ��
Phone#:
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#:
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 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 cer ificate(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 cant'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
Industriai 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 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 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 Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-7274900 ext 406 or 1-877-MASSAFE
Revised 5-26-05 Fax#617-727-7749
www.mass.gov/dia