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HomeMy WebLinkAboutBuilding Permit #327-14 - 210 HOLT ROAD 5/1/2018 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received 16 Date Issued: IMPORTANT: Applicant must complete all items on this page LOCAT Print PROPERTY OWNER_!a& n50u iso 6s ✓sem-' J Print 100 Year Old Structure yesnno MAP NO: '73PARCEL ZONING DISTRICT Histone District yes ,Machine Shop Village yes. TYPE OF IMPROVEMENT. PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family X Industrial ❑Alteration No. of units: ❑ Commercial A Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ El Septic E]Well ❑ Floodplain ❑Wetlands, ElWatershed District n Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: { Identification Please Type or Print Clearly) 78)5-19 75-7.5- QYVNE5_ Name: Dr- v\J t-3 Phone: Address: l3 Gav_61,.J Gq,? nn CONTRACTOR- Name:H�nn„ Lx,nvsn, ?vet 5 Phone: (�D�v•le�3S�zsv/ - -- ' I Address: J D �eit� t_r _t��t• �I✓ttrx� �Jl _ �����- Supervisor's Construction License: y(C'2Scj .Exp: Date: Home improvement License: _ . Exp. Date: a I' ARCHITECT/ENGINEER 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: $ ®o 'o® FEE: $ / Check No.: Receipt No.: NOTE: Persons contractin wKaved tered contractors do not have ac to the gu mry fund .... ___ �_ _ .. ..Signatureof Agenofcontractor,Plans Submitted ❑ ❑ Certified Plot Plan ❑ Stamped Plans ❑ Building Department The fol owing is-a list of the required forms to be filled out-for the appropriate.permit to be obtained. RoofirAg, 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 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 apo,-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Buhding Permit Revised 2012 f Plans Submitted-0 PlansWaived-❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE-_OF-::SEWERAGE DiSPOSAL Public Sewer ❑ Swimming Pools ❑ Tanning/MassageBody Art ❑ 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 CO iMMENTS S r, HEAL TH 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 Tow;! Engineer: Signature: Located 384 Osgood Street FIRE=DEPARTMKAT -Temp Duft§teron site-'yes'.. no Located at 124 Mair, Street. 'Fire'D6paftme'r Jt,sigii9t0—e/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 El Notified for pickup - Date Doc.Building Permit Revised 2010 Location No. 7 ' / Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 26962 Building Inspector NORTH own of E : ndover No. _ , LAKE h , ver, Mass, COC MICHEWICM S IJ BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT .......... BUILDING INSPECTOR �� //0//f � Foundation has permission to erect .......................... buildings on ... ............ ............��....................................... to be occupied as � ��i /.�G/�J. ��a� ri m/� i�?�/ :................. Rough .............. .. ...1......................... G..:................... ................. 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 ...:......... ..... .. .............................. Final BUILDING INSPECTOR 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. SEE REVERSE SIDE ANDOVER INDUSTRIAL SERVICES INC. ROOFING AND SHEET METAL CONTRACTORS r. SEPTEMBER 24, 2013 NORTHSIDE CARTING INC. 210 HOLT RD. NORTH ANDOVER,MA. 01845 ATTN; BRIAN THOMSON RE; MAIN OFFICE ROOF REPLACEMENT SCOPE OF WORK; 1) REMOVE EXISTING EPDM BALLAST ROOF SYSTEM DOWN TO STRUCTURAL METAL DECKING(consisting of stone ballast, epdm membrane and insulation) 2) REMOVE AND REPLACE ALL WOOD BLOCKING AT FRONT AND REAR OF_ BUILDING 3) MECHANICALLY ATTACH NEW 3"INSULATION BOARD AND DRAINAGE CRICKETS TO STRUCTURAL METAL DECKING 4) INSTALL A NEW .060"EPDM FULLY ADHERED ROOF SYSTEM 5) SHOP FABRICATE AND INSTALL A NEW 2 PIECE ALUMINUM PERIMETER EDGE METAL FLASHING WITH NEW ROOF SCUPPERS AND DOWNSPOUTS 6) PROVIDE BUILDING OWNER WITH A 15 YEAR MANUFACTURERS LIMITED WARRANTY 7) PROPERLY FLASH ALL ROOF TOP UNITS AND PIPES PER MANUFACTURERS SPECIFICATIONS 8) REMOVE 16 EXHAUST VENTS FROM ROOF AND COVER OPENING WITH METAL COST; $90,000.00 (priceincludes on site disposal of all roof debris) PAYMENT TERMS; PAYMENT OF $40,000.00 DUE AT CONTRACT ACCEPTANCE PAYMENT OF $25,000.00 DUE FOR 50%COMPLETION PAYMENT OF $20,000.00 DUE FOR 100%COMPLETION FINAL PAYMENT OF $5,000.00 DUE AT WARRANTY TRANSFER ANDOVER INDUSTRIAL SERVICES INC. 611 DATE �IZy Izoll .00 AUTHORIZED SIGNA DATES �3 10 WILLIAM DR. PELHAM,NH 03076 TEL; 1-888-957-7663 FAX;1-603-635-7843 andoverindustrialservicesinc(i ,gmail.com The Commonwealth of Massachusetts - Department ofIndastrialAccadents � Office o fInvestigations 600 Washington.Street Boston,MA.02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/ContractorsfElectricians/Plumbers Applicant Information Please Print Legibly Name usiness/Or ani'zation/fndividual • /!/7,_Vy SCyots ��G Address: - City/Stale/Zip: AIC/G,i Phone#:_ (yD3 •le�So?Sy/ Are you an employer?Check the appropriate box: Typo of project(required): 1.I� I am a employer with Y _ 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a soleproprietor orpariner- listed on the attached sheet.x 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. El We area corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.FKRoof repairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] 'Any applicant that checks box 4f must also fill out the section below showing their workers'compensation policy information. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation,insurance for my employees Below is the policy and job site information. _ Insurance Company Name:- Policy#or Self-ins.Lic.#: ExpirationDate: /Z)/ Job Site Address.�J� ��e> / City/State/Zip: /�bv �• ��by��. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder 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 DTA for insurance coverage verification. I do hereb rt under the pa s a enalties ofperjury that the information provided above is true and correct. si afore Date: 9"S3 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.CitylTown Clerk 4.]Electrical Inspector 5.PIumbing Inspector 6.Other - - 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 ofhire,• 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 grouads or building appurtenant thereto shall not because of such employment be deemed to be an employes." 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 . pp ant who has not produced . p ceptable evidence of compliance with the insurance coveragere aired" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any ofits political ubdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have beenpresented 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 cant'workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe 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 polloy,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 y g g pp h emiit /license number umber wluchwill 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. Anew affidavit must be filled out each year.Where a homeowner or citizen is obtaining a license ox 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 CoMmonweal&ofM_assarhvsPi s Dapafteut of fadustdal Accidents . Office of IRVestigatious 600Wuhiugtoun,Street Boston}MA 02111 Tel,#617-727-4900 ext 406 or 1-877-MASSAF.F Revised 5-26-05 Fax#617-727-7749 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-065.250 PETER J DENN , 113 GARDEN ST ©� W NEWBURY MA 0198 w Expiration Commissioner 04/19/2014 8