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HomeMy WebLinkAboutBuilding Permit #183 - 2201 SALEM STREET 9/6/2007 BUILDING PERMIT NORTII Q�,�TLtC #°�tiO TOWN OF NORTH ANDOVER o? '° o� APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received ATED �SSAC HUS�� Date Issued: IMPORTANT: Applicant must complete all items on this page / ag r � r rr IJrJ TYPE OF IMPROVEMENT PROPOSED USE Resi ential Non- Residential ❑ New Building VOne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Nteration No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition El Other DESCRIPTION OF WORK TO BE PREFORMED: 1 Vp h eeh -71 Identification Please Type or Print Clearly) OWNER: Name: L' Q j� P�Pr j:fA 4 Phone: qr?'3 !n R 3 -5(O I l Address: AAD I t' VP- A- 0113J-l5 r �0N� i^� L✓ "� �r(p 56 �%^ - ° "�� 9.a' .G 'ate / ,✓/� :,r si ux ite N supe Ar! cint� cen;� `p fir r,.y s" a%, , /r w r ``� y ✓ / 'd, n r �•, y xrF- ,g- ®rn lrtf e ve e t Liffe .s >r war 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: $ If). 239, DO FEE: $— Check No.: 2 72— Receipt No.: o20 5 6 NOTE: Persons contracting with unregistered contractors do not have access to a aran fund Sigriatur ►get/Owner � �_mSignature of contactor., Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Swimmin Pools ❑ Tanning/Massage/Body Art ❑ g 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 DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS ii 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 Located at 384 Osgood Street IR ©FPi�t�TM' It I', w11 T rr�p 7umpste � if yes w r iodated a#1'24 Ma n S#e � w� /ib F[Ce a R.���i!��.f'`��,��R���3i.��l��. i���� � ✓/ � �s �/ _ moi`, '" ��" ��'" r ',,., i �I� c' � � '.` �v� � � '"�r����� �'a � "i ray*✓ � �; .ar Fir w,��a`�,w.,:r� /� � �, �,; Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. i 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)l ❑ Notified for pickup - Date ........................................ ............................................................................................................................................................... .............................. Doc.Building Permit Revised 2007 i 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 Li 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 2.2007 Location 0 J�' No. lef�5 Date j0RT#j TOWN- OF -NORTH ANDOVER F _ 9 ' Certificate of Occupancy $ as sArN�s� Building/Frame Permit Fee $ �' Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # l r 20569 Building Inspector Ar% The Commonwealth of Massachusetts .� Department of Industrial Accidents ` �8. Office of Investigations ,1j� �� 600 Washington Street % a/ Boston,MA 02111 :. -www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Piumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): A. SQA' vI Address: i,5 IBJ D r4h C e-+ City/State/Zi 13 P ►`�l 019-70 Phone#: { C Are,you an employer?Check the appropriate box: Type of project(required): 1.[ I am a,employer with 6. ❑ 4. ❑ I am a general contractor and I New construction employees(full and/or part-time),* have hired the sub-contractors 2.❑ F I am a sole proprietor or partner- listed on the attached sheet. t 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 10.❑Electrical repairs or additions 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.❑Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.9'Otherp vl/v 'Any applicant that checks box#I 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. 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.#:_ Cl Q X 191 5ZD Expiration Date: O-7 Job Site Address: 22-0 l r't°i'Yt City/State/Zip: i 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«p 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 certify d r the pains andpenalties ofperjury that the information provided above is true and correct Si nature: Date: Phone#: 0-7s r7,q Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# i 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 M I 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 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 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-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 d to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)saiderson is NOT required to complete p q 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. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax# 617-727-7749 www.mass.gov/dia • 0 P DISPOSAL OF DEBRIS AFFIDAVIT In accordance with the provisions of M. G. L. c. 40, Sec. 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed facility as defined.by M. G. L. c. 111, Sec. 150a. The debris will be disposed at: Salem Transfer Station owned by Northside Carting A/ Signature of Pe it Applicant Date Christopher Zogy Name of Permit Applicant A &A Services,Inc. Firm Name 115 North Street. Salem. MA 01970 Address, City, State, Zip Code ' I -- Board of Building Regulations and Standards Construction Supervisor License License: CS 57733 (Birthdate:=5/26/1958 t Exp¢atinrt._5726/2009 Tr# 13739 R stncttb D0, CHRISTOPHER 115 NORTH ST 'j i SALEM,MA 01970 Commissioner Commonwealth of Massachusetts Division of Occupational Safety �. RobertJ.Prezioso,Commissioner y Deleader-Contractor ` CHRISTOPHER ZORZY W�a Eff.Date 04102/07 Exp.Date 04/01/08 all m DC000440 IN IN Member of C.O.N.E.S.T. BO IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII a SOS ON EN r ..92. Vo7Yf/I)2o02G/Jep.GLfG ✓(/Lp,QdLClQecla .`. Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 101.609 Expiration 6/26/2008 1 Type Private Corporation A&A SERVJCES,INC' Christopher Zorzy 115 North Street' 'Salem MA 01970 Deputy Admmistr dor Ab— tU A & A SERVICES, INC. A&A 115 NORTH STREET,SALEM,MA 01970 • Telephone:(978)741-0424 Fax:(978)741-2012 Contractor Registration No.101609 Federal EIN:04-3090162 Construction Supervisor No.CS057733 WINDOWS AND STORM PRODUCT SPECIFICATION SHEET Buyer(s)Name Date of Contract C72EGj t ,6Ec k y &K7-01V Buyer(s)Street Address,City,State and Zip Code Z ZD l 5,41,0y -S77 A107V)4 AA100 v6V_ W/1 o/8 Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address Li6tky X-ZZo g-G�S8-888& 978-X0$3-Sly// The Buyer(s)listed above hereby jointly and severally agree to purchase the goods and/or services listed below,in accordance with the prices and terms described on this Specification sheet and the front and the reverse of the accompanying CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,'of which this Specification Sheet is a part. _ -- WINDOW REPLACEMENT Remove and dispose of# existing windows. ' Install # T new 2 S U/14P windows: Vinyl ❑Wood v (Manufactu er) Options: Style U it/G t/417-6 Grid pattern Color Interior /dJ/></ Color Exterior 14JP/22E Glass Type Zu E- ii`,J*Wrap exterior trim with aluminum. Style Color All windows will be installed according to the installation procedures in the portfolio. Caulk all interior and exterior edges, 9 . Insulate where possible around new units. Insulate window weight pockets if exist,and around new window units where possible. Included in this proposal are set up,clean up,Hepa vacuum and cleaning windows inside and out. Building permit included. BAY/BOWS/CASEMENT UNITS/ANY FULL CONSTRUCTION WINDOWS ❑ Create new window opening by cutting through existing home and framing in opening. ❑ Remove and dispose of existing unit(s)in its entirety. Note:Electric and plumbing may exist in wall and will require additional costs to customer if need to be dealt with. ❑ Install window(s)into opening(s). Note: If Bay or Bow installation to include cable support system,new roof system(matching color as close as possible) or tie into existing soffit system. ❑ Bay ❑Bow ❑Casement ❑Other window(s)to include new interior style trim and new exterior style trim and head flashing as needed. ❑ Note: Painting and staining not included. STORM PRODUCTS ❑ Remove and dispose of# - existing storm window(s). ❑ Install new storm windows# Manufacturer Style Color Option ❑ Remove and dispose of# existing storm door(s). ❑ Install new storm doors# Manufacturer Style Color Type: ❑Aluminum ❑Solid Core SPECIAL INSTRUCTIONS: Ris agreed and understood by and between the parties that this Specification Sheet,along with CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,constitutes ° .the entire understanding between the parties,and there are no verbal understandings changing or modifying any of the terms.This contract may not be changed or Its terms modified or varied in any way unless such changes are in writing and signed by both the Buyer(s)and the Contract_or.,t;uygr(a)hereby acknowledge that Buyer(s) has read this Specification ShQeety� Contractor Initials: (/'S Date: 8— `—V Buyer's Initials: �yL� Date: 467 �+ Above 1982 A & A SERVICES, INC. 115 NORTH STREET,SALEM,MA 01970 Telephone:(978)741-0424 Fax:(978)741-2012 Contractor Registration No.101609 Federal EIN:04-3090162 Construction Supervisor No.CS057733 CUSTOM REMODELING AND IMPROVEMENT AGREEMENT Buyer(s)Name Date of Contract Buyer(s)Street Address,City,State and Zip Code y5- Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address: o ( zk y x-zzo 978-683-Sb/1 979- S- - The Buyer(s)listed above hereby jointly and severally agree to purchase the goods and/or services listed on the accompanying specification sheets,in accordance with the prices and terms described on the front aDd the reverse of this agreement and any specification sheets(this"Agreement'),and Buyer(s)have requested that such goods or services be installed or provided at Buyer's address listed above.A&A Services,Inc.("Contractorl,hereby agrees to install or cause to be installed the products . or services listed in this Agreement at the Buyer(s)address written above.This Agreement represents a cash sale of goods and services. The Buyer(s)agree to pay in cash the cost of the goods and services urchased as descried herein,regardless of timing or approval of any financing Buyer(s)may seek for their purchase. Re-MIL 121,721, 7 p O ®/�pyr Purchase Price: 10 23/ Est.Starting Date: Down Payment:#3000 Est.Completion Date: O Cash Amount Due on Start of Job: Sok ❑Credit Card Amount due on of Completion: No. Amount Due on of Completion: Expiration Date: Balance Due on Upon Completion: 7 237, CVC Code: It Is agreed and understood by and between the parties that this Agreement,front ad back and any addendum,constitute the entire understanding between the parties,and there are no verbal understandings changing or modifying any of the terms of this Agreement. Buyer(s)hereby acknowledge that Buyer(s)has read the front and the reverse of this Agreement and has received a completed,signed and dated copy of this Agreement,including the two attached Notice of Cancellation forms,on the date first written above. Buyer(s)also (1)acknowledge that they were orally informed of their right to cancel this transaction;and(ii)request that they be contacted via their telephone numbers or e-mail,as listed above,in the event Contractor believes Buyer(s)would be interested in.any additional quality products or services of Contractor. DO NOT SIGN THIS CONTRACT IF IT CONTAINS ANY BLANK SPACES. B&A Services,InBuyer(s) Y: Signature ED v7uy Er Signature Print Name X Na 7�J ignature uCXPI l e 1ALMAJ Print Name You,the Buyer(s),may cancel this transaction at any time prior to midnight of the third business day atter the date of this transaction. See the following Notice of Cancellation form for an explanation of this right. ARBITRATION:The contractor and the homeowner hereby mutually agree in advance that in the event either party has a dispute concerning this contract,either party may submit such dispute to - a private arbitration service which has been approved by the Secretary of the Executive Office of Consumer Affairs arW.9tt5oa Regulations and the other party shall be required to submit to such arbitration as proved in M.G.L.c.1 42A. 77�C ��44� coaha�cor in;dala: soya.feitinl:: NOTICE i/�/,WOFCANCELLATION NOTICE OF CANCELLATION Data of Transaction Z..You may cancel this transaction,without any penalty or Date of Transaction rte—y—a You may cancel this transaction,without any penalty or obligation,within three business days from the above date.If you cancel,any property traded in, obligation,within three business days from the above date.If you cancel,any property traded in, any payments made by you under the Contract or Sale,and any negotiable instrument executed any payments made by you under the Contract or Sale,and any negotiable instrument executed by you will be returned within 10 days following receipt by the Seller of your cancellation notice, by you will be returned within 10 days following receipt by the Seller of your cancellation notice, and any security interest arising out of the transaction will be cancelled.If you cancel,you must and any security interest arising out of the transaction will be cancelled,If you cancel,you must make a,11,ha to the Seller at your residence.In substantially as good condition as when received, make available to the Seller at your residence,M substantially as good condition as when received. _ any goods delivered to you under this Contract or Sale;or you may,if you wish,comply with the any goods delivered to you under this Contract or Sale;or you may,if you wish,comply with the Instructions of the Seller regarding the return shipment of the goods at the Sellers expense and instructions of the Seller regarding the return shipment of the goods at the Sellers expense and nsk. ff you do make the goods available to the Seller and the Seller does not pick them up risk. If you do make the goods available to the Seller and the Seller does not pick them up - within 20 days of the date of your Notice of Cancellation,you may retain or dispose of the goods within 20 days of the date of your Notice of Cancellation,you may retain or dispose of the goods without any further obligation.If you fail to make the goods available to the Seller,or H you agree without any further obligation.If you fail to make the goods available to the Seller,or If you agree to ream the goods to the Seller and fail to do so,then you remain liable for performance of all to return the goods to the Seller and fail to do so,then you remain Hable for-performance of all obligations under the Contract.To cancel this transaction,mall or deliver a signed and dated copy obligations under the Contract.To cancel this transaction,mail or deliver a signed and dated copy of the cancellation notice or any other written notice,w send a telegram,to A&A Services,115 of the cancellation notice or any other written notice,or send a telegram,to ABA ,115 North Street,Salem,Massachusetts 01970,NOT LATER THAN MIDNIGHT OF;01-,9O - North Street,Salem,Massachusetts 01970,NOT LATER THAN MIDNIGHT OF — (Date) (Date) I HEREBY CANCEL THIS TRANSACTION. Consumer's Signature Date I HEREBY CANCEL THIS TRANSACTION. Consumer's Signature Data NORTH Town of No./ 3 =_ _ _ __ dover, Mass., COCHICKEWICK y1. "�,es RATED PPS 5 7 BOARD OF HEALTH Food/Kitchen PERMI T6 TiamSeptic System BUILDING INSPECTOR THIS CERTIFIES THAT................... .. ...... ........................... ....... ........... ..... D�.........^.... .............................................. Foundation has permission to erect........................................ b4!nson .a.404..:.......34. .9*41..... .......... Rough to be occupied as......'.. ��^ �,�. ....... 1 Chimne........... ...... ..... ................ ........................... y provided that the person accepting this p rmit shall in every respect conform to the terms of the application on file in 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 11211.0 PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTS Rough Service BUILDiSPECTOR 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. ir SEE REVERSE SIDE Smoke Det.