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Home My WebLink AboutBuilding Permit #33 - 2230 TURNPIKE STREET 7/14/2009 0U1LU11VV rr-r%mr r t TOWN OF NORTH ANDOVER F APPLICATION FOR PLAN EXAMINATION « Permit N0: Date Received Date Issued- IMPO TANT:Applicant must complete all items on this page TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ane family ❑ Addition ❑Two or more family ❑ Industrial ❑ Alteration No. of units: 0 Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ZME DESCRIPTIONOF WORK TO BE PREFORMED: L A 84r27 142 &IM43 29 14 /I/4--e 6f1�2 �iSTpdQ I entification Please Type or Print Clearly), OWNER: Name: L- Phone: 7J 6f7-a6��- Address'-Usdp- L r r u 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: $ �� 'l�y FEE: $ 0 ' L Check No.: � � Receipt No.:� P NOTE: Persons contracting with unregistered contractors do not have access to the guaran fund n 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 DATE REJECTED DATE APPROVED CONSERVATION ❑ . ❑ COMMENTS DATE REJECTED DATE APPROVED lHEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water$ Sewer Connection/S9nature & Date Driveway Permit Located at 384 Osgood Street �� •�'- £� �q'y; }�"F��" � -�'"`x k �` � � +nom�.�'•n� , I Tn�.' xxs 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 InspectorYes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section on 21A_ F and G min.$100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 1 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ii 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) o Mass check Energy Compliance Report (If Applicable) o 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 o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy.of Contract o 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 No. `33 Date MORTIy TOWN OF NORTH ANDOVER N 9 ' Certificate of Occupancy $ �'ss+cMustt� Building/Frame Permit Fee $ DY Foundation Permit Fee $ r-- Other Permit Fee $ TOTAL $ Check # 22265 Building Inspector NORTH o" of ;.t L Andover No. 3 3 ..:. -mss A H E dover, Mass. - o c OCHIC KEwICK y1. ORATED P'f BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT r w A 1., �.. IA Foundation has permission to erect........................................ buildings on.2Z:J116................ Rough himne to be occupied as .......I�..e�. ............. ............��. .�.►... ...........��. ...... .... . . ......... .T.....�+1.1.1.'�i�r y provided that the person acce tin this ermit shall in efe re ect c of r1 p . p p g ry s}� o o m t a td�ms of tffe application on file m 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 EMPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTR STARTS 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 Until Inspected and Approved by the Building Inspector. BuFIRE DEPARTMENT rner Street No. SEE REVERSE SIDE Smoke Det. HIC # 126-356 ®rD� �Lorot�p �uY�bPr�, �lr�r. 13 SEWALL STREET PEABODY, MA 01960 "r 5� OFFICE: 978-922-6120 FG R,TY•CRP SPECIFICATION SHEET Owners Nante . l . O b . G.f c:ke� .7. . Y1 . . 9 Horne Phone: ./. . . . . . . . .�. J 1�}b ? k .1�p. . . . . . . . . . . . ../. . . Work Phone: .J.- , ../ .�. . . .. .. Honte Address .c;.J.`�.�. . . . . . . . . . . . . .'. .!�. . . . . . City .'. I.�:?'�?-.� State,. A. . . Zip . . . . . . . . . Job Address . . . . . . . . . ., � ��n'�c. . . . . . . . . . . . . . . . . . . . . . City . . . . . . . . . . . . . . . . . . . . State . . . . . . . . . Zip . . . . . . . . . SIDING 1.Siding Type .d=. 2' -�tl L�,t . . . . . . . . . . . . Width ./ . . . . . . . . . . Color . . . . . . . . . . . . . . . . 2.Area to he done. Main House . . Breezeival,'!�'Gs�'�. . . Garage j�� . . . . Additions . . . . . . . . . . . . � . . . Dormers .C- :�� . . . . . . Other . . �!=<�f". . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.Insulation . .. -� ..-17 C�' • ' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. Trim comer � J No Color ! . . . . . . . . . Trim to be done: Sof . . . . . Fascia. Rakes . . . . . . . . . . . . . . . . . Ceilings + . . �. . . . , . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. Casings .. '>~C . . ✓t "?'�'f� ... . .�j✓� > . . . . . . . . . 1 6. Gutters and spouts J Yes o Use hears gauge sc ntless . . !)1. . . . . . . . . Color . . . . . . . . . . . . . . . . p 7.Shutters ❑ Yes &NO . . !l'�'Z � . . . . . . . . . . . . . . / . .... . . . . 8. Windows and Doors 4-14-e1 ROOFING Material Type .A':. . . '�. . . . . . . . . Calor. . . . . . . . . . . . . . . . . . . . . . . . ` � ,� Areas to be done . . .� /. . . . yid! . . . . . . . . Remove existing shingles Yes �i 15 lb.felt ,.!'Yl! ". . . . . . . . Edging . ® . . . . . . Metal Ed to . . . . . ... . . . ... . . . . . . . . . . . Chimney and ver etc ?r�.CY's ►�!°y,> - ?'�'L' Other . : . . . . . NOTF_SC��.'. .�1-�1j�.'Z�`'.�-C� . �'' ?��.. .4�' : .. s. .�� . . . . /.Vie_' . . :-�' =.4-�. . . . . . . . . . . . . . . . . . . . . . . . . . . . G -rte . Zr . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $. . . . ..r. Deposit Material and labor to cost$. .`. !. :. .�.,J. �!: . `.'�'. . . . . .payable as follows: $. CG��, �. .1st Installment $. . -. . . .2nd Installment $. , :Balance on completion Contractor will do all said work in a good workmanship manner. You mase cancel this agreement if it has been consummated by a party thereto at a place other than an address of the seller, which mar he his main office or branch thereof,provided you notify the seller in writing at his main office or branch by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement. /NIWITNETHEREOF,the parties have hereunto signed their names this. . . . . . . . . .. . duy of. 20. Accept Signed! t':4C�°- �.� 1 . �t. � '. . . Owner E �onp i�be��, hitt. Signed, . . . . . . . . . . . . . . . . . . . . . . . . Owner Per. .` . . . . . . . . . . . . . . . . . . . . . . . Repro;entative Authorized Rep. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Strikes,labor disputes, inclement weather,or material supplier delay's resulting in work stoppage are beyond the control of the company. The company guarantees all workmanship for a period of#vear from the date of installation. Guarantee of workmanship assumes performance of product installation tinder normal wear and tear conditions and does not guarantee against storm damage,acts of God or nature,neglect of proper maintenance or malicious damage or vandalism. Material guarantees are the sole responsibility of the manufacturer. North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that.the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: (Location of Facility) Signature of rmit plicant -2 -/ - ® � Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector axi �iaJr f". mg "tide a"ff a�n ad"rds Construction Supervisor License License: CS 39928 P Expe atio _3/1612010 Tr# 19439 �Restncfion `00� PAUL A PIEROG�^ 10001 URNPIKE ST N ANDOVER,MA 0184Commissioner omrwn�vea� �✓�aaacu/u�r,�ta Board of uilding Regulatinns and Standards HOME IMPROVEMENT CONTRACTOR Registration; 159019 Expiration 3126!2010 Tr# 265660 lug V , " TYPe IrdEvidual Vill PAUL A.PIEROG, `r_- ��,, PAUL PIERQG 1000 TURNPIKE ST`� ; NO.ANDOVER,MA 01845' Administrator The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, AfA 02111 www-mass.gov/dia ' Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pl A umbers Applicant Information Please P-0 Name(Business/Organization/Individual): nU I 0 Address: DDF� UI��Jd�I �P " City/State/Zip: 1 �, r 1r 0 I Phone.#: Areyou an employer?Check the appropriate box: Type of project(required). 1.❑ I am a employer with :; 4. 0 I am a general contractor and I ti employees (full and/or part—tune).* have hired the sub-contractors 6• ❑New construction 2. I am a:sole proprietor or partner- listed on the attached sheet 7. (]Remodeling . ship and have no employees These sub-contractors have working forme in any capacity. employees and have workers' g• ❑Demolition [No workers'comp.insurance comp. insurance.1 ' 4 ❑Building.addition required.] 5. We are a corporation and its 10.[1 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised,their 11. -Plumbingr myself. repairs or additions y [No workers' comp. right of exemption per MGL 12.7 Roof repairs insurance required]t C. 152, §1(4), and we have no employees. [No workers' 13 ❑Other comp• insurance required] •Any applicant that cheeks box#1 must also fill out the section below showing their worker;'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. +t ontractons that check this box must attached an additional sheet showing the name of the sub-contractors and sate whether or not those entities have employees. If the sub-contractorshave employees,they must provide their workers'co mp:policy number. I am.an employer that isproviding workers'compensation insurance for my employees. Below is the policy.and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: . 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 5250.00 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 coveraee verification. Ido hereby cert' u e�r}the p • -;d aloes of perjury that the information provided above.is true and correct Si ature: '-'/� f/ [� Date: Phone#: C� if j' l Offw*-.use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Isstunb Authority(circle one): I.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." r 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 mainteaancc,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"ever state or local licensing agency shall withhold the issuance or renewal of-a license or permit to,bperatem business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of co mpliance with the insurance coverage required." Additionally,MGL chapter 1-52, §25C('1)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 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 youare 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-lint. 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 perzaits 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 born 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: Tb.e Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel.# 617-727-4900 ex-t.406 or 1-877 MASSAFE ` Fax# 617-727-7749 Revised 11-X22-06 ww%,.mass_gov(dia