Loading...
HomeMy WebLinkAboutBuilding Permit #583-15 - 225 OLD CART WAY 1/6/2015 BUILDING PERMIT �pOR%ORTy 1, "�o 32 y z'•_ ._ r TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION z y� Date Received �4"�R` Pa C 5 Permit No#: �,�S 5 t .TEo� c �SSACH4 Date Issued:i[k�<� —1 IMPORTANT: Applicant must complete all.items on this page _ +Pn�t 1 I 1PROPERWTY OVI/NER' r__ _ - - �Phnt F� � 100 Year Structure �eyes MAF _ PARCEL. _ � ZONING DISTR.I.CT: Ls'ct eye; Eno Machine`Shop Village ryes tno _ -- TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg 0 Others: ❑ Demolition ❑ Other p Septic Welly Eli, loodplain ❑Wetland d Watershed ®istnct ; ,OWSewer.._ r DESCRIPTION OF WORK TO BE PERFORMED: ScMe7r� 1 Identification- Please Type or Print Clearly 3 OWNER: Name: �`o�-, �„�/ T� -� /�roiiJ Phone:/- Address: .2- `� ��� �i� �✓� `Ctrao ctr Name: 1.' -"4/ Phone: Z� /�51 ,7�? on x Address: 211__ /,•�? 5� /"f 4-* Supervisor's Construction.License :Exp. 2 Z -- Horrme'Iinprovement License,; A_ 9 __.7._ _ .v._1E3cp. 'Date------- ARCH ITECT/ENGINEER __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: $ FEE: $ 2-1 k— Check No.: o12 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have.,:access to the guaranty fund Signature.of Agent/Owner '':.. ' ' Signature bf contract °' Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ F F SEWERAGE DISPOSAL ewer ❑ Tanning/MassageBody Art ❑ Swimming Poolse ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. V Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS r HEALTH 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 ,FIRE,DEPAI �TMENT Temp Dumpster on site yes. _ no,, __.. L+ocate..d.,tat 12&Main.Street Fire`De ktmentsrg:nature/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 Call Email I Date Time Contact Name Doc.Building Permit Revised 2014 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.J.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work o 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 o Copy Of Contract o Floor/Cross Section/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 o Photo of H.I.C. And C.S.L. Licenses , ❑ Workers Comp Affidavit o Two Sets of BuildingPlans (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:Building Permit Revised 2014 Location ' w No. �� Date 1 I . - TOWN OF NORTH ANDOVER • Certificate of Occupancy $ Building/Frame Permit Fee -$26� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# r U Building Inspector The Commo4weaith o f9assachusetis •_ - -• Department 0 fidifshiccZ.Aedd nts Office ofXnvestigaflons 600 Warshington.Street aoston,HA 02111 www massgov/dia Worke& Compensation Affidavit:Builders1ContractorslElectr�icxansR'luanb t bl A Please NintI,licant information N'a1roe(Businessiorganization/Individual):_ Address: � � / '"-��GI s Ci.ty/StatelZip: Phone#:_ Are you an employer?Check the appropriate box: Type of project(required): I am a employer with�_ 4• � x am a general contractor and I 6. []New constntction havehired the sub-contracfo�s ,Rpumodeling employees(fu11 and(ox paxti tie).' '7 fisted on the attached sheet. 2,E]I am a sole proprietor ox pattn er These sub-contractors have 8 ❑ . Demolition ship and'have no employees tyact . workers'comp.insurance. 9. [❑Building addition working for me in.any capacity. [No workers, comp.inscixan.ce $• �We are a corporation.audits 10.[]Electrical repairs or additions officers have exercised their required.] right of exemption per MGL 11.❑Plumbing repairs or additions 3.❑ I am a homeowner doing all work c. 152,§1(4),and we have no 1.2,[]Roof repairs myself.[No workers comp. employees.pTo workers' insurance required.]? 13.[]Other comp.insurance required.] �. %Any applicant that checks box#1 must also fdl outsection below showingtheirwbrkereensationpolicyinfarma"on. com p 'i-Homeowners who submit this affidavit indieatingthhe ey ire doing aliworlc and then hire outside contractors mustsubmit a new af adavit indicating such. TContractors that cheAthis box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. +� X am cue employer'that is pYovicXing wofkefs'carnpensation insurance for my employees: Berow is tiiepoliey ancijob site information. Insurance Company Name:. Policy#or Set£ins.Lic.#: Z 55;1 �9j�/ Expiration.Date: G City/State/Zip: AA Job Site Address' 7.5 r Attach a copy of the workers'compensation-policy dec aration.page(showing the policy number and expiration date). Failure to secure coverageas requixed.under Section25A.of MGL o.152 can lead to the imposition ofcrim nalpenalties of fine up to$1,500.00 and/or one-year imprisonment,as wellas civilpenalties in the form of a STOP-WORK ORDER.and a fine of up to$250.00 a day against the violator. B e advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. - X do Iiereliy cert under the pains a md,venaldes afPefrury that the information provided a overs tate and correct Date• /5 Si ature• Phone#• r 7�� 1 713 4ffeial use only. Do not write in this area to be completed by city ov tOwn official . City or Town: # Issuing Authority(circle one): 1.Board of Health 2.BuildiugDeparfznent 3.CitylTowu Clerk 4.Electrical Inspector 5.Plumbinglnspector 6.Other 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 hirc,. express or implied,oral or wxitten:, An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two ormore 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 p ermit 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 p erformance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have b can presented to the contracting authority." Applicants Please 1711 out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-cont ractors)name(s),addresses)and phone numbers)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,apolicyis required. Be advised that this afixdavitmay be submitted to the Department of fudustrial Accidents fol conal ation of insurance coverage. Also be sure to sign and date the affida-vit. the affidavit should be retomc(4o the city or town that the application for thepermit 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' compensatfon policy,please call the Department at tho 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 t oaffidavit iscomplete andpriatedlegibly. The Departinenthasprovided aspace atthebottom 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 parmit/license number Which-will be used as a reference number. In addition,an applicant thatu last submitmultiple permitTcense applications is any given year,need only submit one affidavit indicating current policy information(ifnecessary)and under"Tob Site Address"the applicant shouldwrite"all locations fa (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 orpermit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc)sand person is NOTrequired to complete this affidavit. The Office of Investigations would Eke 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 anal faxnumber. `1:`ho comm0nweafth OfMmsarhvseo Departmo t O fhdusWal AraoxdoRta Ofte ofJA cstcga-#oAs �0G W44 e-.ftmt W. 617-7.2' 4900 W 40,6 or k-877-f MSAMI Revised 5-26-05 Fay' 617-727"7749 WxW-MAngovAna Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $1 18,200.00 m $ - $ 218.40 Plumbing Fee $ 27.30 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 27.30 Total fees collected $ 373.00 255 Old Cart Way 583-15 on 1/6/2015 Finish Basement NORTH T( wn of No. _ C, h over, Mass, 1 � coc«ic«!WICK 4'A�RAreo BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT ............. .`. SCM........ . e)r.a......,..,,,,,..... , BUILDING INSPECTOR has permission to erect .......................... buildings on .o,�,,,,�.....d 1d C!�r,1,w A -- Foundation / Rough to be occupied as ............... ....................... !t.L,. ......... .1.Y...Q................... 1..D0�'✓1...-�.. 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 ST RT 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. Matt Roman Design Build Restoration LLC 891 Franklin St. Melrose, Ma 02176 Lic. # 149272 Fully insured Tel: 781-710-9713 January 4, 2015 Tom and Jen Thorn 255 Old Cart Way North Andover Ma Frame and finish basement as per plan. Framing to be 2 by 4 with PT plate. Insulation to be R-13 Board and plaster all walls and ceilings. Trim using speed base and colonial casing. Prime and paint all walls. Notes and Exclusions: Carpet, electrical and paint by others Terms: Job to take 45 days or less. Cost for above work: $18,200 eighteen thousand two hundred dollars. Payment schedule: TBD Submitted by: Accepted by: 74 R 7 & 7! 1-5-15 Matthew Roman Tom and Jen Thorn Window /Window Window /Window OIL Play Room W 12 x 11 OIL n rl Fitness Room 17 x 14 © a Glass French Doors Family Room 28 x 14 )I 1 -1�� I I _j HEAT Storage Under Stairs 36 Unfinished Do or Utility Room HW Stairs Up Foyer Stairs � 25 x 13 Exit to: HEAT 36" Door Garac Double Closet Electric Panel 2x12 i Massachusetts - Department Boaof Public Safety rd of Buildin Building Regulations and Standards Construction Supervisor 1 &2 Famih License: CSFA-098983 MATTHEW S RO 17 IMLS1DE AVE Quincy MA 02170 r Commissioner Expiration 09/08/2015 •11 /� . Ml to �Q0797, i,i. ievvaLCIG O�Q%GC1JNlG'�'<A..r 1,ti t Office of Consumer Affairs&Business Regulation tilt ! TOME IMPROVEMENT CONTRACTORIkType. I o egistration: 149272 xpiration:.- 12/16/2015 DBA ROMAN CONSTRUCTION,, 4 MATTHEW ROMAN - 891 FRANKLIN STREET 4 MELR05r--,,-MA 02176 --— - ti.-Undersecretary. . .�