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HomeMy WebLinkAboutBuilding Permit #603 - 251 PLEASANT STREET 4/15/2008 NORTH BUILDING PERMIT 00tt,�o TOWN OF NORTH ANDOVER or '. - =' °°�, APPLICATION FOR PLAN EXAMINATION 70 Permit NO: Date Received 7qgATea � SSUS� Date Issued: IM/P�ORTANT:Applicant must complete all items on this page LOCATION -�—/ U I P r SG t -t—S7—/ Print PROPERTY OWNERht_—W f_ L- Gt = �r✓sT� Print MAP NO: ' PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ne famil Addition Two or more family Industrial Alteration No. of units: Commercial epair, re acemen Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer z . DESCRIPTION OF WO K TO BE PREFORMED: omr1,�. .4ar1 �Sw— !3 40., gak" ,,s Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: 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: $ Ca-- FEE: $ ' Check No.: /yrSl Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/©wne„ �. 'gnature of contractor 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 HEALTH Reviewed on Signature COMMENTS R �F 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 DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/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 - 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 ❑ 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 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:1NSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Location r)5 f 'e 533 -• -� �- No. _ 0—S Date M�RTh TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ �sskSEt� Building/Frame Permit Fee $ 4 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # f � 2 1 0 8 Building Inspector The Commonwealth of Massachusetts Department of Indiestrial Accidents Office of Investigations 600 Washington Street .Boston, M14 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit; Builders/Contractors/Electricans/ptumbers A licant Information Name(Business/or Please Print Le•bl pA1zat►on/Individual): Address: • City/State/Zip: Phone.#: --------------- Are You an employer?Cheek the appropriate box: 1.13 I am a employer with T 4. 0 I am a general contractor and I Type of project(required).` Employees(fill and/or part-time),* 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 sul,-contractors have working forme in an capacity. employees and have workers' 8•. ❑Demolition Y aP ty [No workers' comp.insluance comp.insurance.# 9. 13 Building-addition , required.] 5. We are a corporation and its 10.13 Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their m elf 11.0 Plumbing repairs or additions ys [No workers comp, right of exemption per MGL insurance required]t c. 152, §1(4)i and we have no 12.13 Roof repairs employees. [No workers' 13.[] Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy,information t Hon•cowners who submit this affidavit indicating they are doing all work and them hire outside cont2tors must submit a new affidavit indicating such. {Centra-tors that check this box must attached an additional sheet showing the name of the sub-contractais and state s mita or not(hose entities have employees• If the sub-contractors.have employees,they must provide their won kers'comp:policy number. 1 am.an employer that is providing workers' information. compensation insurance for my employees. Below is the policy.and job site Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/i Attach a copy of the workers' compensation policy declaration page(showing Failure,to secure cothe policy number and expiration date). verage 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/oi one-year imprisonment,as well as civil of up to$250.00 a day against the violator. Be advised that a c penalties in the form of a STOP WOR{ORDER and a fine Investigations of the DIA for insurance covers a verification copy.of statement maybe forwarded to the Of"nce of 1 do hereby certify under the pains-and penalties of perjury that the information provided above is true and correct Si atur`e: "' 11 i Phone#: — FOther only. Do not write in this area, to be completed by city or town officiaC Town: Permit/License# hority(circle one): 1. Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing:pector son• Phone#: Information a.n d 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 p=rson in the service of another under any contract of hire, express or implied,oral or written." i 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 t33Le 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 e``mployer." 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,opera!te.-a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage I required." Additionany,MGL chapter 1,52,§25CO)states'"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work uratil.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-contiactor(s)name(s), address(es)and phone number(g)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, arc 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 Iine. 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 sureio fill in the permittlicrose 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 fo any business or commercial venture (Le. a dog license or permit to bun leaves etc.) said person is 1-40T required to complete this affidavit The Office of Investigations wound 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. fir~ Commonwealth of Massachusetts Department Of Industrial Accidents Office of Investigations 600 Washig n Street Boston,MA 02111 Tel.#617-727-4400 ext.4W or 1-877 IMASSAFE Revised 11-=22-06 Fax # 617-727-7749 www-mass_govldia NORT#j Town of Andover 0 No. o dower, Mass., oLAK It. COC MIC ME WICK V 7,ps RATED PPG �C 1 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT... ........... ..... .i,.... ..... . .... .............................................. Foundation has permission to erect........................................ buildings on ...;)Tt......... .. . '�1r't' .......� Rough • Chimney to be occupied as....&�.:..9A.10V............... ... .......................a��.�l.�.......�.�... ... ..... ..,... ............... .......... provided that the person accepting this permit 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 Final �q PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTR T T 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. a+ pGRTH TOWN OF NORTH ANDOVER •.."�o OFFICE OF . BUILDING DEPARTMENT + 1600 Osgood Street Building 20, Suite 2-36 +�.;�;,;.;:'►��# North Andover,Massachusetts 01845 sswC Gerald A Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please gd DATE: y—/J--08- JOB LOCATION: Number Street Address Map/Lot HOMEOWNER Name Home Phone e work Phone PRESENT MAILING ADDRESS City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsliW for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undersigned"homeowner'certifies that Wshe understands the Town of North Andover Building Department minimum mq)whon procedures and requirements and that helshe will comply with said procedures and HOMEOWNERS SIGNATUItE�� APPROVAL OF BUILDING OFFICIAL Revind 10.2005 Form Homwwnms ExmW ion BOARD OF VPPEALS 688-9541 CO.NSER\'ArION 688-9530 HEALTH 688-9540 PLANNING 6R8-9535 4 #'<EMPER SPRINGDALE RAISED PANEL $4643.00 a KEMPER PAMBROOK FLAT DOOR W/ROPE $6102.00 ff--Y0"XI8"SINGLE BOWL SINK Z cwoc $ 393.00 fj-'KNOBS AND HANDLES $ 350.00 iVLABOR TO COMPLETE KITCHEN $2320.00 OLUMBING ALLOWANCE $ 600.00 LECTRIC ALLOWANCE $ 600.00 TOTAL AMOUNT OF WORK TO BE COMPLETED fr�ME OWNER UI ER T.W.BUILDERS,L.L.C. New Construction&Remodeling Box 226 Tom Latham Sandown,N.H. 03873 603-765-6887 T.W. BUILDERS L.L.C. AGREEMENT WE HEREBY PROPOSE TOFURNISH THE MATERIALS AND PREFORM THE LABOR NECISSARY FOR THE COMPLETION OF THE WORK SPECIFIED IN THE ATTACHED PROPOSAL. ALL MATERIAL IS GUARANTEEDTO BE SPESIFIED, AND THE WORK TO BE PERFORMED IN ACCORDANCE WITH THE SPESIFICATIONS SUBMITTED IN THE PROPOSAL, AND COMPLETED 4 A PROFESSIONAL WORKMAN- LIKE MANNER FOR THE SUM OF: %1jy PWETSa OB` S FALLOWS: JO% 7�6,sfot� 6-4-,VA0% ON ACCEPTANCE OF AGREEMENT 50% ON COMPLEATION RESPETFULLY SUBMITED ANY ALTERATIONS OR DEVEATIONS FROM SPESIFICATIONS INVOLVING EXTRA COST WILL BE EXECUTED ONLY UPON WRITEN ORDER,AND WILL BECOME AN EXTRA CHARGE OVER AND ABOVE THE ESTAMATE. ACCEPTANCE OF AGREEMENT THE ABOVE PRICES, SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY AND ARE HEREBY ACCEPTED. YOU ARE AUTHERISED TO DO THE WORK AS SPECIFIDE. PAYMENTS WILL BE MADE AS OUTLINED ABOVE. SIGNATURE G DATE SIGNATURE 04/04/2008 12:25 FAX 609 382 9387 JOSEPH HILLS AGENCY INC 19002 co D. CERTIFICATE OF LIABILITY INSURANCEOP ID DA�(M*mc"� Ti4B 1 04 04 08 PRODUCER , THIS CERTIFICATE IS"UED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE i TH$ JOSZM S. HILLS A(;=CY INC HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 129 X%IN STRZBT, PO BOX 300 ALTER THE COVERAGE AFFORDED 13Y THE POLICIES BELOW. PLAISTOW NH 03865-0300 P$oaes603-382-9211 Fax:603-382-9387 INSURERS AFFORDING COVERAGE MAIC# KWRW INSUM& Concord General Mutual 20672 INSURER B: TW Builders, LLC INSURER C.- 30ox 226 INauRER IT, ass own NIT 03873 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDIkG§ i ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RSSMT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERON IS SUBJECT TO ALL THE TERMS.PXCLU$IONS AND CONDITIONS OF SUCH POLIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID MAW. L STWE OF INSU POLICY NUMBERp DA LO LIMITS GENERAL UA9IUTY EACH OCCURRENCE S 1 O0O 000 A X COMMERCIALGENERALLMNL1TY 8669409 07/09/07 07/09/05 PROMISES Me wronw) 50 000 CLAIMS MADE X❑OCCUR MED EXP(Arty am person) S 5,090 PERSONALSAMINJURY 31,000,000 GEINERAI.AGGREGATE s2,000,000 GEWL AGGREGATE LIMIT APPLIE S PEP-, PRODUCTS-COMP/OP AGG S21000,000 R POUCY 0 P LOC AUTOMOBILE LIABILITY COMBINED SINGLE UMI S ANYAUTO (Es ooddenp ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per pepon) S HIRED AUTOS BODILY INJURY NON-0WNEDAUTOS (Peraccka:d) i PROPERTY DAMAGE f (Per aCddeM) GARAGE LIABILITY AUTO ONLY-6A ACCIDENT f ANY AUTO OTHER THAN EA ACC $ _•,• AUTO ONLY: A136 S EXC99MMBRELLA,LIABIUTY EACH OCCURRENCE S OCCUR CLAIMS MADE AGGREGATE f- i DEDUCTIBLE i RE:TEPITION S i WORKERS LOS S COMPENSATIONLUWNjry RY UMRa I I ER" _ V�PRo�TB LUDED9 E�VFi EA,EACH ACCIDENT S Iy�,Oosotlbeund�r F-L,018BASE-EAEMPLO f SPECL4L PROVISIONS below El-DISEASE-POLICY LIMIT i OTHER DE$C N OF OP NS/LocAroW i VE cLEs I EOC BION$40M BY Or"INT I SPECIAL Omb CARPMRY - CONSTRUCTION OF DW21,L=G9 CERTIFICATE HOLDER CANCELLATION ' Z=g;SO SHOULD ANY OF TNS ABOVE 01090RIBED POW=88 CANCELLED 09FOM THE ftPuRATIQN DATE THFACO&THE ISSUING INSURER WILL"DEAVOR TO MJNL 10 DAYS WAITTEN NOTICE TO THE CIbRTIRGATE HOLDER NAMED TO THE Lan,BUT FAILURE TO DO SD SHALL TDRA As s oc i dten IMPOSE NO ODU"TWN OR LIASILITY OF ANY KIND UPON THE WSURM ITS AGENTS OR Z Washington Street M! W $av6rlsill MA 01832 A w ACORD 25{20011)5) 0 ACT CORPORATION 1988 T.W. BUILDERS, L.L.C. New Construction&Remodeling Box 226 Tom Latham Sandown,N.H.03873 (603)765-6887 PROPASAL SUBJECT: ANNETTE McHALE 251 PLEASANT ST. ANDOVER,MASS TEL. (978)686-4988 Q� SCOPE OF WORK BASEMENT 1. TEAR OUT EXISTING ROOM, REMOVING ALL WOOD WALLS AND WOOD FLOOR 2. REMOVE ALL DEBRIS,BROOM CLEAN 3. INCLUDES ALL LABOR AND DUMPSTER $1170.00 KITCHEN PREP 1. REMOVE CHAIR RAIL IN KITCHEN AREA 2. REMOVE SECTION OF WALL FROM NEW DINING AREA AND KITCHEN 3. INSTALL PROPER HEADER,SHEETROCK WHERE NEEDED. 4. MOVE ELECTRICAL SWITCHES WHERE NEEDED 5. SKIP WALLS AND CEILING IN KITCHEN AREA,AND PRIME 6. CEILING TO BE FLAT 7. PAINT WALLS TWO COATS,CEILING ONE COAT (OWNER TO PICK PAINT COLOR) (HOME OWNER TO STRIP WALL PAPER) $1700.00 SHEETROCK 1 .INSTALL%z"SHEETROCK OVER EXISTING CEILING,NEW DINING AREA 2.TAPE AND MUD JOINTS AND NAILS,SAND AND PAINT,FLAT FINISH $1600.00 4. SAME AS ABOVE EXCEPT SKIPED TEXTURED $1400.00 WINDOW 1. REPLACE KITCHEN WINDOW WITH VYNAL CLAD DOUBLE CRANK OUT INSULATED WINDOW NO GRILLS $550.00 KITCHEN CABINETS 2. REMOVE EXISTING CABINETS,AND INSTALL NEW KITCHEN AS PICKED OUT BY OWNER FROM E.C.L.INCLUDING REMOVAL OF ALL DEBRIS,PLUMBING, AND ELECTRICAL AS NEEDED, V'CORIAN TOP $3626.00