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Home My WebLink AboutBuilding Permit #457 - 255 SALEM STREET 5/1/2018 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATi1ON S r �ej_ K z,,.Y�®WNERI��' f y f o' Pnnt 1OO1YearOld Structure ., yes n IMAPYNNx® T_J= ARYCELt .Z®NING1DI TRIGTHstoncDistnct� yes, i o ac e pVillay yes nom TYPE OF IMPROVEMENT PROPOSED USE Res' ential Non- Residential ❑ New Building a family ❑Addition ❑Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial At L epair, replacement ElAssessory Bldg ❑ Others: Demolition ❑ Other ❑,Septics ❑We(I F of odplain : ❑V1letlands F < 0,Watershed ®istrct T ,ow DESCRIPTION DESCRIPTION OF WORK TO BE PERFORMED: Wo ja� i'tit Identification lease Type or.Print Clearly) n OWNER: Name: L �� \ C�.4 v�I Q1 Phone: `l 6 Address: Z5-IS 5 V CONTtRACTtOR Name _ V— Ik.. f Phone _l � { Su ervisor,'sCorst"rucfionr'License: ��' __ p _ t < - HomeIrnpro�ernent�License, -�� - ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.0,0 PE�ER,�$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �CS FEE: $ qq Check No.: � f� Receipt No.: NOTE: Persons contracting with unregistered contractors do n"Mave ac c an un of Aent/®wner# `.bx natureof Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan staYRedvPlans ❑ 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 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 Towp- Engineer: Signature: Located 384 Osgood Street F=IRE'DEPARTMENT ._ Temp Dumpster on site yes no Located at124(Maiq.Street Fire Department signaturelddte COMMENTS w 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 j DATER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and.G min.$100-$1000 fine MOTES and DATA- For department use i I, ® Notified for pickup - Date Doe.Building Permit Revised 2010 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 o 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 (ifApplicable) ❑ 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 submtted with the building application Doc: Doc.Building Permit Revised 2012 { »r. Location No. TOWN OF NORTH ANDOVER`. e Certificate of Occupancy $ ' Building/Frame Permit Fee 1$ Foundation Permit Fee Other Permit Fee �$ TOTAL $ Check# 26023 Building Inspector - � NORTIi 0 Twn of _ 6 ndover No. ,� ' - y `PK, h ver, Mass,0 4q 2COCNICHl WICK y1. ADRATED S U BOARD OF HEALTH LD Food/Kitchen Septic System PERMIT T F � ' BUILDING INSPECTOR THIS CERTIFIES THAT .................. ..ln...: a. ............. . .......................................r................ n .............. Foundation has permission to erect ..... buildings on ......C .S., .........Ste^- ••••.•••s p Rough to be occupied as ................1�.:......... ...... ...... ..)...... .4 .sla!14?3:............................................. 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 PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Finan PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TT-e- Service; Rough ............................................................................... 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 i 1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): s4c-�a, Address: City/State/Zip: VC- (�-7 &hone#: Art you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with�_ 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 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. ElWe are a corporation and its 10 Electrical repairs or additions 0 p required.] officers have exercised their 3.❑ I am a homeowner doing1 right of exemption per MGL 1 L❑Plumbing repairs or additions alwork g p p g p myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 1311 Other comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. P 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. it am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. assurance Company Name: ?olicy#or Self-ins.Lic.#: Expiration Date: (j lob Site Address: /7,ES 11 �� City/State/Zip: f k,ttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ?ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine up to$1,500.00 and/or one-year impriso ell as civil penallies-in-the form of a STOP WORK ORDER and a fine if up to$250.00 a day against the violato vised t i'"a cop of f this statement may be forwarded to the Office of nvestigations of the DIA for in_uxanee, o" do hereby certify under the pains \ry that the information provided above is true Ind correct. .i nature: Date: (i ) 'hone#: 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.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Workers' Compensation and Employer's Liability Policy Akl UARD NorGUARD Insurance Company - A Stock Company h� Policy Number STWC355504 MR N URANr E Renewal of STWC242600 GROUP NCCI No.[25844] Policy Information Page [1] Named Insured and Mailing Address Agency i Stephen Ventola PAYCHEX INSURANCE AGENCY 154 Boardman Ave 150 Sawgrass Drive Melrose, MA 02176 Rochester, NY 14620 Agency Code: NYPAYC10 Federal Employer's ID 27-2499080 Insured is Individual Additional Names of Insured (N2) DLM Remodeling [2] Policy Period From May 08, 2012 to May 08, 2013, 12:01 AM, standard time at the insured's mailing address. i [3] Coverage A. Workers' Compensation Insurance - Part One of this policy applies to the Workers' Compensation Law of the following states: Massachusetts B. Employer's Liability Insurance - Part Two of this policy applies to work in each of the states listed in item [3]A. The limits of our liability under Part Two are: Bodily Injury by Accident - each accident $100,000 Bodily Injury by Disease - each employee $100,000 Bodily Injury by Disease - policy limit $500,000 C. Other States Insurance - Part Three of this policy applies to all states, except any state listed in item [3]A. and the states of North Dakota, Ohio, Washington, and Wyoming. D. This policy includes these endorsements and schedules: See Extension of Information Page - Schedule of Forms [4] Premium The Premium Basis and, therefore, the premium will be determined by our Manual of Rules, Classifications, Rates., and Rating Plans. All required information is subject to verification and change by audit. (Continued on another page) Total Estimated Policy Premium 2,229 Total Surcharges/Assessments $ 111 Total Estimated Cost $ 2,340 INTERNAL USE xx Page - 1 - Information Page MGA :STWC355504 WC 000001A Date :04/08/2012 MANOTE 16 South River Street* P.O. Box A-H • Wilkes-Barre, PA 18703-0020• www.guard.com Dg. M Remodeling Steve Ventola Dave Merrifield 154 Boardman ave, Melrose, Ma. 02176 781-223-6629 781-789-8827 Leah Magaldi 255 Salem St, North Andover,Ma. 1-978-764-7810 Leah.magaldi a,gmail.com Contract Scope of work to be performed: Windows: - Remove existing windows and storms Inspect for and repair any rot Prep opening for new window installation Install White Harvey Classic vinyl replacement windows Insulate and caulk Cap exterior sills and casings with aluminum coil stock Re install interior stops Remove all debris upon completion of work Price includes all labor and materials Pricing: 15 Double hung windows with grids between the glass on top and bottom sashes @$425 per window................................................... ............$6,375 1 Harvey 2 lite casement window in kitchen @$525... ......... ... ..........$525 Cap 16 windows with aluminum coil @$60 per window ....................$960 Total Investment: $7,860 v' Deposit Required: $2,600 Balance due upon completion of work Respectfully submitted: Stephen Ventola for DLM Remodeling. Date: September 29, 2012 Accepte •.......................... .. .. ............... ............Date. Windows - Doors - Siding - Roofing Dees - Porches - Carpentry Hic license#131704 Builders license#076135 ✓> � oPiness Ra-ulati n License or registration valid for individul use only OfSce of Consumer Affairs&B�tsmess Re;ulation I HOME IMPROVEMENT CONTRACTOR ' before the expiration date. If found return to: Registration: 161597 Type: Office of Consumer Affairs and Business Regulation :10 Park Plaza-Su'le 170 Expiration: :..'1.0129/,2014 Individual Boston,MA 02 �� i S HEN VENTQLA r� d,. STEPHEN VENTOLA 154 BOARDMAN AUE {, MELROSE, MA 02176 f<_,�,,; Undersecretary ! Not vah wit t ure Massachusetts- Department of Public Safet% Board of Buildin!- Regulations and Standards Construction Supervisor License, License: CS 92687 STEPHEN M VENTOLA 154 BOARDMAN AVE " MELROSE, MA 02176 .. : -5 -35;� Expiration: 1012/2013 ('umtnistiuncr Tr#: 4877 I