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HomeMy WebLinkAboutBuilding Permit #46 - 261 WAVERLY ROAD 7/9/2010BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received A NORTti o �- i A SSACHUS 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 Others: Demolition Other Septic" Well,Floodplain Wetlands` a Watershed Distr ct ; t. d �r,:� l/llater/SewerE . 9'7 iY'� ,, .;'l ':»'�"`� DESCRIPTION OFWORK TO BE PREFORMED: ... a n Iden ' tion Please Type or Print Clearly) OWNER: Name: rC ® 2-. '(" 4, All A i c9 Arirlrr=cc- rt 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: $ dJ FEE: $ �j Z Check No.: '�Receipt No.: �� C NOTE: Persons contra ing with unregistered contractors do not have access -to the guaranty fund 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 COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comm Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: _ 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 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 ❑ -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 _u 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 Li 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: Building Permit Revised 2008 LocationL-�2�/ No. Date NORTH TOWN OF NORTH ANDOVER 0:�.c° : , 0 ° . • OL A Certificate of Occupancy $ 7 '� s"••° t<� Building/Frame Permit Fee $ �cMus Foundation Permit Fee $ Other Permit Fee $ j TOTAL $ Check #-3—'i f Building Inspector pt, 0 H 6 x 0 12 0 w2 C/) 0 cou 'a X to a2 V . u — ca x X to CL94 O 10 Uu :3 u u cd 94 :j Cd Wu a 8 0 OO Cc CL 2t. Ca •E i. >1 CF 44 LU CL ca E s ul ,A C2 00 ts CD t� E CL= C42 CD C� L- O il-ol N M13 CA cm CA cc• C DCOD E UI.—.Ca CLA f -.l CL m cm CA Cl %L. ..C.2 LZ 0 O cm C3 40 Cl CD oca CLCD '— COD co :5 'D C* ui•2c c a W CD C3 CD jE ccm r— C.34D CL 0.0 0 COD '. cis FE CA 212 co z .12 L- CL.O.. Z U) z 0 9, Rid t C/) z 0 U Cf) U) r"I E O ts O CA I cm CD CD CD 0C2 CD � C3 CM< H -0 cc ca CD ts CD cc cc CL CO) The Comszonwerztth of1V'assachusetts Department` o frndustrial -4ccidents office of npesizb ations 600 ff r,,h ntrton Street 1$ostorz, AM 02XXX ' Workers' Compensation Insurance Affidavit: t: �uilclers/C 10cant Informsifion ontractors/Electricians/Plumbers Nast; (Business/Qrganization/Individual): Acl dress: `; 61 .- bi ,3 Y (� /City/date/Zip: , %4- Phone#:5", Are you an em Io e 9 Ch P y r. eck� fine a"ropriaie boa; 1- ❑ I am a employer with ' G/ i 4. ❑ I ama co employees (full and/or p * 2. ❑ I the sub -contractors and I have eae am a sole proprietor or partner- ship and have no employees listed on the: attached sheet t These sub_.contractors have working for me in any capacity.'. workers' comp, insurance. [No workers' comp: insurance 5. ❑ We. are `-co required.] 3.0 I am a homeowner doing rporation and its . offiicershave exercised their all work myself. No workers' right of ex .� emption per. MGL comp, insurance re uired t ' q C. 152, § 1(4) , and we have no employees. [No v'vorkers' ' *- 5 p, Y.� s comp. insurance required-] � •-n ' •--_ * t ci:�ks boy: 4! mast �n iY,.l c:�'C the secuos b . I3omeown en; who submit this affidavit ' di Type of project (required):' 6. ❑ New constru non 7. o Iing 8• ❑ Demolition 9• ❑ Building addition I0.❑ Electrical repairs or additions .11.11 Plumbing repairs oradditions 12-E] Roof repairs 13.❑ Other cahag ihc;' azr doing -won and r - -- rte"� zc—,. naa Contractors that eh=- this box a+Lst att:rhed an a war hire outsic}E coatxEcto o MUV, bruit a new ddsiional sheet show affidavit indicating such. we same of the s,_b c uLL ..ur and their work � —.L an em er rs provuiing workers' --- --'••r• r��+-Y ++uuiIDaIIon. compensation in surance for my employees. Below it thepolicy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: k, -e_? U/7 // Expiration Dale: Job Site Address; L- 5/JJ City/State/Zip: Attach a copy of the workers' compensation policy declaration -patre (shovdng the poi ey niFfiiber and expiration date). fiFailure to secure coverage as required under Section 25A ofMCiL C. 152 can lead to the imposition of c ne up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK 0 P criminal penalties of a Of up to $250.00 a day against the violator. Be advised that a co a fine Investigations of the DIA for insurance coverage verification, of this statement may be forwarded to the Office of I do hereby u« yc icruues qj perJury thrtt the information provided above is true and correct_ Q-f-f'Cial use only. Do not write in this area, to be co mpltd City or Town: hi' Cifi, or towlt official, 1111 --'Ir ! Cense Issuing Authority (circle I_ Board of Health 2. Building Department .3- City/Town 6. Other Contact Person: Clerk 4- EIectrical Inspector 5. Plumbing Inspector Phone #: Information an- d - kstrudions 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,-associ�tion, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including tie Iegal representatives of a deceased employer, or the remivar or trustee of an individual, partnership, association a:i& other legal entity, employing employees. However the owner ofa dwelling house having notmore fihan--three apartu>Lehfi ana 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 appurtF-ream thereto shall not be: cause of such. employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local Iicensing'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 ca:Ampiiance 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 taveff acceptable evidence of compliance with the ir'eurance requirements of this chapter have been presented to the coniia cting 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 cerdfrcate(s) of insurance. Limited Liability Companies (LLC) or. Limited LiabHiiy Partnerships (LLP) wi no employees other than the members or partners,. are not required to carry workers' comp csafion insurance. If an LLC or LLP does have - employees, apoli cy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confumation ofinsurance cover. ge..Also be sere to sign and date the affidavit. Tht affidavit should li3e i utv toed t4 the City 4r town that— elle au�+hGatrori tui the per�ait or IiCer•'�e lR being requested, not the •Departme.•lt of Industrial Accidents. Should you have any questions regardirti g the law or if you are reT-red to obtain a workers' compensationpolicy, please call the Department at the nnmbcr listed below. Self-insured companies. should enter their self-insurance license number on the appropriate line. = , City or Town OfflcFals 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 lnj, esdgations has to contact you regarding the applicant Please be sure to fill in the permit/lieanse 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 iu (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 pelZnits 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 burn leaves etc.) said person is NOT required to complete this affidavit. The Office ofInvesiigaiions would Ire to thank y_ou in advance f6r your cooperation and should you have any questions, please. do not hesitate to give us a call The Department's address, t:lephone.and,fax-numbers__._ 'f'he Co=onwM1ffi- oaf Ma&&E r sates I epartmemt offmdT st al A=identg Office .of Inrestt atio.ns 6x40 WaAington. Straat Sastan, MA 02111 Tel. 9 617-727-49-00 ezft 4106 or 1-9 77 MASS- FE Pax # 6.17-727-7749 Revised 5-26-05 vmrvi7.mam-1(Yov/dia. / G \\/ \ L) � )\\ \: .2 §�\ k 5 . - � e5\ /2 > x j \ ./1:2 ZC) w & . L ] §/ o / }c 2 Cl) i( § LL }\ f 0!22 § �. 45)R § \ �222gaLU \ /< 0 8 \ 2 < ) ?'°k § 2 2 ...\ / ! £ of @ w (I[ ) f < 0 = OwlE g m n ( . / 11 f 8 2 Illi 24.DISHW 441 WORK AROUND W1830 REDUCED PIPE CHASE DEPTH TO 7" I 0 -GAS -RANGE i u i i u i 3 O 1 -TRIM FILLERS 0 AS NEEDED 2 -ATTACH F330 TRIM TO FIT 3 -ATTACH FILLERS © 0 TOGETHER CREATING CORNER / \ / \y, 4 -PULL (#13) WC3330 FOWARD_________ ________________ll// SO THAT (#14) W1830 LINES UP - AT THE END OF THE :20 19 7 15 1 RUN - WITH (#12) B27 21 5-627 REDUCED IN 22 DEPTH TO 22" 6 -ATTACH TEP2484f1.5 7 -ATTACH TALL FILLER 104'," 8 -PLACE HEATING VENT UNDER CABINET -105-1" THROUGH THE TOE KICK N rn Legend 1: F330 2: B12L 3: SB33STS 4: 3DB12 5: B9FHL 6: CF330 7: F330 8: W3030 9: W330BCFP 10: W3012 11: W1830L 12: B27 13: WC3330L 14: W1830L 15: U338424SS 16: TF384 17: TEP2484F1.5-WD 18: TEP2484F1.5-WD 19: 4DB12 20: TRBD18 21: W331524 22: W3030 All dimensions _size designations given are subject to verification on job site and adjustment to fit job conditions. This is an original design and must not be released or copied unless applicable fee has been paid or job order placed. Designed: 5/16/2010 Printed: 6/24/2010 414095E4.kit All Drawing #: 1 a P1 M lit W V V- 1 'I' l l 2 1 /11, 11 2 522 3 1 33 3011 r I 16 514 " 3,13 , 126 13 13 3311 18"T -1731-611 r IN r IN r N _ O WC3330L 1830E M - r- ICV Cr) CO U3TF384SS OD OD M I� 0) CF330 B27 N M � /L--25111-7 _„ 2 7" 9 6 24" 16 783,. 227„ 243., 4 8 -6 - All dimensions size designations This is an original design and must Designed: 5/16/2010 given are subject to verification on not be released or copied unless Printed: 6/24/2010 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. L 414095E4.kit El 2 Drawing #: I 11442' 1 " 3 01 8., if30„ 18 if14-2111 r N MICU r r W3012 — — F3 �,r� U -)DO N �IN N Wd W3030 3 ==C3M L VC33301 - IN - _ �I ®(D ®® - ❑ ❑ cm ICD C)�I`V F3 M M B 22L 24.DISHWSB33STS 3DB130—GAS—RA(g 09 :CF330 2" —24 11 3311 12 3 " __232" 25" 28 ;" „25;x" 1 16 6 ;" 21 a" 25 a" Page 9 of 10 NO. 2685-172464 Home Improvement Agreement PLEASE READ THIS important information regarding Customer's rights may be contained in an attached Staete supplement. hent. p General Terms and Conditions, Scope: State This 'Ag reement' consists of this page, the following a part of this Supplement if ap licable, and any drawings or voice and Change Orreers e U SxpressIA.mince ('The Home Depot' en Nome Depot) Any between the Cust mer identified on the Authorized installation service s provided under this Agreement shall be performed by a licensed nor doesditpmake structural Service Provider.. The Home Depot does not perform architectural or engineering changes to dwell ngs or other structures, The Home Depot and its Authorized Service Provider will perform installation services in accor ance with applicable law. pay the total amount of the sale Payment :ichedu e: Payment is required as indicated below. Please initial here to opt to Supplement. now; Customer ha the option of paying less as further specified in the State Supp $_ 2950 26 — Due in full immediately. Payment: If applicable. $ Sales Tax: �Q1 �6 87 Includes all applicable discounts, rebates, and $ Total Amount of ale: taxes. Excludes finance charges.' te *Any interest pay iich The e or otherand will be in additionharges llto customel be lr's paymentned by tunder this Agreement.customer�Cust meldee or r s subject totthe elrms and Home Depot is NOT a party, able to Authorized Service Provider; conditions of the ardholder or loan agreement, as applicable. No funds should be made pay however, Authori ed Service Provider may collect Customer's payment(s) made payable to The Home Depot. ynTlGlpaarsu SD Start Date: 06/16/2010 Finis Date: Delivery(Date: of goods Acce lance a d Authorization: Cusco customerauthorizes The agreesHome Dapdtunderstands arrange t ghisoAgreemlent�is the entire and services i ceen c customer the Invo said goods and services and supersedes all prior agreement be een Customer and The Home Depot with rtoard saidogoods and services, This Agreement can not be discussions an agreements, either oral or written relating assigned or arra nded except by tivolungtaely accepts d by � he terms of and s emer and The Home ntitled d to and hasaeceiveld agcomp ee agrees that Customer as read, understands, of this Agreem nt at the time Customer signs the Agreement. Do not sign if blank or incomplete. ee that the digital signatures of the parties included in this Electronic Si nature: The parties to the Agreement agrdtng and to Agreement are intended to authenticate is the pelrsan name ave the same force d on The Home Dot contract number identfied oneffect as the ue ofl the point of Customer ack owledges that he or sale device. CELL ION: CUSTOMER MAY CANCEL OME DEPOT S AGREEMENT I BY MIDNIGHT ON HE OBLIGATI N BY DELIVERING WRITTEN NOTICE TOTHE H THIRD BU (NESS DAY AFTER SIGNING y aft AGREEMENT. circumstances, customer's payment(s) wil be returned within ten (10) arThe omas receipt of Customers Accepted p 05/16/2010 X Date customers Signa ure Ass ci te'st uth rized Service Provider's Full Sig lure Authorized Service Provider's Full BusinesslTrade Name, Address and License No. or N (s)., as applicable: Date Associate: Please print your salesperson's license number, if applicable. License No(s). Authorized Servider are a Provlder'sTel. No.answer uestions? If The Home Depot stoor customer Art orized Service Prov are Department at 1-i800-553-31 91 ortCustomer's Questions, use the address below. Customer ma contact The Home Dep Home Depot U.S.A. Inc., 2455 Paces Ferry Road, N.W., Bldg B.3, Atlanta, Georgia 30339 112010 Page 9 of 10 0O. 2685-172464 Store Copy