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Home My WebLink AboutBuilding Permit #863 - 265 HAY MEADOW ROAD 6/5/2012BUILDING PERMIT o` :6A -N TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION _ w 1� Permit NO: Date Received � / �SSACHUS�,C Date Issued: I!/ IMPORTANT: Applicant must complete all items on this page 'L®CATIf®;Nl AD� OP nn VA :. m AN0 `� �q PROPERT�YY®QWNER f`�w PARCEL: Z®NING DIS,TRI'QA HtstonctDistncf; yes:. nod r 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 :> Se tics Weill P Floodplairn"Wetlandss�+Watershed®istnctc E Water /Sewed. DESCRIPTION OF WORK TO BE PREFORMED: Please Type or OWNER: Name: Aririracc- Phone: Q:-9"-� C\L4 —9 t 96 TT -R Name` - -- Phone: Address, Supervisors�Construcfion01License r LL - Expo Date v V Home�lmpc ro,,vement�Liense: Exp+ Date _ .:,�-...,-.,.� ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT. $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ FEE: Check No.: �D 3 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Sim nature of.A ert/Owrer. - -'� -` - A � f - ' 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 9 1 COMMENTS IF Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street fNylaii 1 rv;1415F1} r a er..J . w.a�,yo,rtek r„T,y� to � � c�Xxf d �,y� ,�� s��R x `� i �.: " c .. ♦ ;iY`r -Y eDnt-s,ignature/date�t epartme„f di'i't`� „�}4°i`f�'.'•�` x� ka+�s. � ��'cA3. �5%'��'�Y`i5'^'{ ��^•�,,,,:= ^(, '��„��'y�.wpY,,.�. r "{�a,T-•�.+r"�'-"+ ��, �. �,1� NTeS_ MMEr �.., ..-<.„rr^a , a4111 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) o 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 o 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Location,:;),�� x--" No.-PA3 Date Check# ( 0 3 3 25361 TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL Building Inspector CA m X 14 ,mww Vr m S y — � O CD z CA CSD O 'C C/) O. =y O a='00 �C C2 `° CD O rr'• V• CL �n Q ` J CD CD O CD O cn cmy. C/) O -� CDz D.O CO) CO C=D cm C40 � -vCD Z CD 0 ` c CD o C O C ? O d = tl w O N w O Cco-, C m Off'.® am H C2 C. nCD y Cl) ,.d GOD b • � .0 3 H � to GtTj •^ CL 0 CD M C042o m H CO a 0 0 ro d o tl w w A, I� n w � ,.d GOD b � � a�n 0 a to GtTj •^ CL x d x I. • y 0 0 c Serrano, Tony & Renee 265 Haymeadow Ln. N. Andover, MA (978) 697-8767 Job Description: Kitchen renovation • Removal of existing sink/faucett assembly • Removal of existing cou ntertop/backsp I ash • Removal of existing upper & lower cabinetry • Removal of existing framed pantry & door • Removal of existing crown molding • Removal of existing 2 1/2" colonial door/window molding • Removal of existing 2 1/4" oak flooring Electric • Installation of 20 amp lighting circuit • Installation of 20 amp designated microwave circuit • Installation of additional 240 W oven circuit • Relocation of existing oven circuit • Installation of updated counter receptacles (4) • Installation of nine (9) recessed can fixtures • Relocation of existing light fixtures to center • Relocation of central -vac port • Installation of two (2) 6" ceiling speakers Plumbing • Relocation of refrigerator water feed • Installation of new undermount sink • Installation of new faucet assembly Ceilings • Installation of 3/8" blueboard along entire kitchen ceiling to resurface Skim coat plaster to finish Cabinetry • Installation of new upper & lower kitchen cabinetry • Installation of related crown mouldings, fillers, extended stiles and skins • (Cabinet style to be determined by homeowner) Countertop (See allowances) • Installation of granite countertops along all base cabinet lines per allowance Appliances • Installation of dishwasher • Installation of refrigerator • Installation of double ovens • Installation of surface mount cooktop • Installation of venting microwave Trim • Installation of new 3 1/2" crown moulding along kitchen perimeter • Installation of new 3 1/2" colonial casing along kitchen passages & window o Installation o'136" wainscotting along kitchen perimeter 11 0 Installation of new 5 1/4" speed baseboard along kitchen perimeter Flooring 0 Installation of new 3 1/4" unfinished oak flooring along entire kitchen 0 3 coat sand, tack, poly of entire floor surface to finish Debris 0 Removal/disposal of all construction debris .incurred Work total: $25,000.00 2 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 r Name (Business/Organization/Individual): AnA];-h c ny � j1� Q—rrza(1_o Address City/State/Zip: M . And,nu�—r /L� Phone #: 9 :7C' -79'+ C'�5 I a Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. $ ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. Of I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other *Any applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing 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 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 $250.00 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 coverage verification. I do herebfcertify ander thR�pains and penaft1es)gf pgrjury that the information provided above is true and correct. 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 #: 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." 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 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 permit 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 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 may be 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 you are 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 line. 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 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 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 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: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia Gerald A. Brown Inspector of Buildings Please print DATE:� , JOB LOCATION: TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 600 Osgood Street Building 20, -Suite 2-36 North Andover, Massachusetts 01845 Telephone (M) 688-9545 Fax (978) 688-9542 HOMEOWNER -LICENSE EXEMPTION BUIDING PERMIT APPLICATION Number 5 et Address Name Home Phone PRESENT MAILING ADDRESS Cit; Tov!n State . r Map/Lot " 14n�)`7(a.'] Work Phone Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings to two units .or tizmless a_??r1 acts as supervisor). State Building to allow such homeoers to engage ua hidividuaLfor hire who floes not possess a license, provided that the owner (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Persons) who gwns a parcel of land on which he/she resides or intends to reside, be, a one or two family structures. A person who constructs more on which there is, oris intended to considered a homeowner. that one home in a two-year period shall not be e The undersigned "homeowner" assumes responsibility for compliances with the State Building Code and other Applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Forth Andover Building Department minimum inspection procedures and requirements and that he/she will comply with,said procedures and requirements. �� HOMEOWNERS SIGNA APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-954] CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535