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HomeMy WebLinkAboutBuilding Permit #875-2016 - 265 SALEM STREET 2/10/2016NORTH Cp BUILDING PERMIT o��tLeo �bgtia a�' 1 TOWN OF NORTH ANDOVER2 APPLICATION FOR PLAN EXAMINATION _ Permit No#: '�t Date Received SQAEg) ' ii �S-S CAUs���5 Date Issued: I ` IMPORTANT: Applicant must complete all items on this page LOCATION (v5 Sf etyl Print PROPERTY OWNER J AIMI +1� AA L 1aW)C(,S Print 100 Year Structure yes 6n MAP 031® b PARCEL: Z01 037�ZONING DISTRICT: Historic District yes no D°3�-moo L Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Exp. Date: 1-4 - !3 Residential Non- Residential ❑ New Building ane family Exp. Date: ❑ Addition ❑ Two or more family ❑ Industrial 9<1teration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other :OtS ptic� t❑�Well��'�*f �- ����� ��FI od ;lainr ���Wetlantls� t ®i �W�ater�he d D ict� ' t t• h A DESCRIPTION OF WORK TO BE PERFORMED: 1-1 ✓1 i SNI 6ato en4 9-N- 04d,(Ji o ricd (1 V wz S OaCL(P !CV4 r o 0 rvN y S+ ro-q-p l Identification - Please Type or Print Clearly . OWNER: Name: Address: 9&S' -d-16*vl -: NOt'4i Contractor Name: Jason I44y')`A) Address: �ff Phone: <,6(j��1-3-70.01;Co (" J1 Supervisor's Construction License: (-IS - 0, 11 1 F q Exp. Date: 1-4 - !3 Home Improvement License: 1,7q/37 Exp. Date: i, " P7 ARCHITECT/ENGINEER Phone: Address: Rea. No FEE SCHEDULE: BULDING PERMIT: $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ 1`71 vi ap FEE: $ �P Check No.: � 1 I Receipt No.: I ( l NOTE: Persons contracting thvunr�red contractors do nAot-have access to a gnd Plans Submitted ❑ Plans Waived ❑ Certified Plot flan ❑ Stamped Flans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF o U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Reviewed On Signature_ Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments C nservation Decision: Comments Water & Sewer Connection/Signature Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street a^�^° 4°`.�. `'rri,$" �""tStiaii$•;3 '#8.i �y;��T" tatg'�"'"rrS •,..�- a^ FIRE F.Ul EM NT Tema Dumpsfergon Located at 1=24 Main Street Fire Department signature/date+ �COMMENI�.a ¢ , s a y ,.1 , „ � x �� , * � `i. r�. TS �� � ., Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. )U3 : loi i,�Ad Total land area, sq. ft.: 13? ELECTRICAL: Movement of Meter location, avast 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 NU I L5 and IJA, I A -- (t -or aepartment use ® Notified for pickup Call Ema Date Time Doc.Buildinb Permit Revised 2014 Contact Name 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 4 Building Permit Application 4, Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses .46 Copy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: 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/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 TOTE: 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 4. 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 P-1 N o. Date TOWN OF NORTH ANDOVER �117 Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ C2qt 10 Check # 29998 /bluil�ling Inspector Enter construction cost for fee cal - North Andover Fee Cakulation Construction Cost $ 179200.00 m $ - $ 206.40 Plumbing Fee $ 25.80 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 25.80 Total fees collected $ 358.00 265 Salem Street 875-2016 on 2/10/2016 Finish Basement O Q uj LL OZ p m N u O LL N N u N (n p V W z Z m c O v O LL t O w c s U O LL Ooc W CL z J d t O w O LL W d z Q v � W s p K ` (A C LL p F- a Z (7 sz 0 OC C LL Z W W LL ++ v O r�� E o C oz N c c 3 Cy)oO L Qa)= Q L) M �+ u _ 0 I,rm A- •N v o O CL •� W � 0+ m _ + OO LL C y C ca w uml L E •moa V Q o •a CD N N .•O`er C F' ..o+ Q 0 C.i 0 W ILcoz z Co CO cb H' O W O Z U W OC r a Z w' O U) W CL Z a w 0 s c mo 0 C' CL EF) Q r C J � O4-0 Z CL N/\ C O O C o .0 •� L as Q clC.) � V Q. N E o � c a o L (� � 3 d � c 1 • i > _ c L y N c — o V s U) (D E o C oz N c c 3 Cy)oO L Qa)= Q L) M �+ u _ 0 I,rm A- •N v o O CL •� W � 0+ m _ + OO LL C y C ca w uml L E •moa V Q o •a CD N N .•O`er C F' ..o+ Q 0 C.i 0 W ILcoz z Co CO cb H' O W O Z U W OC r a Z w' O U) W CL Z a w 0 s c mo 0 C' CL EF) Q r C J � O4-0 Z CL N/\ C Jaime Flores 2,6 Salem St. North Andover Ma Jaime.flores@Dhilips.com com Basement/Playroom Renovation Scope of work: Frame exterior walls, strap ceiling, insulate walls with Refect room with louvered door. Create storage in walls. Hand blue board and plaster all walls and ceiling. Instal! Pref 350sgft is,needed). Install 3 '/2" colonial base and trim out any storage created in Remove existing stair treads and risers. Install preprimed rise coats of urethane to treads. Install preprimed white square bal Electrician: Install new sub panel in utility in utility room. In approximately I every 6' throughout basement. Install 13 rec heater/blower. *unknown plaster repair of stair well to be determined and nc Cost of Job: $17, 200.00 Permits: Cost to be determined and paid for at that time. Payment due as follows: $5700.00 due as signing of contract $5000.00 at compl6tion of rough fr ing and rough electrical $3500.00 once�plastering is co ete $3000.00 due ubon �omnletio �.- Homeowner Signature Contractor Signa re Frame small closet for water pipes. Frame utility hardwood floor (supplied by homeowner. S. Install natural read oak treads. Sand and apply 4 ers and red oak handrail on staircase. 8' light in utility room. Install outlets I lights with switches to operate. Install in -wall t included in cost of proposal /i 17 Date t✓'L;; �i.�`�` l.'J �%t-j^=`rot:-�v� � � , ' �' ,�, h fir S i. A8 commonwealth of. arssa huseits ;. .1�epc�rtmeni of.X�edr��st�i��Accic%�ts 4 ... d ICongressStreet,�'uite 100 Boston, JW 02114-2017 w www mass:goMid Workers' Coanpensationlnsurance Affidavit: ]Builders/ContractorsimectrcicianslPXuxabexs. TO BS'iTY. Please Print Le 'bl AnWieaut.lpformation Na= (BusinesslOxganizaiionlludividnal): , 1 i,,,'•E7�N A.dddxess: ijt�w►e�i1:�=+<. D City/State/Zip: lf,i�G ��•f W j' Mono #:, Are you an employer? ChecktKe appropriate box: q7�F, (ori r1. L'3i- 101 am.a employer with employees (full andlor part time).' 2. Wam. a sole proprietor or parhtership and have no employees Working for me in any capacity. [No workers' comp. insurance required.] 3.,Qiamahomeowner doing allworkmyself[NO workers'comp."Bur ancerequired.]t 4.[] lam a homeowner and will. be hiring contractors to conduct alt work on my propertye . Iwlll ensure that all contractors either have workers' compensation insurance or are sol 5. n I am a general contractor and I have hired the sub-coixtractors listed onthe attached sheet. These sab-contractors have employees and have workers' comp. ins urance.t 6.[] We are a corporation and ifs ofitcters have exercised their right o£ exemption per MGL c. 152 §1(4), andwe have no employees. [No workers' comp, insurance required.] Type of project (required): 7. [( New construction 8. [Xmodelidg 9. Q Demolition 10 [] Building addition 11.[-Kecirical repairs or additions 13.E] Roof iepairs 14. ❑ Other *Any applicant that checks U ..:#I must also filn outthe section Mow showing their workers' compensation policy information. i 7 omeowners who suliriiit flus affidavit indicating they are do in all work andthea hire outside contractors must submit anew affidavit indicating such. ?Contractors that check this box must,attached an additional sheet showing the name of the sub -contractors and stafe whether or not those entities have . employees. if the sub-corilraclors have employees, &t rimst provide their workers' comp. policy number. I am an eMployer that is pidvzd1hg workers' compensation insurance fer,rrcy-employees: Below is the policy andjab site information. Insurance Cc 1 VV'- Policy#orSelf-ins,Lic.#."" �btt ExpirationDate• b ` -' fobSite-Address: 9� 6 S�Iei� S�-' City/State/Zip: '` /Y►� uy2� MA a copy of the Workers' compepsation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL o. 152, §25A is a criminal violation punishable by 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. A, copy ofthis statement maybe foiwarded to the Office oflnvestigations ofthe DIA for insurance coverage verification. Ydo hereby cerci ,, p K' mat the inforrrtatiorz 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]Hcens6# , Issuing Authority (circle one): i 1. Board of health 2. Building Department 3. CityiTown Clerk 4. Electrical. Inspector 5. Plumbing Inspector 6. Other Contact Person* Phonte #:, 0164' Rightfax C2-2 2/2/2016 7:56:47 AM PAGE 2/002 CERTIFICATF nF I__1AR11 1Tv 1MQ1112Ah1t-= Fax Server DATE (MM/pD/YYYY1 -- - - _ _ - wba.m RTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS rCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. S CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE 90—JANUDL-TMH E.99 U" Q LR_ORTANT: If the certificate holder is an ADDITIONAL INSURED, the pol)cy()es) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the poilcy, certain policies may require and endorsement A statement on this certificate does not confer rights to the certificate holder In Ileu of such endorsement s . PRODUCER CONTACT NAME: CROSS INSURANCE PEA13ODY LYNNFIELD STREET PHONE FFAX139 (AJC, No, EXt): o): PEABODY, MA 01960 E-MAIL ADDRESS: 72CKF INSURERS) AFFORDING COVERAGE MAIC N INSURED INSURER A: HARTFORD UNDERWRI'MRS INSURANCE COMPANY HAYDEN, JASON 5 INSURER B: INSURER C: 5 GUNSTOCK DRIVE INSURERD: KINGSTON, NH 03548 E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: T141S IS O CERTIFY THAT THE POLICES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSUFIED NAMED ABOVE FDR THE POLICY PFJTIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIDNS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. WSR LTR TYPE OF INSURANCE ADD L SUB R POLICY NUMBER POLICY EFF DATE (LWDDIYYYV) POLICY EXP DATE (MmnokyYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CH OCCURRENCE $ DAMAGE TO RENTED $ PREMISES (Ea occunence) CLAIMS MADE OCCUR, D EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY [—] PROJECT Q LOC PRODUCTS . COMP/OP AGG $ AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOS SCHEDULE AUTOS COMBINED SINGLE $ LIMIT (Ea accident) BODILY INJURY $ (Per person) HIRED AUTOS NON -OWNED AUTOS BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Par accident) UMBRELLA LIAB OCCUR EXCESS LIAB CLAIMS -MADE DEDUCTIBLE EACH OCCURRENCE $ ~� AGGREGATE g $ RETENTION $ $ A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY YIN ANY PROPERITOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? Q (MandalaryinNH) If yes, doscribo under DESCRIPTION OF OPERATIONS below N/A UB-SBOS7430-15 06P12P2015 0612W201 WC STATUTORY OTHER X LIMITS E. L. EACH ACCIDENT $ 500,000 E.L. DISEASE- EA EMPLOYEE E.L. DISEASE- POLICY LIMIT s 50O,DDD DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIRESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. THE WORKERS' COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR HAYDEN, JASON S. CERTIFICATE HOLDER CANCELLATION.......»..........r ....................."`�""""'"" """"""""" ""'"" JAIME DIAZ AND ANA LIAMAS 265 SALEM ST SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITHTHE POLICY PROVISION NORTH ANDOVER, MA 01845 AUTHORIZED REPRESENTATIVE �Vd _4"f��, ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD1988-2010 ACORD CO PR UWMZ! "'i!>rtllbFits reserved. '4C R0 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) INSR LTR 2/1/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT: AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Cross Insurance -Peabody 139 Lynnfield Street NAMEACT Lauren Goldman PHONE (978)532-5445 FAX AIC No (978)532-2217 ADDRESS:lgoldman@crossagency.com INSURER(S) AFFORDING COVERAGE NAIC # Peabody MA 01960 INSURERAMain Street America Assur. Co 29939 INSURED JASON S HAYDEN 5 GUNSTOCK DR INSURER B: INSURER C: INSURER D: INSURER E: KINGSTON NH 03848-3469 INSURER F : COVERAGES CERTIFICATE NUMBER-CL162162508 REVISION NUMBER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUER WVDPOLICY NUMBER POLICY EFF MM/DD POLICY EXP MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 500,000 MED EXP (Any one person) $ 10,000 MP045991 2/2/2016 2/2/2017 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: N POLICY ❑ PRO- a JECT LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 OTHER: Empbyrrment Practices Liability $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO ALL OWNED SCHEDULED BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ AUTOSAUTOS HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A $ PER OTH- STATUTE ER _ E.L. EACH ACCIDENT $ (Mandatory In NH) K yes, describe under E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H more space is required) t_FDTICICATC unr ncn SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Jaime Diaz and Ana Llamas THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 265 Salem St ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Lauren Goldman/MD1 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 onl4nii inrestricted - Buildings of any use group which Dntain less than 35,000 cubic feet (991m) of nclosed space. ailure to possess a current edition of the Massachusetts tate Building Code is cause for revocation of this license. x DPS Licensing information visit www.Mass.Gov/DPS Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supenisor License: CS -078189 - tl: [ t .V JASON S HAYDE$' ` 5 GUNSTOCK DK 1 KINGSTON NH '0384k"m ig,; 512,.,, " Expiration Commissioner 12113/2016 r —r 12 eZ Mil -- v I I - I I I I I I e.+ y I 1 -+--- I I — I V I I a I ' I Re loaw zm"awall4 VV 11taaeaclu�aell2 Office of Consumer Affairs & B siness Regulation r HOME IMPROVEMENT CONTRACTOR Registration:.; 174188 Type: -= r' Expiration: 11712017 Individual JA N S. HAYDEN JASON HAYDEN [= 5 GUNSTOCK DR. ��- KINGSTON, NH 038481.. ;, Undersecretary License or registration valid for individul use only before the expiration date. 1f found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MA 02116 V Not v:' id :th signature