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HomeMy WebLinkAboutBuilding Permit #083-2017 - 28 STAGE COACH ROAD 7/26/2016 BUILDING PERMIT NORT q .{LED / ,6 TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION _ P. Permit Not#•• Date Received to I R,rEo SACHUSE Date Issued: zo GO IMPORTANT:Applicant must complete all items on this page LOCATIONa J t� CC Print PROPERTY OWNER R!'cVC&--, Print 100 Year Structure yes o Historic District yes �o MAP PARCEL: ZONING DISTRICT:_�� i Machine Shop Village yes n TYPE OF IMPROVEMENT PROPOSED USE Resid tial Non- Residential ❑ New Building &-6ne family ❑Ad ition ❑Two or more family ❑ Industrial &Alteration No. of units: ❑ Commercial epair, replacement- ❑Assessory Bldg ❑ Others: ❑ Demolition- ❑ Other `® Se tic _C] e '* = ® F1©odpl=, � tlands " ® Wa e shed District } . P t rt �a- # Wate S� eWe s . , -;• Mx ,t+r'•'#r., tc DESCRIPTION OF WORK TO BE `, ( a < ERFORMED : 2a A r < rCc` a � d /n c Co 0 Identification- Please T e or Print Clearly OWNER: Name: �.� }- �� C_rc-ty.J Phone: L123� Address: co Ph Contractor Name: dLley c� one: Ili f .. . Email: ' Address: S-f? CnrAL,% o Supervisor's Construction License: 00 3 3 4 Exp. Date: /% -7 - 1-7 i Home Improvement License: 2,2-//Y Exp. Date: Z 3 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDIMG PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$9 5.00 PER S.F. o� Total Project Cost: $ o, FEE: $ Check No.: p Recei t No.: NOTE: Persons contracting with unregistered contractors do not have access to the my fund g --- -- - -- R L Plans Submitted lq 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.FO,RM PLANNING Cox DEVELOPMENT Reviewed On Signature_ - COMMENTS CONSERVATION Reviewed on Signature COMMENTS I - I HEALTH Reviewed on .Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes K Planning Board Decision: Comments 0 Conservation Decision: Comments E Water & Sewer Connection/Signature &Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street r RE DEPAR4TIVIE1111 Tern Durnpster omsite 4�Lcated at 12.4 Main Street 4 �,Fi�rke Department aturate �� ,• ' < v � ' `a=' . ���r , . _'� �, y�,s,�'� t nti .%.• :r 3t�3•i:i���f!�,*�"�?'��t a";��x�a �"- "°. �.-- ,� gg r 1 ' i i I 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! i NOTES and DATA— (For department use) i II i ® Notified for pickup Call Email f Date Time Contact Name Doc.Building Permit Revised 2014 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 hoto Copy .Of H.I.C. And/Or C.S.L. Licenses . opy 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 Y Addition Or Decks Building Permit Application Certified Surveyed Plot Plan j Workers Comp Affidavit aPhoto 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family a Building Permit Application Certified Proposed Plot Plan I 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 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 I Doc:Building Permit Revised 2014 I'r I R Location 17 No. CJ3 �.�G� Date ' O i . • TOWN OF NORTH ANDOVER mow " Certificate of Occupancy $ / - • Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 7 30664 Building In pector [ f Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 349000.00 m $ - $ 408.00 Plumbing Fee $ 51.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 51.00 Total fees collected $ 610.00 28 Stage Coach Road 083-2017 on 7/26/2016 Remodel Basement, 1/2 Bath NORTF. BUILDING PERMIT o�<=�Eo 6�ti TOWN OF NORTH ANDOVER o «-; APPLICATION FOR PLAN EXAMINATION Permit No#: C Date Receivedto Sys R,7Eo SACHus Date Issued: IMP RTANT:Applicant must complete all items on this page `LOCATION Print PROPERTY OWNER So PSI Print 100 Year Structure yes o MAP�PARCEL:.�ZONING DISTRICT: Historic District yes Machine Shop Village yes , TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial teration No. of units: ❑ Commercial epair, replacement- ❑Assessory Bldg ❑ Others: ❑ Demolition 0 Other $.e. ,c F-lootlp ain UVetlan s Water ed Die ,c-ate, e efi DESCRIPTION OF WORK TO BEERFORMED: ('oto c. 4�ri ccs a `E GJ / --r Identification- Please T e or Print Clearly OWNER: Name: ,.' 0 LA }- � �� ��!'<<Vtj Phone: �-1 Z� U'7 17 z i o Address: Co r� Contractor Name: L AlCy F- : Phone Email: . Address: -�J Cnr-,Ai % t }_�;���L �e1� MA- i Supervisor's Construction License: 06r) 339 Exp. Date: Home Improvement License: l Z-L//rr Exp. Date: Z - l ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$9 5.00 PER S.F. Total Project Cost: $ FEE: $ 11 � Check No.: � Receipt No.: � Y NOTE: Persons contracting with unregistered contractors do not have access to the g city fund AS�nnatirof o Tractor ^ �_. NORTH Town of : _ Andover No. TL 2� 2A, h ver, Mass, O L K i �. COCNICNNWICK S V BOARD OF HEALTH Food/Kitchen PERMITP LD Septic System THIS CERTIFIES THAT ..........�d�....... ..... ...... ........t�.! I BUILDING INSPECTOR .... .... ........................�...... C . Foundation has permission to erect .......................... buildings on .42W.. .. ...... .... �1 ....... drs Rough to be occupied as .....WftA .....cml.15�...�„ ....�.. ..... ........... 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 tohe In pection,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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST TIO S Rough pea Service ... ...... .. . ......... ..... Final BUILDI SPEC R 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. Daniel Construction Company Mark Emero 56 Cordis St.Wakefield, Ma. Proposal John and Sue Percival Stagecoach Rd. No.Andover Scope of work: remodel basement Contractor will: • pull permit • demo basement as needed • frame all walls,doorways, closets and half bath • install electric to code including 24 recessed cans • install plumbing for half bath • move wash sink to other side of wall • install plumbing for bar sink • insulate to code • blueboard and plaster all walls and ceilings • install exterior door into basement area • install interior doors and locksets • install deadbolt and lockset on exterior door • do minor HVAC if needed • the and grout bathroom floor • homeowner to supply tile and grout as well as plumbing and electrical fixtures • install baseboard and door trim as needed • homeowner to supply flooring,carpet on floor and stairs,as well as painter • dispose of all job related debris 1 Totalcost of labor and Supplies..............................................................................$34,000.00 Payment schedule......$9,000 to start..........$5,000 after electric inspection........$5,000 after bldg.inspection.........$5,000 after plaster..........$5,000 after the and trim......$5,000 upon completion i DL 2 ArCA Vim.( L�7�,t`i� T r m C..A C. �xl� Al C�r�.sJ P ---- --- I t1-� Oyu+PPS r�� The Commonwealth of 1VMassachusetis Department oflndastrialAccidents �._: :•_ _. d 1 Congress Street,Suite 100 ' Boston,MA.02114-2017 =y� "4 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORI'T'Y. A_nplicant Information ff Please Print Le�iblY Name(Business/Organization/Tndividual): s�-1� /►'lUf Address: f/o Co rJ t 3 S 4- City/State/Zip:C ),.1 _QtW MA 6 Wo Phone#: r7 a� a(t V J- Areyou an employer?Checktlie appropriate box- 0d):Type of project(xequir 1.Q l am aemployerwith employees(full and/or part-time).* 7.• Q New coiistruction 2.L�`a„,a sole proprietor or partnership and have no employees working for mein $. emo delirig any capacity.[No workers'comp.insurance required.] 9_ ❑Demolition 3 Q I am a homeowner doing all work myself[No workers'comp.-insurance required.]t 10 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or.additions proprietors with no employees. 12:[]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. RoOf repairs These sub-contractors have employees and have workers'comp.msurance.T 6.FJ We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have nq employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information T Homeowners who submit tivs affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that cheAthis box must•attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors fiave employ!)hey,must provide their workers'comp.policy number.* lain an employer that is piovidingworkers'compensation insurance for my employees.'Beloit/is thepolicy acid job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: 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 MGL c. 152,§25A is a criminal violation punishable by a lime 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 of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify under thepains and aloes ofperjury that the information provided alcove is true and correct Signafore: - Date: C Phone# �7l Official use only. Do not write in this area,to be completed by city or town officiax. City or Town: Permit/License# Issuing Authority(circle one): i 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 enferprise,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 cons#net buildings in the commonv�ealth for any applicant who lias 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•plhone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees'other than the members or p artners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Ba advised that this affidavit maybe submitted to the Department of•Industrial Accidents foi•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-insure_d 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 areference 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 stamp ed 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 I Tel. ## 617-727-4900 ext.7406 or 1-877-AIASSAFE Fax#61.7-727-7749 Revised 02-23-15 www.mass.gov/dia 2016/07/2610:00:40 2 /2 '4COMY CERTIFICATE OF LIABILITY INSURANCE 7/26/2o 6"' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMA71ON 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(les) 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 COME CT Select Department Eastern Insurance Group LLC AICC.N Ext: (800)333-7234 x66807 FAX No):(781)586-8294 233 West Central St E-MAIL ADDRESS:selectwork@easterninsurance.com INSURER(S)AFFORDING COVERAGE NAIC 0 Natick MA 01760 INSURER AHarle sville Worcester Ins Co 26182 INSURED INSURERS: Mark T Emero INSURERC: 56 Coxdis Street INSURERD: INSURER E: Wakefield MA 01880 INSURERF: COVERAGES CERTIFICATE NUMBER:16-17 CERT 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR I S WVD POLICY NUMBER MMIDDIYYW MIDDrYYW GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 A CLAIMS-MADE a OCCUR SPP00000039892V /27/2016 /27/2017 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X1 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED sPP00000039892V /27/2016 /27/2017 BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X AO OOWNED Per c de[DAMAGE $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION I WCSTATU- OTH- AND EMPLOYERS'LIABILITY Y I N FEL ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ OFRCER/MEMBER EXCLUDED? F-1 N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Residential Carpenter CERTIFICATE HOLDER CANCELLATION (978)688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING DEPARTMENT 1600 OSGOOD STREET ALMHORIZED REPRESENTATIVE BLDG 20, STE 2035 NORTH ANDOVER, MA 01845 John Koegel/KH3 ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 r7n1nn51 n1 Tha Cr f)pn namo and lono nrP rPnictararl markt of ArORr) ent of pub tSafety Massachusetts Depart'lations and ss f Board of Building Regu License: CS-067334rvisor � Construction Supe 4 MARK T EMERO -` `' 1 56 CORDIS STREET, 0 4 WAKEFIELD MA 01880' # 4 (� Expiration: 11108!2017 ommis Csioner ��c I�ia��znczaorcaercl��o��'laaaac�u�eGC Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR i Registration—, 122114 Type: Expiration A!21-2018 Individual MARK EMERO MARK EMERO 56 CORDIS STREET WAKEFIELD,MA 01880 Undersecretary