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Home My WebLink AboutBuilding Permit #10811-15 - 29 BALDWIN STREET 6/22/2015 i G NORTH BUILDING PERMIT o�tt� 6;�tio III TOWN OF NORTH ANDOVER 3? h.:..`` IN - oz APPLICATION FOR PLAN EXAMINATION Permit No#: I Date Received 7pA°Rwie°�P¢`45 gSSACHU`-+�� Date Issued: Z- I O TANT:Applicant must complete all items on this page LOCATION / � �•�`�,, 51Ze e,- Print,. PROPERTY OWNER 0, I Print,- J 100 Year Structure yes ZONING DISTRICT: Historic District es . MAP.�PARCEL:�� Y Machine Shop Village yes Q. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 46ne family ❑Addition ❑Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial [repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic ❑Well p Floodplain ❑Wetlands ❑ 'Watershed District 0_Water/S'ewer ---- - DESCRIPTION OF WORK TO BE PERFORMED: Ilee- Identification- Please Type or Print Clearly OWNER: Name: ��. �y.`��Uc� �T�vsi`rs i�v �®,�� Phone: ��Vit, Address: 5/(-/, -e Contractor Name: e��Cr9 - �,q/ `� Phone: 7 02 5 Email: Address- 10V,.4 �591 ily o _ Supervisor's Construction License: CS -n.I bS,31/ Exp. Date: C��3 !S Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: f Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ -3 , ,�O J FEE: $ 4, • 0e) Check No.: Receipt No.: NOTE: Persons contracting with unregis 'red contractors do not have access to the guarantv fiund Location,' :�F W �� No. t 1 ( � Date . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ . Building/Frame Permit Fee $� Foundation Permit Fee $- Other Permit Fee $ TOTAL $ i D Check# �b � r^ l 28911) J Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimaning 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS "-'HEALTH Reviewed on Signature t� COMMENTS Zoning Board of Appeals:Variance, Petition No. Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Wafter& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 3 t w w. ree 'FIRE DEPARaTME11tT mp D on ye's": � ' :"� -'°` ` no : Osgood 7,4 um pster site = Lo ted at 124 Streets fi Fire 7 1 epa5 e�ntfs gnafur�e/d'a, at ter 4 C®aMM N�TfS _ s' , . 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 NOTES and DATA— (For department use) ® Notified for pickup Call Email '4 £ 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 Workers Comp Affidavit 4. Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract j 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 4, Building Permit Application 4 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) j 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 6 2012 IECC Energy code 4 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 ed at the Registry of Deeds. One co and roof of recording e this record PY P then t over. The applicant must g Y that the appeal period�s ov pp g must be submitted with the building application Doc:Building Permit Revised 2014 � NORTI� Town of . E ndover o IL C, Lh , ver, Mass, COCNICHIWICK �S V '( BOARD OF HEALTH Food/Kitchen - PERMIT T D Septic System �1 / / BUILDING INSPECTOR THIS CERTIFIES THAT ........... :Y!.0� Vii.. ........... .... . .............................................. "� ,/� � Foundation has permission to erect .......................... buildings ons, l.....'rl�-�r.� .... .:'��h.................................... Rough or— tobe occupied as ......... ..... ........... ....'................i................................................ 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 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 CONSTRUCTISTA S Rough Service ............... .... .. .....:................................................ 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. WAMERICAN CABINET 04/22/15 436 Broadway Methuen,MA oi844 978-687-6825 Bill To: North Andover Housing Authority i Moreski Meadows North Andover,MA o1845 978-682-3932 PROPOSAL -31 Baldwin St. _ __.__..._ .......-......_._._.._._._____... __--_.__�_.___ DESCRIPTIONAMOUNT _ __ Cabinets $ 2,040.00 Contractor's Choice Newberry Birch .. : s [ o coN f :: :_. Finish Autumn Counters $ 90000 Square Edge Laminate ! Travertine 26-77 . _. I .... ! 4Inch Backsplash --------------- --- _ - Hardware $ 6 .o0 Allison Knobs#53012-EB(16) ! Allison Pulls#53013-EB(7)_. - --- — -- — - -—. — ----- -- J._.._ . .... - __ ........._I Taxn/a Tax Exempt#. nLJ 7 c( 2?2� _ _ __--_-__-- �... __ ._........... .._ — - -- - --- Delivery $ 85-00 .............- - - ---- - - - - —— ._._� ._.._............... ! Installation(cabinets and counters only;does not include disposal of cand oar $ 775.00 I Total $ 3,869.00 i Please sign and date below to confirm shown above and return a signed copy to American Cabinet to place your order. A 50%deposit is required at time of order. The remaining balance is due upon delivery. Please understand that,by signing this proposal,you will not be allowed to cancel or return all or=order. Price is subject to change once a field measurement has been taken. Signature: ( Date: _1V - S Thank you for your business! /� North Cabinets: Counters: omer: S uare Ed a Laminate Andover Housing Authority Contractors Choice _ 4 greski Meadows Newberry Autumn Travertine #3526-77 h Andover, MA 01845 Standard Construction Loose ed Endlash 978-682-3932 4 Applied Endcaps Parts: Deliver to: 1 - F331 Hardware: 31 Baldwin St. 2 - TOEKICK8 16 Knobs - #53012-EB North Andover, MA 01845 1 - MSW8 7 Pulls - #53103-EB 1 - TKC Contact: Jim Camire 978-815-6567 Installer: Scott Ozana 107-1" 53 4" 534" ti k� v r W1'S30= W3018 W3630 w ch BC42—Ls BC42— 2ANGE x.4,1 2 4. A' LO; 1 W U1 0~0 Pull Blind Co er Cabinets 7 ; to appropriatel fit on both NT 0 0 sides of range. y M OD AF "n ' I - I I I I I 1 . I - {i. /� 31 Baldwin E . ------------ I ------------- I All dimensions-size designations This is an original design and must Designed:4/14/2015 given are subject to verification on cN otosi s not be released or copied unless Printed:4/25/2015 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. NAHousing_3 I Baldwin All Drawing#: I No Scale. The Commonwealth of Massachusetts :. F Department of IndustrialAccidents 1 Congress Street,Suite 100 _ Boston,MA 02114-2017 www mass.gov/dia yaakkers' Compensation Insurance Affidavit:Builders/Contxactors/Electricians/Plum exs. TO BE FILED WITH THE PERMITTING AUTHORITY. Please Print Le ' A ' licant Information CY) Name(Business/Orgauization/Individual): Address: f a �„,/ o i one i' City/State/Zip: �� s Type of project()required): Are you an employer?Check the appropriate box: employees full and/or part-time).* 7. ❑New`constriiction 1.�aemploy,with,�_ 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.] 10[]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.❑Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole proprietors with no•employe6s. 2. ,JFPlumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.,0 RO6f repairs These sub-contractors have employees and have workers'comp.insurance.T Other 6.❑We area corporation and its,officers have exercised their right of exemption per MGL c. 152,§1(4),and'we'haye no employees.[No workers'comp.insurance required.] *Any applicant that checks box#i must also fill out the section below showing their workers'compensation policy information. Homeowners who sub mit•this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such $Contractors that check finis box must attached an additional sheet showing the name of the sub contractors and state whether c r not those entities,have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. �� Insurance Company Name: U`�/ Q_ ,-A -XS _ Expiration Date: 3 policy#or Self-ins.Lie. �j /J� �tii�c— � City/State/Zip: IVO- �._ �l G1S Job Site Address:_ 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 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 of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify nd aep s andpenalties ofperjury that the information provided above is true and.correct. Date: � 's Si afore: Phone#: 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): i 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector i 6.Other � Phone#• Contact Person: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their enlpP6yees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of W6, express or implied,oral or written." An employer is d'efiried 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'dr trustee 6f 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 certificates)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 maybe 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"fob 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext.7406 or 1-877-MASSAFE Fax#61.7-727-7749 Revised 02-23-15 wwwmass.gov/dia Nlassachuse tts -Department of A Board of Building Regulatio ublic C">nstr Safety uction SnPen,isorns and Standards License: CS-016534 r�r JAMES BL Connrnissioner Expiration 10/23/2015