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HomeMy WebLinkAboutBuilding Permit #275-11 - 294 BEAR HILL ROAD 10/1/2010 NO R T{i BUILDING PERMIT °�<t�Eo 4aq'�'o 2 '�� d• ";;'�.to O TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION _ / H ' Permit NO• � I Date Received p�aA / Date Issued: 0``� 1 �/ v this page IMPORTANT:Applicant must complete all items on r lPnnt !P.Fi®PERhTYtOWNEF2 iPrint _.ti _ �i _ s_ ° �� { �Sho Village'.. ` es no 'MA N- PARCEL ZONING,IDISTRICT' HistoncfDi_s_s"tnct eyes: no. 'Machine p _ y TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial teration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ �s ❑Sepfic t®;Well {Floodplain D Wetlands 3 ❑ 'Watershetl ®istnct } DESCRIPTION OF WORK TO BE PREFORMED: 1 V6 n4,k3 vtJ `•-1— s1 P i , G= PP�Y ✓I �►��- r D f a� Identification Please Type or Print Clearly) J g 3 3-3 4 ER: Name: T/ � OWN �� l-/�a,J�I Phone: Address: . ?- N 0 V tC:ONTtRACe -ame. ITc Su ervisor'stConsfructon License: _- -t P- Ex 100te -L L. p. = s ARCHITECT/ENGINEER Phone: �— Address: eg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ ��. y FEE: $ Check No.--/ Receipt No.:o n NOTE: Persons contracting with unregistered contractors do not have access to t guaranty fund -- - Uf A -- - — — v .rick :Sianature� gent/Ownerh__. .-._ r _. �__ w .._.. �Signature,of'contractor._ Location,— No. Date ®� NpRTN TOWN OF NORTH ANDOVER to w 9 _ L �e :a Certificate of Occupancy $ skMU � Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee $ a TOTAL $ r Check # Aw 23512 Building Inspector 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 ❑ f THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ I COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS \d . Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street fFIREDE PARTMENT Temp�Dumpsteftonasite yes� �rLocatedeatA24TMainlStreet {Fire ed`artment'si nature/date_. . P 9, i g 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) ❑ 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 ❑ 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 DEPARTMENTMFORM07 ORTH TONM of And No. ° �; F .. ; 075 — // - A K -O dover, 1VMass., !1 • I I C) I� COC MICMEWICK 7,p ADRATED C'P�t�� BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........ .�/r......... •........I.0..1�/..tlti1 .W.......... .... ....... .......... ...� ..................... Foundation 4 has permission to erect.........:........:..............�..... buildings on ...... � .......... fir...... �.� ....... ..% Rough to be occupied as Chimney p ...... ...�. .�.�..................�.� ...... .I��11.. .. ��.. ...� 0 �ir provided that the person accepti g this permit shall in every respect conform to the terms of tRte application on fi a in Final 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 3 PERMIT EXPIRES PTION NTHS ELECTRICAL INSPECTOR UNLESS CONS TARTS Rough ............................................ : Service BUILDING Final Occupancy Permit Required to Ocmpy Building GAS INSPECTOR Rough Display in a Conspicuous, Place on the- Premises — Do Not Remove Final No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. i - r I GTS Board of Building cc Reguons and Standards u�aelfi HOME.IMPROVEMENT CONTRACTOR r Registration: 111990 Expiration: 2/11/2011 Tr# 280787 TYPO: LLC ROBERT LANGEVIN BLDG 8&REMOLDING LLC. ROBERT LANGEVIN 795 DALE ST ' N ANDOVER, MA 01845 " ,� Administrator iVlassachusetts- Department of Public Safety Board of Building Re�-ulations and Standards Construction Supervisor License r License: CS 2685 Restricted to: 00 i ROBERT M LANGEVIN 795 DALE ST N ANDOVER, MA 01845 : Expiration: 2/24/2012 ('unmii�siuncr Tr#: 15366 Page No. of Pages ROBERT LANGEVIN BUILDING AND REMODELING 1, L 795 Dale Street NORTH ANDOVER, MASSACHUSETTS 01845 (978) 686.3607 ,f I c- PROPOSAL SUBMITTED TO PHONE DATE STREET JOB NAME 41 tR D C-,- CITY,STATE and ZIP CODE JOB LOCATION 06 o r5'' `7 lyARCHITECTDATEDATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: ................_._... ................... ....._^�..��_.......... '! � �- .........................v ........................ ......v�....._.._N.f................._............_..... .....................................�._......-4t.......7..6-.-!.....N.... :�....j ................�� ' _�................. ....�.....O.._N 0 � :�1...r�4-h........' ._ ..........._ ..... ..E_..._................. a .-..................,�....c�'c!-.��y._�.._ -....tl..=`......_.._�...../._...�._� ............... ._......_ ...�_.-.......................�._ .._�-°w / ....._.................... � -e""i`J i. ° 1 i T� cam (' C'� r ................................................................................................. _ ................... ... .............................._ 5' 'w .......................................... ............. '' _� C' � ��_- . ._ '........._�Jl._I.�............ . .............. a _ �-t,4 ... _.................................................................................................... ....._............................_ �— ... ..L._-`_�'!..d�._� !'�t.1 Jf�, ...._.._C� �1 ................................. �......... .r►�.._ ! .................. ........, '..,C�, ......... .... . \� ,.............. D1: � M .............. ................ ... � 1 c ..... _ . ... ........_ .. ........................ i ............................................................................................ r-":..._.._��....'`�-:._ ........_�-'-,>� t R-� U�'; D VM i0s-rte,� s,E.+ev i ce- ...._ ............................................................................................................................, ......._..........IP P PPOPOSP hereby to furnish material and labor—complete in accordance with above specifications, for the sum of: dollars($ �77 Payment to be m de as follows: i 0777 e 7 �.. ` /Z) Ali IN i s All material is guaranteed to be ass ecified. All work.to be completed in a workmanlike manner accordin to standard practices. Authorized g An alteration or deviation from above specifications P Y P Signature involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control.Owner to carry fire,tornado and other necessary insurance. Note:This proposal may be Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days. �CrP fttYICP 0 PII II�tt� —The above prices,s�eaonsC_and conditions are satisfactory and are hereby accepted. You areed Signature to do the work ass ecified. a ment ill be made as outlined above. -'1k� p _ L: /� Date of Acceptance: ��' � Signature ,� The Commonwealth of Afassachuselts Department o f rndustrial Accidents office offInVeszio ations 600 Washington street BOston, MA 02111 )''"'"'-massgov/din Workers' Compensation Insurance Adavit:Affidavit: An licant Information ffi ,/� Please Print Legibly Name (Business/Organizationdndividual):�iS i— �0 Y� ►.3 . ,p \1 711�(J z.Z>�J&' 4A.C Address: -7 �s �1�-�..E �^- City/State/Zip: -, C�v,ifir` Z f_Phone#: 47 -SIC) �' 7Areyou employer?Check theappropriate boa:employer with 4. ❑ I am a general contractor and I Type of project(required): yees(full and/orpart-time).* have hired the sub-contractors. am a sole proprietor or partner_ listed on 6' ❑Nein construction the attached sheet x `% odeling and have no employees These subcontractors have ❑ working for me in any capacity, workers coin . ' 8' Demolition [No workers' comp. insurance 5. P Insurance. 9. ❑ We are a corporation and its ❑Building addition required.] 3. I am a homeowner doing all work officers have exercised their 10•❑Electrical repairs or additions ❑ right of • myself gh exemption Per MGL 11.❑Plumbing repairs or additions Y [No workers'comp. c. 152,§I(4),and we have no insurance required.] t employees. 12.7 Roof repairs [No workers Pomp.insurance required.] 13.❑ Other *Anv applicant that chb :k:.bo: mut sso fit.out thesect=b-cio4. _e _"ameowners Who submit this affidavit indicating th g^r dC'.. 7 . : -•^wON�S'CQmY.-.g.?*_��........ 'Contractors that chu)c tut be.*.must z ac,ed an additional onai sheets wing the thea hire outside cont facto: rGe:; submit a new affidavit indicating such. name of the sub connectors and their workers'comp•Poii� information.I am an em P�J'�the is providing workers'compensation insurance for my employees Below is the policy and job site informadon Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: e(showi Attach a copy of the workers' compensation policy declaraban pavng 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 ) fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties of a Of up to $250.00 a day against the violator. Be advised that a co pthisees m the form of a STOP WORK ORDER and a fm-- Investigations of the DIA for insurance coverage verification. PY°f statement may be forwarded to the Office of Ido hereby J✓'u der the pains penalties ofP %er ury thrrt the info Signature- , rmadon Provided above is true and correct � � .R�_ _... Date.:...._ ._ _ ...... _..__ Phone#: �d' 3oe Official use only. Do not write in this arca, to be completed by cam,or tonin off�cia[ City or Town: Permit/License# Fssuinb Authority(circle one): L Board of Health 2.Building Department 3. Citv/Town Clerk 4.Electrical Inspector 5.plumbing 6. Other b Inspector Contact Person: Phone n: Information an- d Instructions struct�ons 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 pf_�—rson 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 t3a legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association oic other legal entity,employing employees. However the owner of a dwelling house having not more than three aparWaL eats and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenna.nce,construction or repair work on such dwelling house or on the grounds or building appurtenant 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 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 calitnpliance 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 un-til acceptable evidence of compliance with the ins=e 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 Li.—ability partnerships(LLP)with no employees other than the members or partners,.are not required to carry workers'comp enation 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 svure to sign and date the affidavit The affidavit should be returned to the city or town tha',the ar uliea.uon for the Dee -or 1,:cm-o uq being reJ�lleSt:d,not the Department 0{ Industrial Accidents. Should you have any questions regardi^b the law or u you are rNqi;ired 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 p=nit/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 penouits 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 than you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Deparunent's address,telephone.and.,fiix number...._ The Commonwealth of Massachusetts. Department Of Industrial Accidents Office of Investibatfaas 600 Washingtan Street Boston,M-A 02111 Tel. # 617-72.7-4900 est 4016 or 1-8 -M4SS:AFE Revised 5-26-05 Fva 4, 6.17-72.7-7749 ufrvrw.mass._g ov/dia.