HomeMy WebLinkAboutBuilding Permit #717-14 - 31 HEWITT AVENUE 4/15/2014TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: I Date Received i
11 a
Date Issued: I> ►-
IMPORTANT: Applicant must complete all items on this page
LOCATION . t H
Print
PROPERTY OWNER MAGI?7-1 13-11617 -
Print 100 Year Old Structure yes no
MAP NO: �_PARCEL:�ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no_
TYPE OF IMPROVEMENT.
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ One family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Afteration
No. of units:
❑ Assessory Bldg
❑ Commercial
epair, replacement
❑ Others:
❑ Demolition
❑ Other
❑ Septic ❑ Well
❑ Floodplain ❑ Wetlands
❑ Watershed District
❑ Water/Sewer
- -
OWNER: Name:
Address:
CONTR/
Address:
DESCRIPTION OF WORK TO BE PERFORMED:
q%� 2 -
Identification Please Type or Print Clearly)
hone:
L/
Supervisor's Construction License:...., Exp. Date:
Home Improvement License:
ARCHITECT/ENGINEER Phone:
Address: Reg. No
FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ � OC C FEE: $ Z(( 1
Check No.: Receipt No.:
NOTE: Persons contracting will unregister c ntractors do not have access to the guaranty fund
Signature of Agent/Owner _ Slgature of contractor
Plans Submitted LJ Plans Wa6ved ❑ Certified Plot Plan ❑ Stamped Plans ❑
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r-
- Plans Submitted ❑ PlansW- ,givPrl T7.
Certified Plot Plan ❑ Stamped Plans ❑
-TY—P� OP: SEWERAGE"DISP.DSAL
Public Sewer ElSwimmin
-
Tanning/MassageBody Art E]_
❑
g Pools �.
Well ❑
Tobacco.Sales ❑
,
•Food Packaging/Sales ❑
Private (septic tank, etc.: ❑..•- ; .
Permaneint Dnpster on Site ❑
=THE. FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM `
PLANNING & DEVELOPMENT
COMMENTS
:CONSERVATION Reviewed on
COMMENTS
_-DATE REJECTED:
El
DATE APPROVED
� r
0b, �.
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes .
Planning Board Decision:
Comments
Conservation Decision: Comments
Water & Sewer Connection -Driveway Permit
e
DPW To`v.s Engineer: Signature:
Located 384 Osgood Street
FIREDE tl ENT - -'Temp Dumpster on site yes no
Located -at -I1 4,Mair, Street=- `p
Fire'Depa'ftme►it signature/date " y, ,
COMMENTS ;
..Dimension
Number of Stories:
Total land -area; sq. ft.:
Total square feet of floor area, based on Exterior dimensions.
ELECTRICAL: Movement of Meter location, mast -or service drop requires approval of
:Electrical Inspector Yes No
DANGERZONE LITERATURE: Yes No
MG L.Chapter-466-Section 21A.zF and G min.$100=$1000 fine
Doc.Building Permit Revised 2010
r-
Building Department
-' The fol owing"is`a-list of -the required forms to be filled ouffor.:the appropriate -permit to..be obtained.
Roofirig, Siding, Interior Rehabilitation Permits
❑ Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/O-r 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
a 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)
Engieering_Affidavlts 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
o 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
o 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 apnaal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be subm:+-ted with the building application
Doc: Doc.Buiiding Permit Revised 2012
Location
No. -7/7,/
Check # T5
Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Building Inspector
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(Quin rvo nsnran.ceeAgenrvo nr.
a division of the Quincy Companies
144 GOULD STREET, SUITE 152, NEEDHAM, MA 02494-2337
EST. 1865 (781) 431-9600 • FAX (781) 431-9595 • WWW.QUINCYINSURANCE.NET
June 4, 2013
Frank Armitage
12 Sutton Hill Road
North Andover, MA 01845
Re: Businessowners Renewal
Dear Frank,
We are pleased to enclose your Businessowners policy renewal effective June 5, 2013 to
June 5, 2014. The policy continues to be underwritten by Norfolk & Dedham Insurance Company.
The coverage provided by the renewal policy is as follows:
Norfolk & Dedham Insurance
R 0310803
06/05/2013 to 06/05/2014
Business Personal Property $ 10,000
Equipment Breakdown Included
Deductible $ 250
Business Income Actual Loss Sustained
Liability: General Aggregate $ 2,000,000
Products & Completed Operations Aggregate $ 2,000,000
Per Occurrence Limit $ 1,000,000
Damage to Premises Rented to You $ 50,000
Medical Payments (per person) $ 5,000
Additional Insured — St. Aidens, LLC
Employee Dishonesty $ 10,000
Theft of Money & Securities $ 15,000
Reconstruction of Accounts Receivable $ 25,000
Reconstruction of Valuable Papers $ 25,000
Annual Premium
$ 1,350
We appreciate the opportunity to provide your insurance program. Please let me know if you have any
questions as you review and I will be glad to assist.
Sincerely,
G ficfi e7 L` ehffi n vl�lGL tre_
TO" OF NORM ANDOVER
OFFICE OF
BUMDTNG DEPARTMENT
:1600 Osgood Street Building 20, Suite 2-36
North Andover, Massachusetts 01845
Gerald A. Brown 978) 688-9545
Inspector of$uiidings Telephone (
Fax (978) 688-9542
• �OMEOWNER•LICENSE EXBN[PTION •
IU ING PENT APPLICATION
Ple-�nnt '• .
DATE: ;O C-? 0* 1
TQB LOCATION: 3 j 'q,�
StreetAddress
lin/ So� L)79
Home Phone
-Number
IZOMEO'iT�NER i 1
Name.
MaptLot
Wnrlr Pl,nna
PRESENT MAILING ADDRESS
0121 h Y� A) ee
p Code
The current exemption for "homeowners" was extended to
to allow Such 3,o,nPo,,, x -.chide owner -occupied dwellings to •itvo units -Or loss and
r3i CIS to engage an i; �diVSd1sal.for hire wino does notpossess a -1iconse, provided that the oymer
acts as supervisor). StateDuilding (Code Section. I08.3.5.I)
DEFINITION OFHOMEOWNER
Persons) who owns ly stra I of land on which he/she resides or intends to reside, on W� ich there is, oris intended to
be, a one or two fau�ily structures. A person who consiracts more that one home in a two yearperS, shall not be
Considered a homeowner.
The undersigned "homeowner" assumes responsibility for compliances with the State Building Applicable codes, by-laws, xules andregulations, g Code and other
The undersigned "homeowner" certifies that he/she understands the Town of North AndoverBuilding partment
minimum inspection procedures and requirements and that he/she will co
requirements, y ith,said procedure
HONMO'WN$RS SIGNATURE
h ,
APPROVAL OF BUILDING
Revised 7.2009
Form Homeowners Exemption
'BOARlb OF APPEALS 688-9541
CONSERVATION 688-9530
HEALTH 688-9540 PLANNING 688-9533
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, employingemployees. However the
owner of a dwelling house having notmore than three apartments and who resides therein, oe the occupant ofthe
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 employes."
MGL chapter 152, §25C(6) also states that "every state or local lie -easing 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 ofpublic work until acceptable evidence of compliance with the insurance
requirements ofthis chapter have beenpresented to the contracting authority."
Applicants
Please fill out the workers' compensaiion 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, apolicyis required. De advised that this affidavit maybe submitted tothe 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 fdl in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple pezmit/license applications in any given year, need only submit one affidavit indicating current
Policy information (ifnecessary) and under "Job Site Address" the applicant should write "all locations in (city
town)." A copy of the affidavit that has been officially stamped or marked by thor
e 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. ad og 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:
Tho Commonwealth of M.assachvsi-
Depaidment
o onwealthofM.assachusi-
Depaidment ofIndusWal .A,ccxdonts
Ofte ofhavestigationg
600 was*8ton sten
Boston,MA02111
TQL # 617-727_4.900 oxt 406 or. 1 -877 -
Revised 5-26-05 Fax 9 617-727-7749
WWW M=%govfdia
r#1
yThe Commonwealth of.tMlassachusetts -
Department oflndystrialAccldiiks
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Xnsurance Affidavit: Builders/Contractors/Electricians/Plumbers
Aplilicant Information Please Print Le:sibXy
Name (Business/Organization/Individual):
Address:
City/State/Zip: Phone #:
Are you an employer? Check the appropriate box:
Type of project (required):
1. ❑ I am a employer with
4. ❑ I am a general contractor and I
6. ❑ New construction
employees (fall and/or part-time).*
2. El am a sole proprietor or partner-
have hired the sub -contractors
listed on the attached sheet.
7. ❑Remodeling
ship and1ave no employees
These sub -contractors have
8. ❑ Demolition
working forme in any capacity.
workers' comp. insurance.
9. E] Building addition
[No workers' comp. ,insurance
5. ❑ We are a corporation and its
1011 Electrical repairs or additions
required.]
3. VT am a homeowner doing all work
officers have exercised their
right of exemption per MGL
I L [] Plumbing repairs or additions
myself. [No workers' comp.
c. 152, §1(4), andwehaveno
12.❑ Roofrepairs
insurance required.]employees.
[No workers'
13.❑ Other
comp. insurance required.]
xAny applicant that checks box#1 must also fill out the section bel6w showingtheir wbrkers' compensation policy information.
i Homeowners who submit this affidavit indicating they Aie doing all work and then hire outside contractors must submit anew affidavit indicating such.
tContractors that checkthis box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
X 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. M.
Job Site
ExpirationDate:
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 requiredunder Section 25A ofMGL o.152 can lead to the imposition of criminal penalties of a
fine up to $1,50 0.00 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 verifytion.
X do hereby cert& under the pains
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 Cleric 4. Electrical Inspector 5. Plumbing Inspector
6. Other - - -
Contact Person: Phone
In %4
Flaw
14. -
Flaw
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Massachusetts -Department of Public-Safety,gal i
Board of Building Regutations and Standards
Construction Supervisor
License: CS -091193.
ARWTAGE;r-
FRANCISJ
12 SUTTON ii] RW,
NO ANDOVER NA 01845
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ti-
J,�� ,� „ ► `�
Expiration
'I
0511412014.
commissioner .
Off►ce n qn rs & B mess Regulation
HOME IMPROVEMENT CONTRACTOR Type=
Registration: 167562 Individual
Expiration: ,101412014
I CIS J ARMITAGE
_• i"
ti FRANCIS ARMITAGE,
12 SUTTON HILL RD,
MA 01845 Undersecretary
NORTH ANDOVER,