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HomeMy WebLinkAboutBuilding Permit #214-15 - 318 MAIN STREET 8/27/2014 BUILDING PERMITNORT11 '9w- ��tt LE.D 16 0"IO TOWN OF NORTH ANDOVER 3� y ='" APPLICATION FOR PLAN EXAMINATION o ' .A Permit No#: ( r Q�- Date Received ADR.ITED 01? cy I a1(f— im �SSACHl1`'Et Date Issued: v P TANT:Applicant must complete all items on this page rr ( LOCATION HAI M ar PROPERTY OV\1NERJ6R N P�N6 LA .. _ rint�+�JA(�.n�_�J_ Rnnt 100 Year Structure MAP PARCELyes C r_ ZONING•DISTRICT:_ .. -Historic District yes - _ Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential No Residential ❑ New Building XOne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: El Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain 11 Wetlands D Vllatershed District ❑Water/Sewer DE CRIPTION OF WORK TO BE PERFORMED: 40 Identi ation- Pleas T e or Print Clearly OWNER: Name: Phone: r' Address: ( ANLOV6k /44 61d � Contractor Narhe: Phone: PAddress: _ Supervisor's Construction License: Exp. Date: -1F -- ,�- H. Improvement License: _ p -- = Exp. Date: --L 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: $ FEE: $ Check No.: Receipt No.: _a�M(� NOTE: Persons contr ting with unregistered contractors do not have access to t guar n and Sig e of Agent/Ovvne Signature of c c ori ii 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 ❑ 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 COMMENTS I i 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 FIRE _DEPARTMENT - Temp Dumpster on.site yes no . Located at 124 Main Street Fire:Department signature/date COMMENTS _ -- 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 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 a Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o 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 o Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o 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) o 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) o Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o 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 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 Doe:Building Permit Revised 2014 Location zt� Na Date o - TOWN OF NORTH ANDOVER a Certificate of Occupancy $ Building/Frame Permit Fee q3-6 �"- -� � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#4�� f 27960 Building Inspector f. f: r10RTF� Town of _ Andover O ti. to No. i­ioi*'r -W-PI- W CL kaox h ver, Mass, c oc Nuc Ne .C. 1• U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ........ ......00ft. . U! BUILDING INSPECTOR has permission to erect ....................�... buildings on ....8.1a Foundation ....�,Q,�.I�....... ,..�,,,,,,,,,,,,,,,,,,, Rough to be occupied as ............ ........ t. ...... Chimney ... ................................. provided that the person acceptin this permit shall in every J- A pect 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 MONTHq ELECTRICAL INSPECTOR UNLESS CONSTRUCT ST 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. T � 1 IlimaAil ,� e �• aY� i f 9'� '' 9iQQ 1 oa 1� r � . �� � ' aaa ala The Rome Tzapmv®altContracinr Lav provides howwwam with ibefW tm initiate an action(as= aftnastive m aetict)iftbay bazre a dim WI&a ono or:.Ibc snot right is n m Bans a6atded to e - . h�owaret:1La c�0�r wooM have m�emp�d�itdsheims wig a m coni� bo4hpadmagmetoStopficamatelmoseplow below.Ibis eiaascvAmMgive the contactorthesame zightto atb�ration as is ttffordedmfhe Lotmawz�erbytbel�o®elmpr+ove�CoaaaetmLtay. • Mccortractormd8u i bmTbymmAmftagzeeinadvaom fimintbeaivac Ihammammatorhas adlspum oommznm 9 ibis 4 do rmap saI tic dispumefo ap iwate I approved by U�_ by ive o�cc tbnanmer AfiBia mdB Reg�rat the be rephed as provided laMamacbs tCmwAfhe abatapplyaetymthe The may imtiato alm�ve disptgc n even wkm fit's�is m by*mpfftics. aanrevwaea"s B�Zts , A hem's zigtns aodetthe Rom hopmemmutCotttraetor Law(MGI,edupW 142A)sad other eomsomer prow:rnm Inas rip–)&L chaps%A)may not ba vtaived nimay way,eves by agcaromw&Howave=,bomeowma may be emb ded from mrft, rigbts if the oonhaaetor tory choose is not ptopcdy z m pjcm' ed by}stir. Homwwmn who wane flea otim bmldmg l 'I are SuMmadcaW aceLded fitmt A GmmanLy Food pwvWom of the Hmme I ; I COdhclat Law.The com4actor is nmpowfl&fur oompletmgtht wort[as des<abed,inn timely and wad®enlaoe ttmmorr Hemeowtns may be anfilled to add spoeft legsl dgbb if8m corbackr garanjow or pmvides as express watraoty fin vera ar nmkdals. Ia addmianto g orvaasarties provided by the eont—tor,alt gno8s sold in hUmachumm ommy 4a mopes y efmaalambbW amd fitness for apa Wmalar pmp w-An ems. of o&w maSb I s anvol mat t hmnwwaer ma combacmr lawfully agm may be added to the looms oftbe as Iwg ms they do rot nsmnct a fbImmwowmet's basic nustmertagbl5. Ifyoo have questions about yon: tigfis the Ce�aetmerhomniflon Rafte(wed below)- Emeeotim ofCmtract The aemutamzmm bo finftfieftendahold mtba sigmd-twM-a copy of all=b'bta and nftff nmd dac»m Imvebea►atta;fred. Paths am also advised zmtto signihe doamww�ttoml ail hht�c Imre berm filled is or named as voK delemed,ornotapplicable, One MOW Signed copy of the contract W& is to- be Onto the er ownmdthe otherIneptby the m ft ' ' coarserzmat �3' >p attgtml ha m vvtitrog and fm both Wed by parties-Commraemed wotic ones not begin ttmtl bortlt parties have received a fntly exaromed copy of be canotm and 60 that day tion period has mmuad. A=Awamed Paymmb A cwmtzaomor may not dommd paytamft in advaom of ow dabs specified an fie paynrmt schedule in cases wbme fire homoeoviom drams hmofLetsvfYo be finem finny i Hmwc rer,in imlzmoos wbom a eoubmtw deems bkn&ccpdf to be fimmdl f b m%the amnam r may"gmt t wAt babtace of fmtds tar yat doe be placed in a jots esraow aom=asapramqumfttDconftwmgtwcontactBdwa& Wit&==offimds from said axotmt would retrofire l&e signuturesufbodb; 6, "didond Ieformatima ffym have gmaal questions or need addtiional infomoation about&a Home bnptovmnm t Corms ntor Lew or oiber «nscmmex*OIs,err if yon wish tb obtain a fibs copy of RA Conn=Otddb to the Home hupTavcwcat Commta tm �R . - coftun=bzfiwadSoa Hotline Of ft of Consw=Af3 m and Busmess Regulation 10 Park Phm,Room 5170,Boston,MA 02116 (617)97344 or 1{g8)2833757 Ifyoa want m verify ft regtshadin of a Contr=ftr or ifym have questions or treed additimai uhnombon specifically eborfteomeactor>agimatianeoaozponentttfthe.HambmwevementCaufteceorLaw, Director ofHome h0mvema d Conbacbr Reeisbatim Bum=ofBlplcling Regubtiom and Smudmds One Asbbudon P1ace,'Room 1301,Boston,MA 02108 (617)727-3200 or 1-800-223-0933 - i For w1 mfotmal modiatim c f dispmmtx m m formal�laiats against abusincss,caIl Constrmer Camtpwud swc un Office ofth Aft envy General (617)727-NO AMIOR BeVar Baines Bateau (M)651,4M (508)755-2548 (413)734-3114 x Massachusetts -.Department of Public Safety Board of Building Regulations artd Standards Coisrrucon Supen•isor l W21 Famlj License:CSFA-M279 I qtr` THOMAS W PRICt I 41 0RC14AR_S'C M[ERRIMAC NAF 018b0 Expiration. Commissioner 11N8/2014 Rn , •.�,-tom- GJ , License;ur reg�straAon va Citi �nd�a r 8fficc a onsufner a►rs;' > aess egg a on - t r �el�oretlie�gp�rattci�n dates�f ,4 IVIPitl/f<MENT CTO CONTRAR.` .' a 1, iliicabf Consumer Affairs an Usin Registration U9526 TYPe RV 1Q Park Plaza-Suite X170 ` Private Co Ex iration 1 014 Boston,MA 02116 P:. T: AS PRICE INC 3 7` -A l: THOMAS PRICE 41 ORCHARD ST igmg MERRIMAC.MA 01860 Undersecretary Not valid without signature �I The Commonwealth a•f faswhuselft , • - Office o,fInvesfigafeons 6©01%Gashineon Sfteet Boston,HA 02111 vmmass go-pldla Wo r kexs;'Compensation Insurance Affidavit:Su der olCo)atradores/Electr icianslpi*bex.o ADp ewat oxmaton Ploase,Print LORD •Name(BusinessIOxganizationl]ndividual}: � Ci€yrSta�et ip: Mc,� m4-r-�� Phoned: S288, 61!-�13 Are pox m employer?cheek. the,appropriate box: Type of project(regv iced) �, []X am.a general contractor and I 1. T am a employer with____�__. 6. []Now cdnstxuction mployees(�zlland(orpar time).T havemredthesu�b-contractors 2.[] S am a sole proprietor or partp.ez~ listed on the attached sheet:T 7• n E emodeling _ These ship and`havena•employees suTr-contractors Have 8. �Demolition wort ing forme in any capacity. workers'comp.insurance, g. E]13�dhig addition [lb workers' comp.plsurance • ❑We are a corporation and its 10.r]Electxicalrepairs or additions q*ed.] officers have exercisedtheir xG3.Ela homeowner doing all right of exemption per MGL 11.E]r Mbingxepairs or additions myseL Egoworkexs'comp. c•152,§1(4),andwehaveno 12 flRoofxe7paks insuranc�re ed. i employees.[No workers' ~ comp,insurance required.] 1 . Other Auy applicantthat checks box01 must also fli I ouxthe section,bcompensationpolicy information. Hbraeowners who submitihig affidavit indicating they 6're doing ailwork andthen hire outside contractors must sulniff anew affidavit indicating sizcb. xcontracfom that clzecktbh box most attached as additional sheet showmi gthe,name ofthe sub-confractors and thekworkus'comp.policy information. �araaccr2 erazprayeNt�iccjisp ovidingw0ger�'eorptpe i atianir�sr��aneefa•x�yern Loyees. Berowistiepalieyanc�roh,�iie infarmadon. Insurance CoxnpanpName; ��� Policy#or.Self-IM.LIG. Tole SiteAddxess �s' M44,-\, Zt� City/Stately: trca Affach,a copy oyMa workers'eoxap en.sation-poRcy cleclaxattou page(showing-tlte policy-umber and expiration date). Failure to secure coverage as required.under Section 25.1.ofM'GL o.152 cart lead to the imposition of cximinalpenalties of a im risonment as well as civil enalties iathe form of a STOR WORK ORDER.arlcd a ane e to$1,500.00 andlox ones-year p x p ofup to$250.00 a dap against the violator. Be advised that a copy ofthis statement maybe forwarded to the Office flf fnvestigatlons of the DTA.for ibis arance cove age verification. r .a do Xiereby certify un ie&ng and malt �o�perjury tliai the inform adon provided above rs true and eo reet Si e: Data: 02 'hone#: O�eial use o�tly, Do riot write in AM area,fo Ire conwleted iiy city or town official. City or Town: PermitfLicense# fss-ul gAuthoxity(circle one): Z.BoarcT of�ealth.?.BuiYding70epartm.end �.Cx£y/Tow�a Clerk �.ElectxzeaXxnspeetox 5.FZurahzngJCuspecto�• f.Other - - i bfor�iafion and Instrue fions Massachusetts General Laws chapter 152 xegmes all employers to provide workers'compensation for their employees. Pursuant to this statute,an MTloyee is defixted as"...every person,ui•die service of another under any contract oRl*a, • express orhuplied,oral oxwxitten" era r, is defined as"an individual,parEnership,association,corporation or other legal entity,ax any two Ox more oftheForegoingengagedinajointenterprise,andincludingthalegaIxepxesentativesofa.•do easedemplo�yex,.oxtie receiver oxtrciste0 ofaukdMdual,paxtnersbip,association ox othexlegal entity,employing employees. �Sowaverthe owner of a dwelliughouselzavingnotmoxe thmmree apartments audwho xesides therein ort a occ ., h upant oftlte Il dwelling house of another who employs persons to do maintenance consixu frc" om orrepazx work on such dwellinghouse or on the grounds or building appurtenant the shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local lic-eusm* g agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth fox any applicant who has not prod-aced-acceptable,evidence of compliance with the insurance coverage reNr'ed" Additionally,MGL chapter 152,§25C(7)states'Noitherthe commonwealth nor any of its political subdivisions shall enter into any contract for theperformauce ofpublicworkumtiZ acceptable evidence of compliance with the insurance xegairem,ents of this chapter have bcon presented to the cQntracting authoxity." Applicants Plead f l out the workers'compensailon affidavit completely,by checking the boxes that apply to your situation and,if necessary,supplysub-contractox(s)name(s),addxess(es)andphonenumbex(s)alongwith their certiffeate(s)of insurance. Limited MabArCompanies(LLC)or Limited Liability Partuerships Ap)withno employees other that the members oxpartuers,arenotrequiredto carxywoxkers'compensationiasurance, lfauLL CorLLPdoeshave QM0loyee8,apolicyisxequired. Be advisedtlratlhi affidavit may besubmitted totheDepartmentof industrial Accidents fox connrmation ofinsurance coverage. Also be sure to sign and date the affidavit. !'lie affidavit should be xetumdd to the city or town that the application for thepannit or license is being requeded,not the Dq�attm.ent of Industrial Accidents. Shouldyou have any questions regarding the law or if you are required to obtain,a*orkexs' eompensati(MpoVcy,please,call the Department atthenumber Itedbelow. Self=iusuxedcompWes shauldenter their • se1E insurance license numb ex on the appropriate line, . City or Town.Mcials Please ba sure that the affidavit is complete and pxintcd legibly. The Departm.enthas provided a space at the hottom of the aMdavit fox you to fal out in the event the Office of Zuvestlgaiionshas to contact you regarding the applioant. Please be-sure to sill:hthe permit/-hoemo numbex whichwill be used as a xezerence number, In addition,an,applicant tlaatxnstsub.m.itmiAti le om it/Rce:mo applicationsin any gz eM year need only submit one, afda vis indicathIg cuentpo c znfoxmaizon recessay)and under Job Se Address the apphcant shouldwzlte a111acations in or towxc):'.A:copy Otte affidavit that has been.of rially stamped or ma&ed by the cit�t ox tovrn may be provided to the applfcantasproofthatavalidaffzdaet'*On,EG�OrfuturepMENorlicenses. Anew affidavit mustbeMed6-ate eR year.'Where,a home owner or citizen is obtaining a license ox p exmit not related to an business or commercial (i.e.a dog lie ense orpermitto burn leaves eta. said erson N NOT e 1 venture ) p cluiredto complete this affidavit. The Office of Investigations would like to that&you in advance For your cooperation and sh.Quld you have any questions, please do not hesitate to give us a call. The Depaxtm.ent's address,telephone and fax numb er, `rho GQrnm4jdwtalt ofM macc"AMO-t-I .Depa e.Ut d.uclu Mal Acctdento 600 WagWngf Qn S Ce BOMM,MA 02111 Tei, 617.72'&49,00 W,40,6 Qx 1-877;MA���� _ Revised 5 2605 FM#61M.7-7749 ' v;iw4�•�la�,g�v�c�la