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Home My WebLink AboutBuilding Permit #16 - 33 ELM STREET 7/6/2009 Tl� BUILDING PERMIT o�ttr10ROR 'sa TOWN OF NORTH ANDOVER c? b` '' '° o° APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received0Anieo�1,1y �SSACH�1`�� Date Issued: ILL b IMPORTANT:Applicant must complete all items on this page LOCATION �J^J �'1 -- Print PROPERTY OWNER 1 � A G G wE' Print MAP NO: I PARCEL: 3 ZONING DISTRICT:_Historic District yes Machine Shop Village 09MNno TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Buildingne fa i Addition Two or more family Industrial No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: 5 vel M r— ( O C Identification Please Type or Print Clearly) OWNER: Name: ��✓aN e 9�c3�r � Phone: ci- -7 5" Address: CONTRACTOR Name: 'S"oAr�.t�S +C S'rA Phone: Address: S +ate PA -e. w.,) S4- 60,-) Supervisor's Construction License: 5 LO l Exp. Date: CfzS / a 01 0 Home Improvement License: D a g Exp. Date: I I -,;'0O°l ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ I cl 00 FEE: $ 2�11 Check No.: 3 � Receipt No.: 9- a ( (f�— NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor Location 53 Sr— No. Date TOWN OF NORTH ANDOVER ?o.4,.60 6 0L L s ; , Certificate of Occupancy $ MU°'E<�' Building/Frame Permit Fee S Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 22 1 t. J Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL ublic 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COJ,�41MENTS 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 Os ood 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 WO ✓ �U ❑ 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 DEPARTMENT:BPFORM07 Revised 2.2008 J+Iussachusetts - Depaijinent of Public Safetl Board r)f Bum�ildi Rc��plutiont; and Standard.s Construction Supervisor License License: CS '54718 Restricted to: 00 JAMES M TESTA 5 APPLETON ST N ANDOVER, MA 01845 MUM Expiration: 6/8/2010 ( Tr#: 27973 Board o B ildih o nrj 8fS ' HOME'IMPROV" PNT CONTt2ACTOR Registr"00 ,26296 ? � �xprration 11/19/2009 Tr# 261225. f?,t� rTYRe D�A� TESTA BUILDIN' & JAMES TESTA ObE1-ING 5 APPLETON STREET N.ANDOVER,MA 01845 Administratur VAO R T1-! Town of 4Andover No. dower, Mass., ' T Q LAKE COCMICMEWICK V ADRATED P'P�\ �y `s E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...... ................... w.`.................................................. Foundation 1116 has permission to erect........................... ............ buildings on ....!............��!......... .......I................. Rough dw to be occupied as................�IGI. ��R1!�!�.............. =Ic �. ..... 11�j..r .�i Chimney Ch' e provided that the person accepting this permit shall in every resporm Io the terms of the application on file 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 A` PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR V' UNLESS CONS TR ST S Rough ........... .......................... Service BUILDING INSP OR J Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. ✓S. U U Building and Remodeling 5 APPLETON STRET NORTH ANDOVER ,MA 01845 (978) 682 2023 PHONE/ FAX I?Iroposal July 1, 2009 Proaosal Submitted To: Diane Bowe Home Phone: (978) 975-5458 33 Elm Street North Andover, MA 01845 JOB : New bath Obtain building permit Complete removal of all demolition and construction materials generated by Testa Building and Remodeling and its subcontractors. CONSTRUCTION: Totally gut all the walls and ceiling and floor. Remove and replace the tub. Re insulate the bathroom . Install new shower valve and new shower head. The walls in the shower will be Swanstone panels. Remove the window and eliminate it totally . The bathroom will be hung with blue board and skim coat plastered . Install new under layment and a new tile floor. Install an exhaust fan in front of the tub. The labor for the installation of the plumbing fixtures , electrical fixtures and the tile is figured in this price. I need a check for$7329 for the plumbing fixtures. • NOTE : There is no allowance for • Electrical fixtures • Tile • Painting and or staining. A finance charge of 1 U2%per month(18%per year)will apply to all accounts over 30 days past due. In the event collection activity is required the customer shall be responsible for all costs associated with collection,including reasonable attorney's fees. I propose hereby to furnish material and labor complete in accordance with above specifications,for the sum of: $ 14,600 Fourteen Thousand Six Hundred Dollars One third to start, one third after plaster,final third at completion . Authorized signature—q-IrAl I reserve the right to cancel this contract if not ted in 30 days Sig Signature NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: 3 £i S +- is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section I OA. The debris will be disposed of in: en- (Location of Facility) c� ignature of Permit Applicant -7// 0 cj Date The Commonwealth of Massachusetts ^j ! Department of Industrial Accidents Office of Investigations 600 N-ashington Street Boston, MA 02111 c ' www_nnas gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeQebly Narnle(Business/prgeniza6on/Individual): Address: 9 1--e V City/State/Zi : 7 .- - `I P �v�� i )q 0 tcs Phone #: ? 6 8 F2.K re you an employer?Check the appropriate box: I am a em to er with 4, Type of project(required):P Y ❑ I am s general contractor and Iemployees(full and/or part-time).* have bred the sub-contractors6 ❑Naw coristrvction I am a:sole proprietor or partner. listed ori.the attached sheet,x 7. Remodeling ship and have no employees These su&contractors have 8. [7 Demolition working for me.m any capacity, workers' comp.insurance. comp. insurance 5. 9• (]Building addition [No workers' P ❑ We are a corporation and its required.] officers have exercised their 10•❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself..[No-workers'comp. c. 152, §1(4),and we have no insurance required.] 12.❑ Roof repairs � ] .employees. [No workers' .[] comp. insurance required..] 13Other "Any applicant tient checks bo)C#I must also fill out the section below showing their workers'compensation policy information. t iiomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Contractors that check this box must a_ftohed an additional sheet shown.tate mune of the sub-contractors and their work='co^sp.prli�irfamiaHon. ant an employer that is{►rovtdutg:workers'comp infarmatiom ertsation insurance for MY employeaL Below is the policy and job site Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/Statmzip: Attach a copy of the workers' compensation policy declaration page(showing 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 penalties of 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 in a to$250.tions 0 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 verification. I do hereby certify under the pains anti penalties of perjury that the information provided above is true and correct. Si tore: �J Date: -7// / , G Phone#: FF,ff� usennty. Do not write in this area to be conplet�d by city or town official n; Permit/License# ority(circle one): ealth 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector son: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all emp 3 oyem 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,assnoiation,corporation or other legal entity,or any two or more of the'foregoing engaged in a joint enterprise,and includirlkg the legal representatives of a deceased employer,or the receiver or t ustee 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 tto 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 compie✓tely,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'cornpensation 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 sure to sign and date the affidavit The affidavit should be returned to the city or town that the.appiication for the permit or license is being requested,notthe 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 numberlisted below. Self-insured companies should enter their self insumnce'liceme 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 perrnit/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".lob 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 bum leaves etc.)said person is NOT required to complete this affidavit- The ffidavitThe 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. The Commonwealth of Massachusetts Department of Industrial Accidents Office of InvestEigstions 600 Washington Street Boston, MA 02111 TeL# 617-7274900 ext 406 or 1-8.77-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia