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Home My WebLink AboutBuilding Permit #233-13 - 33 UPLAND STREET 9/21/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO- Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page t – — �A– - t.. n P FR®PERTI( ®WNERa t m — _ A_ yy�� Pnnt 10Q'Yea_r1.Old Structured yes; no d MAPN® UPARCEL D ��ZONING9DISTRICT= HistoncsDistnct yes nog _ Slie _ . Machine opUillagr dyes nod - TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition W-Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: _ ❑ Demolition ❑ Other - .- — 0 Septics Welll 3 �;Floodplam ❑1Netlands� WafershedlDistnctl .� Water/Sewer_ --- DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: 17A 14 Phone: Address: > L) i`. 0 s I C®NTRACTOR{ Name � _ . taxes ;.Address _YC<J r - - - -- - _ - Su - ervisocfsConstructrgnLcense . `r� Ex- T Date "z--_• . p t HorneImprovementyLicense_. Exp Date 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: $ 9FEE: $ I I ft (D Check No.: 1�`� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature ofgent/®wrer .. y..__ y Signatureaof£contraator is Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan 11 Stamped Plans ❑ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL i 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature r i COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes 4 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 Qumpster on site yes no , *qa Located at:124,Main:Street:. . _ .. - ... .:.. , .. ..,. . Fire Die partrrment signature/date COMMENTS.' 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 - Date I I Doc.Building Permit Revised 2010 i 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 i 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: Doc.Building Permit Revised 2012 } Location No. 3 Date--qjz i e - TOWN OF NORTH ANDOVER t4 : . Certificate of Occupancy $ t � _ Building/Frame Permit Fee $ r .t Foundation Permit Fee $ Other Permit Fee $ ` TOTAL $ Check# 25738 Building Inspector NORTH Town of � t ndover to As_ ; No. 233.,- r3 t - z h ver, Mass . 21 2. CONIC c"R Mt WICK j ��AOR�TEO PPP,��y � S V BOARD OF HEALTH PER IT LD Food/Kitchen Septic System i BUILDING INSPECTOR THISCERTIFIES THAT ........... .. .......................................................... .............. ............................... { - u Foundation has permission to a ect .. b 'Idings on . .�..... ... .......... ................ Rough ' 116A ,N � to be occupied as ��...... ..��...... Chimney E provided that the person accepting this permit shall in ever respect conform to the terms o 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 HS ELECTRICAL INSPECTOR UNLESS CONSTRU IONS RT Rough Service ............. NIS .......... .................................... 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. SEE REVERSE SIDE P.ToPps.a.1 ....... ............... ...................-.-.-.....-..................................................................-..--....-..--..-.....--.................................. FROM: Ken Surette Job. No. 33 Georgetown, Ma. 976 616 6417 PROPOSAL SUBMITTED TO: Name: Mr &' Mrs Dan Hakim Phone: Date: 9/20/12 Street: 33 Upland St city: N Andover State: M a Zip: Remove interior wall between dining room and back room and repair all wall and ceiling damage pertaining to this wall removal. Replace back door to deck and install a 6ft sliding door A deposit of($ 4000.00). Second Payment of to be made as the work progresses to the value of(50%) of all work completed. The entiVe amount of the contract is be paid within 3 days after co letion. Any alterations or deviation from the above specifications involving extra cost of material or labor will be executed upon written order for same, and will become an extra charge over the sum mentioned in this contract. All agree nts ust be made in writing. Authorized Signature � ACCEPTANCE You are hereby authorized to furnish all materials and labor required to complete the work mentioned in the above proposal for which Dan Hakim agrees to pay the am sur t me^:ion€d in said proposal and according to the terms thereof. A_- � -0 _0 I� Signatu e Date www.socrates.com Page? of 1 SS4301-340-Rev.05/04 e� d � � `J f JUN-11-2012 11:48 From:PINGREE INSURANCE 978 352 8078 To:978528417 P.1/1 e - 19 F a 'MAN C- f ANID ' M41-p%-'M UPON THE GMT!MATE 117-DER. THIS ra -, .t_ 'r r .: r - r iSELow. THIS C>:12'fiiFidoe w.Atwtlmme t30a N is Rei si A wwwoRA" i. _.: iiiE :e.:r�:�$r Rzr Qwp _�. .�F--ED REPRESENTAYIVE OR PRODUCER.AND THE CER1M KATE HOLDER. IMPORTANT: M the catdiflcate holder Nen ADDITIONAL INSURED,the Pallcy(les)must he endmod. ff BLIBROGAMN IS WAIVEC►,Zwet to the — PRODUCaR dldl N Pingree Insumoe Ap"Inc "Mo 24 East Mai-a sumv. Georgetown — -- - MA - 01833 INf9URLA 1_A�QRMCOM" - NAICN . 1N3fIRf;D EN* nnRg;W"Mn?tWhOdIn_ffQ 86 Searle Street Met"c —._. .. _. M 01833 ar:tu o; __ _ - -• COVERAGES CERTIFICATE NUMBER REVISION NUMBER: SMI 130t.GVU RAVE SM IS9UlED TO THE INSURED NRMEC ABOVE FOR THE POLICY PERIOD THIS iS TO CERTIFY YWAT THS PbLIGIGS OF INSURANCK LI I, _ e,t.•�A� eeaTA .T.R!K I h!�Jf3FAICEvnAuFFOuRDE^DF It^Y reT`H E°Pt±1U�RCLiTESD8RE5JTCIR Ei8RE D3ftiCEtSi7M :SCT M!CH INDIGA-11z0- 2Eld 14 SUBJECT TO ALL THE T WS: eM I .- Vren7rR '- e4e.,c FXCIUSt]NSAND GONDMONS OF SUCH POLICIES.LIMITS SHOWN MAY PAVE BEEN REDUGEA0Y PAID CLAfNS. iMW119 OV INSURANCE T _ --- PD UABTS A agNMLLIABILnY NPP8083748 111Q3t2019 11JD3/;;012 EACMoCtIEIA6NC0 _. s. .... 1,OAG,ODQ.G ".�w1lisnE&`.t4i:: wcc-`vl"s.itiuliaz ' j"�. F:P.�+�uP.�.: '-w.'r2^Jrd�^i _ _ ._._1 .�Q.. CRAre�+g..0E❑0=0 t �eDmrni/�w�pe� M8OML A ADV KnJRY 611NIMLAGGMA•ff'<_. s,_ &000 000.00 GfIN'f.AGMEGATE LUT APPIAN PRODUCTS,^��c act � ¢(a0,f20Q.OR POLICY LDM Fj LOG At1T0UtpOU LIAMUIT GOlNf31 D dnl0te Iimlr S ANYAU O DDOILYt1w6AiYlParparsoe2 S ALL OWNED AUPM BODILY INJURY(Pet e0ftil) S eCNCOMM AUr08 PROPf RTf t taAee - y HIRF,DAUYOS (ParaafdmFl) - 140N-OM€isi3AUTOt3 ____. ...___— —•- UA ITLIA LIAOCt Oco'mNt RIC65eAUIa � S A WDflKeRe cOt!PQl�A71D)t 7 JJtt L' -- AND6tRPLOYBRe'LIADIIITY ANY ARCVRrMR7PARTNERlEX�1'nV[ Will r; ie_L*ACI_I ACGDL<Nl' .. . OP,10EftY w'F�'P.nC!JG[77 I_,,[ N/A $.l.Dt3°..°.o s"°+-Lfl— $ ft ye0�eot�wH�er r OL O1SkAeiti•POLICY Lfw iM MUM - - DkbCItiPTiONQPQP131tA7tONB11.aCAT1ONb!{IEHICLH6{AtteGhA06ftY3i0#.A6dNi++riaiFiaamFksBCfie�ui0.tFF�tesP�IIegt+g4treq) CERTIFICATE HOLDIER CANCELLATION MOMA) ANY OP TRd AW4 MICRMO PMCHM De r,ANCMJJM e13PORo YHg VOW''nON MTB"MIM NOtICa VVU DD DDLIVERED IN AC+CORD"Cf3 WITH"0 POKYPRQVISfONe. Al)nl R WNTATIV6 RpoRAYtON. Alt rIWM ra�erved. AC ORD 264200M) The ACORO name arsd logo am r13gMbued marks of ello The Commonwealth of Massachussetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,AM 02111 www.massgov/dia Workers' Compensation Insurance Affidavit. Buildeli s/Ccn'tractors/Electa icians/Piumbers Avolicant Information Please Print Le ibl Name(Business/Organization/Individual):___e /� \ Address: _ _ .._, City/State/Zip: .fCeV a,c-1,o , Phone#: 477& G /8 8� 0 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. 1 am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. F-1 New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. &Remodeling ship and have no employees These sub-contractors have 8. Demolition workingfor in aci employees and have workers' me any capacity. x 9. F-1 Building addition [No workers'comp.insurance comp.insurance. 10 Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ P 3.® 1 am a homeowner doing all work officers have exercised their 11.®Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required] *Any applicant that checks box#I must also fill out the section below showing their workers compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. -v.._ "'>...�.. ..... ............ .......__..._...�..__,...___......�.....__..__.._ate__. .�..,._.... _�;r��...._Ct�ia.d:a;:3't...e iirl'ietl;£..,.a...tl'iJSc entities lir.e employees. if the subcontractors have cmYloy_;s,they;rust pro:-,& I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site ier,�ogrN:i�dofl=. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: lit lS 4td/�ip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). � `M ^C Failure to secure coveraige as require-4_nele fine up to$1,500.00 ar_tlior one-year imprisonment,as weft as civil penalties in the form of a g OF WORK.ORDER and a tine 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 verification. Ido hereby certify unde th ains d penalties of perjury that the information provide"above' tru and correct Si nature: Date: c � Phone#: Official use only. Do not write in this area,to be completed by city or town of ciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 91te Office of Consumer Affairs and uslness Regulation 10 Park Plaza a Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration "v= Registration: 168661 Type: Individual Expiration: 3/24/2013 Tr;l 210386 KENNETH SURETTE - - KENNETH SURETTE = _ 36 SEARLE ST GEORGETOWN, MA 09 833 Update Address and return card.Mark reason for change. Address RenewalEmployment ❑ Lost Card DPS-CA1 is 50M-W04-6101216 Office o�n °e'r' a refiu�in`ess egu a 5� License or registration valid.for individul use only - ,HOME IMPROVEMENT CONTRACTOR before the expiration date_ If found return to: — Registration ,168661 Type: Office of Consumer Affairs and Business Regulation § ." Expiration: 3/24/2013 Individual 10 Park Raza-Suite 5170 Boston,MA 02116 KEN i=TH KENNETH SURE7TE 36 SEARLE ST GEORGETOWN,MA 01833 Undersecretary Not valid without signature 11assa imsetts- Dela l-11101t of Public !safctN Board of Building Re!-ulations and Standards Construction Supeirfis6, l icense Lkense: CS 23453 fi KENNETH P SURETTE 36 SEARLE ST GEORGETOWN,.MA 01833 . Expiration: 9/29/2012 e (',nnatixsirnc'r Tr=• -9135