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Home My WebLink AboutBuilding Permit #615-12 - 33 WALKER ROAD 2/24/2012TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: 6J —/2 - Date Issued: 2 ,z ti// z IMPORTANT: Date Received must complete all items on this LOCATION �" Print PROPERTY OWNER C �/ I S yi >-g z 16, Print MAP NO: 23 PARCEL: ZONING DISTRICT:. Historic District yesno Machine Shop Village yes 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ,Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Nand . L. �.,-c...�.,n,..c.� dt.$...:�.sc� zs...2a; 6i.._irs'.�r Zv x � .�s� l �,.Laet � r r. 1 k � 5•,� .. LZaWurIWIN L) -P- wuK& TO BE PERFORMED: 07e s1 (identification Plpse Type or Print Clearly) OWNER: Name: f` Ay I Sti ii 4 {-g 7 / /a Phone: 1,29 Address:_ © 0//Q nQ -ve wk -.6 k7 c �,a� CONTRACTOR Name: , � Phone: Of -% 90 7 Address: 6 %c7<<h G P ell S Gi, C 11 Supervisor's Construction License: 01-5 S-9 6 % 0 Exp. Date: 6 ao2 I Home Improvement License:. Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. 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: $_ /vl 0 FEE: Check No.: 2 / Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the euaradty fund- r, ._ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer El - I Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ I permanent pumpster on Site ❑ I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS. CONSERVATION COMMENTS HEALTH COMMENTS Reviewed on - Si nature Reviewed on Si nature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments 10 Conservation Decision: omme Water & Sewer Connection/Drive) a Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Duwnpster 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 DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10041000 fine Doc:.Building Permit Revised 2011 June/mi 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 o 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 o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o 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 o 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 2008mi _-r 4 Location L No.— 6q,/r-/-? Date a/.av//Z- Check 4-Qj-11r 25045 TOWN OF NORTH ANDOVER Certificate of Occupancy $- Building/Frame Permit Fee s-20—,Od Foundation Permit Fee Other Permit Fee TOTAL building Inspector m m m m X m v m v y C � C2 Z r CD CL �• � � C CL O y O � Cn o CD O��"'• VJ CD CD O CD O CA �.n z �. CD J dC2 y O �O CD cn S y O � CD O CD CCD Oi 7d 0 0 Z o. r« 0 0 U2 O 1 a COco co c 0 0 CL H VJ c?10 -Po - a = .. y O c y mCD 4 a0cm ®� 10 y e'. m y mCL 3. Cl) M ` �o C� o� 'D0 O . � I a: _ -• o CO).� o T � m d =r a .. a � m y d �� b —lomco' o tri �m!!4. =-o CL -P-: a � ....,.. . 0 y O =r O O .y a = _ ... � =r CD O H y � mCLcr Wd c ci CO) o ,y, = o c o d° a m mCD 4 wy. � q �e 0 e'. ao� rd � WPD �' ` �o C� o� 'D0 O . � I a: O C2 m � m d ®CA 0 d �� b = o tri CL -P-: ci CO) o ,y, = o c o d° G� 0 e'. Ti - rd � WPD �' ` aGa o� � R � O d b tri z 0 omi 0 0 c The Commonwealth of.Massachusetts Department of InlustrialAccidents Off1ce of Investigationg 600 Washington Sheet s Boston, MA 02111 www.mass.govIdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Ulectriciansfflumbers 1piicant Information Name (Business/Organization/individual): r Address: City/State/ZipQ Q U Ohone #: % gG l,!�) cl • 7 Are you an employer? Check the appropriate box: 1 • I am a employer with 4. ❑ I am a general contractor and T 2. ❑employees (full and/or part-time).* I am a sole proprietor or have hired the sub -contractors listed partner- on the attached she ship and have no employees uet. These sub -contractors love working for me in any capacity. [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a coipoxation and its required.] 3. I am a homeowner doing all work officers have, exercised their right of exemption per MGL myself. [No workers' comp, c. 152, §1(4), andwehaveno insurance required.] i employees. [No workers' comp, insurance re- Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. El Demolition 9. [l Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing 'repairs or additions 12. n Roof repairs U ME] Other . ' xAny applicant that checks box #1 must also fill out the section below showingtheir workers' compensation policy information. 1 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. am an employer ill at isproviding workers' coYn information. pensation insurance, for my einployees Below is thepollcy and joh site Insurance Company Policy # or Self -ins. Lic. Expiration Date: J"ob Site Address: , 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 required under Section 25A ofMGL c. 152 c -an lead to the imposition of criminalpenalties of a ine 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 If up to $250.00 a day against fine violator. Be advised that a copy of this statement maybe forwarded to the Office of avestigations of the DIA• for insurance coverage verification. do Hereby cWMY ander fit epains andpenalties ofper, jury that flee information ps'ovided ahoye is true and correct. OJJ1eial use only, DO not write an this area, to be coinpleted by city or town officiad. City or Town: Permit/License �SsuingAuthority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5, plumbing Inspector Other Information and instructions Massachusetts General Laws chapter 152 requires all em Pursuant to this statutean employers to provide workers' compensation for their employees. , .,.every person in. the service of another under any contract of hire, 1 or written." ployee is defined as " i express or implied, ora` 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, paxtuership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who -rreside therein, e the occupant However 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 4emed to be an employer." MGL chapter 152, §25C(6) also states that "everystate 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 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 of this chapter have beenpresented 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) andphone numbers) 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, a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation.of insurance coverage. Also be sure to sign and date the affidavit. The affidavitshouldbe returned to the city or town that the application for the permit or license is being requested, not the Department of Indusirial Accidents. Should you have any questions the 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. TheDepartmenfihas provided aspace 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 permit/license number which will be used as a reference jnumber. In addition, an applicant that must submit multiple permit/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 or town)." A copy ofthe affidavit thathas been officially stamped ormarked 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. Anew affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit notrelated to any business or commercial venture (i.e. a dog license or permit to bum leaves etc) said person is NOTrequired to complete this affidavit. The Office of Investigations would no to thank yo -din, 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: T" e Col orm—alh, o.i . jas adhimetts Departmont of ladwt zal Accidents Office of Invesagatiolis 600 Washington Street Bost . .MMA, 02111 TeI. # 617-727,4900 ext 4 a 6 ox 1,s77 m,ASSME PROPOSAL 10 RICHARDSON COURT METHUEN, MA 01844 978-360-7909 GARNETHOMESOME.COM MICHAEL OUIMETTE LIC. # CS58670 EXP 06/21/12 HIC. #107456 EXP 08/03/12 garnet constuction OWNER: CHRISTINE FAZIO CONTACT INFO: 978-409-6128 FAZIO STYLING SALON 33 WALKER ROAD NO ANDOVER, MA 01845 DATE 2/06/12 PROJECT: REPLACE ENTRY EGRESS DOOR Description , PERMIT 1 $30.00 $30.00 1 EXTERIOR OUT SWING DOOR 36" 1 $600.00 $600.00 2'/2 COLONIAL CASING 21 $0.40 $8.40 5/4 x 6 PVC 20' 1 $58.11 $58.11 5/4 x 8 PVC 12' 1 $43.20 $43.20 FASTENERS 1 $20.00 $20.00 SEALANT 1 $8.00 $8.00 FLASHING 1 $3.50 $3.50 CARPENTER 1 $300.00 $300.00 CARPENTER HELPER 1 $100.00 $100.00 MATERIAL DISPOSAL 1 $30.00 $30.00 Subtotal $1,201.21 $0.00 Total $1,201.21 WORK TO TAKE TWO DAYS CAN BE CANCELLED WITHIN 72 HRS AFTER ING OWNER DATE lCJ < –9—/1 Office o lEo sumertXffs rs i"bg ineftt"At'i H HOME IMPROVEMENT CONTRACTOR Registration: 107456 Type: == Expiration: 8/3/2012 Individual MICHAEL J. OUIMETTE License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MA 02116 Michael Ouimette 10 RICHARDSON CT. �."uts METHEUEN, MA 01844 Undersecretary N `la..arhu.ctt. - Dcpartmcnt of Public *'afct% 9 Board of Buildim_ Rc-uulations and standa'As Construction Supervisor License License: CS 58670 MICHAEL J OUIMETTE 10 RICHARDSON CT METHUEN, MA 01844 ( �nnmi.�i�au•r Expiration: 6/21/2012 Tr--: 30338