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HomeMy WebLinkAboutBuilding Permit #485 - 34 EAST WATER STREET 2/20/2008BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION d Permit NO: -/iO3 Date Received V tt %,cv 16'-ryO\ p Date Issued: 2-62�—a P. IMPORTANT: Applicant must complete all items on this page LOCATION � `Print PROPERTY OWNER Print 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 Alteration No. of units: 6 Commercial e air, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: TYt�eril�r 1Nyndy- rnon.t NPw r-10drIn �u[vtf, itit7Pl+tor r c yY) 4- 61 2V y G! h c1�S }'► /� c ✓ �C�c/I.A h 019 .-n �� S j'Z f ra �1 Glee kPc✓ k,elitaco Identification Please Type or Print Clearly) OWNER: Name: R Lc. 6, ed 1 -<a -f-"2 Phone: Address: 3,S-9 Ghe4na+ WZl1fAU/_ Br ijh�yn 2-/3 CONTRACTOR Name: Jo3ee R G goer Let,! CsC rrnanra � Phone: 6C-7 Z 7E-3 Address: 1 L a/►tc:S G f 5 1� r� rt l tri c �r 1�1 {�- Supervisor's Construction License:. � 3 6 L5' 1Exp. Date. 1 / 7,f Homeylmorovement License; (G 3 - Exo. Date - ARCH ITECT/ENG IN EER ate: 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: $ 12dOate- FEE: $ lie 000— Check No.: 13�_/ Receipt No.: cid 9,6 7;�" Location No. Date MORTh TOWN OF NORTH ANDOVER Of t`.e ,•,�•C 0 9 + ; ; Certificate of Occupancy $ ass._ Ott Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # ��yv 2 0 4 2 y--- Building Ins Ctor 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Com Water & Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street FIRE DEPARTMENT - Temp Dumpsteron 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.s100-s1000 fine NOTES and DATA — For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 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 OTE: 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 TOTE: 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 TOTE: 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 2.2007 CA m m m V/ m m D y C � 0 CD n Z y CL O . CO) a� 0 o CD CD 0 CT CD CD o CD CD CL v y CD I S v CA O 1CD Z a O CD O CCD 0 b 0 O cn cn n O cn a1 'PA cn V 07� 0 f� V J C 0 C =r-, O d Z 0 R y OM m 0 -0 SR o 7� �, mm yma= 3, ' ?'p CA' =o ...►= .d -►d B. C T .. CD a = m y CO O =m = 2 m W y O ?i Q C d cn O M � q N: n CO R o � x 41 b -X � 7� �, o a� /t" " y 0 o ,� to M O CL X a O O C �T y CD O' p CLcaN W y d d ; Q ��: yco N O 1 = m O CD O n ...r O CD O � 3 CD CD m CD m moCD: m m CL nC.) CA = m z 0 H 0 9 � X.. n. � r-ooyy N cn O M � q b 0 R o � x 41 b -X � 7� �, o a� /t" " y 0 o ,� to M O n p X a O � y CD O O CL ol C CD ►y The Commonwealth of Massachusetts Department of Industrial Accidents 92. Office of Investigations 600 Washington Street .Boston, MA 02111 www.mass.gov/dia ' Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): L[>r aS Address: City/State/Zip:N a r-4-/4 Wnd)oCrx a M'� Phone.#: 9 7 f- �7 - Type of project (required);, 6. ❑ New construction 7. [9 -remodeling 8. ❑ Demolition 9. ❑ Building. addition 10.❑ Electrical repairs or additions 11.0 Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and thein hire outside contractors must submit a new affidavit indicating such. !Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub-contractorshave employees, they must provide their workers' comp, policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: G-"cto ,�,d _P_ VL S G Policy # or Self -ins. Lic. M, L rul 0L. '3 ir Z S— Expiration Date: a` � %- Q Job Site Address: D"- City/State/Zip: )jo7 yt /,V G,, pt-, 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 of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify under the pains •and pen es ofperjury that the information provided above is true and correct one #: '7 f G&--7 Officiatuse only. Do not write in this area, City or Town or town official Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 6, Other Contact Person: 4. Electrical Inspector 5. Plumbing Inspector Phone #: Are ayou an employer? Cheek the appropriate box: 1. [3? -am a employer with ' 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2.fFr-am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp• insurance.$ required.] 5. ❑ We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their . myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' comp. insurance reouired.l Type of project (required);, 6. ❑ New construction 7. [9 -remodeling 8. ❑ Demolition 9. ❑ Building. addition 10.❑ Electrical repairs or additions 11.0 Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and thein hire outside contractors must submit a new affidavit indicating such. !Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub-contractorshave employees, they must provide their workers' comp, policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: G-"cto ,�,d _P_ VL S G Policy # or Self -ins. Lic. M, L rul 0L. '3 ir Z S— Expiration Date: a` � %- Q Job Site Address: D"- City/State/Zip: )jo7 yt /,V G,, pt-, 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 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 under the pains •and pen es ofperjury that the information provided above is true and correct one #: '7 f G&--7 Officiatuse only. Do not write in this area, City or Town or town official Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 6, Other Contact Person: 4. Electrical Inspector 5. Plumbing Inspector Phone #: 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." r 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, 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 Iicense or permit to,bperate>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 162, §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 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, 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 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 youare 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 fill in the permit/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 "Job 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 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 Ofee of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-44300 ext.40,6 or 1-877-MASSAFE ` Fax # 617-727-7749 Revised 11-X22-06 www.mass-govldia CERTIFICATE HOLDER CANCELLATION NORTHI3 SHOULD ANY OF THE ABOVE DE5CRI1 ' M POLICIES BE CANCELLED 9EFOP.E THE: EXPIRATION DATE THEREOF, THE ISSUING INSURE WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDEF NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Town of North tOVEr IMPOSE NO OBLIGATION OR LIABIUTI ]F ANY KIND UPOIJ THE INSURER, ITS AGENTS OR 384 Osgood street North Andover MA 01845 REPRESENTATIVES. AUTHOREbENTATI K :4444 7$CORD 25 (2001108) 0 ACORD CORPORATION CERTIFICATE Or LIABILITY INSURANCE OP ID�DATE(MMIDOfYYTY)LEVIS10/25f07 ,ACORN PRODUCER THIS CERTIFICATE IS ISSUE)] AS A MATTER OF INFORMATION ONLY AND CONFERS NO RI: )HTS UPON THE CERTIFICATE Michaud, Rowe And Rusaak Ins. HOLDER. THIS CERTIFICATI : DOES NOT AMEND, EXTEND OR 198 Massachusetts Ave ALTER THE COVERAGE AFI ORDED BY THE POLICIES BELOW, North Andover MA 01845 Phone: 978 668 8829 Fax: 978 557 2130 INSURERS AFFORDING COVE RAGE NAIC # II`{SURID —� INSURER A' Prrferxed Nutual Sn: i Co_ 15024 _ _ INSURER E: Guard Insuxan ,e Group Levis Cevis es Inc. INSURER Safety Insura :.ce Co an 33fi1B Joseph LY__ Levis 150 Pleasant Street INSURER D: North .Andover MA 01845 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PE - :IOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS : ERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCI I)SIONS AND CONDITIONS OF SUCH POLICIES. AGC3REGATE LIMITS SHOWN MAY HAVE BEEN DEDUCED BY PAID CLAIMS. INSA --- PdQt7FFFE`G'f19E'F' AFIi1N — LTR INSR TYPE: OF INSURANCE POLICY NUMBER DATE MDAMUM i DATE MHUOaV LIMITS GENERAL LIABILITY ` V 'H OCCURRENCE $ 1000000 -M,,R.LY 1 C-RffNTE- A X I COMMEItC,ALGENERAL LIA&ILITY CPP0100589059 10/26/07 10/26/08 PF 11.18ESIEZOaurena) $50000 CLAIMS MADE [—xi OCCUR MI II EXP IAny ane person) 5 5000 PE ISONAL&ADV INJURY j$1000000 _ GI'JERALA(3GREGAi� j S 2000000 GEHL AGGREGATE LIMIT APPLIES PSR: PI )DUCTS - COMP/OP AGG 151000060 X POLICY r I j� I j LCC j — - AUTOMOBILE LIABILITY McINFM SINGLE LWIT C ANY. AUTO 821254 01/01/07 1 01/01/08 Ltcl: eccidord) AI -L CWNED AUTOS R .OILY INJURY $ 500000 SCF:EOLLED ALIrOS I (F r res—) X ti;RED AUTOr I 8 :OIL' INJURY $ 500000 ` X NON-0VN:3i j ALTOS i _, I r,cPrrDAMAGE s 250000 (1 rocc;dena I GARAGE LIABILITY I TO 0*4LY- E4 AC ---ENT S �A ANY AUTO C HER THAN EA ACC i S 1 ITC ONLY; AGG S I EXCESSJUM13RLILLA L ABIUTYIiII I -'CH GCGJREE RENC DCCUR CLAIMS MAGE 1 / 3REGATE L OE00CTB LE IS - � � 4_7ENT10N S I 5 WORKERS COMPENSATION AND I TORY LIMITS ER EMPLOYERS' LIAEIUTY -I 8 ANY PROPRIEORIPAerfNER.�.ECLMVE! LEWCS03625 02/27/07 02/27/08 L, 1+CHACCOENT I s 100000 0FRCERA4FMBER r�C.LUDEQ? L. usE.AsE. E-A E-LOYEt S 100000 If yes, deswibe under - -IRE&IAL PROVaONS �e!ew L. DISEASE - POLICY LIMIT j S 500000 fOTHER I . I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I OCLUSION —ADDED BY ENOORSEMCNi r SPECIAL PROIAIM S Residential Construction and Remodeling, Offices Bldg Re=deling- CERTIFICATE HOLDER CANCELLATION NORTHI3 SHOULD ANY OF THE ABOVE DE5CRI1 ' M POLICIES BE CANCELLED 9EFOP.E THE: EXPIRATION DATE THEREOF, THE ISSUING INSURE WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDEF NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Town of North tOVEr IMPOSE NO OBLIGATION OR LIABIUTI ]F ANY KIND UPOIJ THE INSURER, ITS AGENTS OR 384 Osgood street North Andover MA 01845 REPRESENTATIVES. AUTHOREbENTATI K :4444 7$CORD 25 (2001108) 0 ACORD CORPORATION 91te-� �;� Board of Building Regulati ns and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement'.Coltractor Registration Registration: 103772 I y` _f Type: Individual , - i" Expiration: 7/9/2008 JOSEPH G. LEVIS l l ` JOSEPH LEVIS 160 PLEASANT STREET = NORTH ANDOVER, MA 01845 - t Update Address and return card. Mark reason for change. DPS -CAI ti 50M-05/06-PC8490 Address E] Renewal 0 Employment ❑ Lost Card ✓1. �anvr wouoeall/ o� /l�cravac/aueetta Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR /e) 03772 Ex ,p ratio '=7/9/,2008 {= T: e: ;,Individual I JOSEPH G. LEVIS JOSEPH LEVIS 160 PLEASANT STREET;.`._:'9 NORTH ANDOVER, MA 01845 Deputy Administrator License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rnt 1301 Boston, Ma. 02108 Not valid w' to gnature J� Board of Building Regulatio s and Standards ti Construction Supervisor License License: CS 30651 Expiration: 1/7/2010 Tr# 11968 Restriction 00 JOSEPH G LEVISz; 160 PLEASANT SV N ANDOVER, MA 01845 Commissioner LEVIS COMPANIES, INC. General Contracting "Residential & Commercial" PO Box 952 Lawrence, MA 01842 levisco@verizon.net (978) 687-2783 OFFICE (978) 687-3042 FAX TO: Richard Kates 358 Chestnut Hill Ave Brighton MA 02135 We hereby submit specifications and estimates for: Install six new interior door units Install 1 new vinyl window first floor Install new VCT tile first floor Install new carpets for second floor and stairway Install new 1x5 trim for windows and baseboard Paint apartment complete two coats Replace six feet of kitchen Cabinets p�opo��a0 Page 1 of 2 225 PHONE DATE 2/12/2008 )B NAME / LOCATION 36 East Water Street North Andover MA 01845 JOB NUMBER JOB PHONE We Propose hereby to furnish material and labor — complete in accordance with the above specifications, for the sum of: Cont' d I n Q U C'& 'A lr � � dollars ($ r Poo c ). Payment to be madeasfollows: Th rye f Rv�.S� rot ��i�dr �P�ioSl� �� l�o N C`Gt P ��lo vt �d Ci -4 All material is guaranteed to be as specified. All work to be completed in a professional manner according to standard practices. Any alteration or deviation from above specifications Authorized involving extra costs will be executed only upon written orders, and will become an extra Signature charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado, and other necessary insurance. Our N . his proposal may be workers are fully covered by Worker's Compensation insurance. withdrawn by us if not accepted within Acceptance Of Proposal—The above prices, specifications and con- ditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Signature (r Date of Acceptance: Signature PRODUCT 13128M USE WITH 771 ENVELOPE NEBS To Reorder. 1-800-225-6380 or www.nebs.cofTl PRINTED IN U.S.A. B, 'W3 14 days.