HomeMy WebLinkAboutBuilding Permit #616-14 - 350 WINTHROP AVENUE 5/1/2018 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received l
Date Issued:
IMPORTANT:Applicant must complete all items on this page
- I
LOCATION c3;0, GU.�i�Ti`�iS ' -
_
PROPERTY OWNER --
u� Print 1007Year Old Structure yes no
MAP NO: µ- PARCEL-: ZONING DISTRICT r Historic District yes no
- - ,Machine. Shop Villageyes no
TYPE OF IMPROVEMENT. PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
El Addition ❑Two or more family% [I Industrial
Alteration No. of units: [5�Commercial
El Repair, replacement ❑Assessory Bldg
❑ Others:
❑ Demolition ❑ Other
'Septic ❑Well p Floodplain ❑.Wetladds ❑ Watershed'®strict
_Water/Sew'er _
DESCRIPTION OF WORK TO BE PERFORMED:
Identification Please Type or Print Clearly)
OWNER: Name: �" Phone:
Address: 0v`F . i d-/,�6 7
CONTRACTOR Name 7:1�,Ao
e i
Address: i ' 'I. /,
Supervisor's Construction License: CS'--c3� f/1:� Exp. Date:
Home l-mprovement License r a _ Exp.- Date;
ARCHITECT/ENGINEER Phone: 024rj
Address: Reg. No.
FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. r
Total Project Cost: $� c� FEE: $ e/O0
i
�/ t No.:
Check No.: Receipt���� p +
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
r -
Signature of Agent/Qwner^' �1/�� 1.c i' S1gature of�confract �F]
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ amped Plans
1
Plans Submitted �. .. Plans Waived-0 .Certified Plot Plan ❑ Stamped Plans ❑
-
TYPE_OF-,-S) WERAGED3§-P-0SAL
Public Sewer Swimming ❑
Tanning/MassageBody Art E]. . g Pools
Well ❑ Tobacco.Sales ❑
ToodPackaging/Sales ❑
Private(septic tank,etc._
❑ Permanent Dumpster on-Site ❑
THE.FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
- -DATE REJECTED: DATEAPPROV
PLANNING & DEVELOPMENT" ❑
COMM 6 / �1 f1low
ENTS r �I /�P/ f le
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
yVater & Sewer ConnectionlSignature& Date Driveway Permit
DPW To`v;2 Engineer: Signature:
Located 384 Osgood Street
FIFE DEPARTtIIt 1�9T Temp Dumpster on site Es r/ no
L6cated-at,,124 Mair Street -. .
Fire Departure►jt signature/date
COMMENTS +'
ILL
Number of Stories: Total square feet of floor area, based on Exterior dimensions._
Total-land area; sq. ft.:
-ELECTRICAL: Movement of Meter location, rust or service drop requires approval of
Electrical Inspector Yes No
DANGER..Z®NE LITERATURE: Yes No
MGL.Chapter-166 Section.21&..F and G min.$100-$1000..fin.e
NOTES and DATA— (For department use
I
4
0 Notified for pickup - Date
i
Doc.Building Permit Revised 2010
1
I r
i
Building Department
--`rhe fol';swing is=a listof-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/Gr 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
9. I
❑ 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) N
❑ 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 1
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
In all cascs if a variance was ors special permit required the Town Clerks office must stamp the decision from the Board of Appeals
P P
that the apu•,al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submAted with the building application
Doc: Doc.Bui?ding Permit Revised 2012
Location 22�`-' / �'uj�G/1
No. 6, Date
Date
• - TOWN OF NORTH ANDOVER
S 46
Certificate of Occupancy $
a.� Building/Frame Permit Fee $ �
J g Foundation Permit Fee $
r
Other Permit Fee $
- r � TOTAL $
Check#
27328 Building Inspector
NORTH
own of
t ndover
0
No. (016 * _ -
i b
Y , h ver, Mass,
coc«Ic«!WIC.1 1'
A�BOO P`y
7 RATED PQ �'��
S V
BOARD OF HEALTH
PERMIT T
Food/Kitchen
�J Septic stem
�
THIS CERTIFIES THAT ..... ................... .............................. :.......................................................... BUILDING INSPECTOR
hasp buildings on 2 ® Foundation
permission to erect .......................... ..gd.: .....�............. ..�a.:...............................
to be occupied as ...:::.. .. s �.7�.� ....,.�,���F ........................................ ch Rough
... ......... Chimney
provided that the person accepting this permit shall in every respect 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 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION ST RTS Rough
Service
.......
...................
.
..... �� BUILDING INSPECTOR Final
GASINSPECTOR
Occupancy Permit Required to Occupy Buildinz 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.
Enter construction cost for fee cal - North Andover Fee Calculation
Construction Cost
$ 54,500.00 m
$ - $ 654.00
Plumbing Fee $ 81.75
Gas Fee 100 comm. $ 100.00
Electrical Fee $ 81.75
Total fees collected $ 917.50
350 Winthrop Avenue
616-14 on 3/3/2014
Tenant Fit Up
COM-COIN CON7RACT'ORS INC.
CONTRACT
SHEET NO. I
DATE:3/4/14
SIJBM1TTED TO: Delta& Delta Realty WORK TO KE. PERFOR—VIED AT:
NAME Steve Cuchii;arti ADDRES 330 Winthr oup Ave.
Tewksbury,Ma.
ADDRESS
DATE OF PLAN'S 9-3-213
i dONE NO.97/$--00-51-0200
''�i_�i_Ci-''e_1Ti+' -Tiida'L1aQ Oi` tovsl�J'
We hereby propose to furnish the materials and perform the labor necessary for the completion of
Demising Wall,Two handicap baths and moving of entrance door.
All materials is guaranteed to be specified,and the abode work to be performed in accordance with the
drawings and specifications submmed for above work and completed in a substantial :workman like manner
for the star of Fifry fowr thousand filve hundred dollars $54,500.00
Any alterations or deviation ti-•^n:above specifier:ors involving ext-a-cost vdil e er._:tted?oni, .up in written and wd!be-come
an extra charge over and above the contract All agreements contingent upon strikes,accidents,or delays beyond our control.
it shall be a default if payments are not made as set forth above and:
A. Contractor may withdraw its men and materials and e�LipinPnt from the cite, Jany pact associated yyitn ciaeh withdrawal and
returnshall be considered an approved extra.
B. All attorneys'fees,expenses and cost of collection shall be added to the contract price.
C. Any delinquent amount shall accrue interest at a rate of 10° o per annum.
Respectfully submitted.
Per Com-Con Contractor's Inc.
r"
ACCEPTANCE OF CONTRACT
The above prices;specifications and conditions are satisfactory and are hereby accepted
You are authorized to do the work.as specified.Payments:will be made as.outlined above.
Tile iuidersigned personan �
ally gua tees the obligations set ,iih above and all niodifcancins thereof:
Date Signature
13 Surrey Lane Pelham, New Hampshire 03076-2516 (603) 893-2002 Fax (603) 890-9110
I
Massachusetts-Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor
License:CS-024116
JOHN P LAROG�fiELLE- '�•� ~
13 SUR]BEY bN o
PELHAM r4# 03076 1 ,
J r
°"�,.(.... 1A, Expiration
Commissioner 0412412014
v
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 ancontract of hire,
,
express or implied,oral or.written.
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 to do maintenance construction p Ys P ersons n or repair work on such dwelling house
or on the rounds,or building mg 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 loeal licensing agency shall withhold the issuance or
renewal of a license orermit too operate a business p p ss 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 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 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 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 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. 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/licens
e 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 pp i ant as proof that a valid affidavit is on file for future permits or licenses. A
new affidavit must be ed
P 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.ofMassachusetts
Department of Industrial Accidents
Office of:Iavestigations
604 Washington Street
Boston,MA 02111
Tel,#617-727-4900 at 406 or 1-877:MASSAFE
Revised 5-26-05 Fax#617-727-7749
ww..mass,gov1dia
The Commonwealth of Massachusetts
Department ofIndustrigl Accidents
Office of Investigations
Uf 600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le0bly
Name(Business/Organization/Individual):
Address:
City/State/Zip: ZZe,,, A4),�z 5a Phone#:
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4.T�'I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
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
working for me in any capacity. workers'comp.insurance. 9. ❑Building addition
[No workers'comp.insurance 5. ElWe are a corporation and its
required.] officers have exercised their 10.El 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 12.❑Roof repairs
insurance required.]t employees.[No workers'
comp.insurance required.] 13.❑Other
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
T Homeowners who submit this affidavit indicating they aie doing all work and then 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 their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:. Z� �
Policy#or Self-ins.Lic.#: /.U/� �'7D�'y D Expiration Date: /
Job Site Address: �D 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 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.
I do hereby certtfy under the pains and penalties of perjury that the information provided above is true and correct.
Si ature: Date:
Phone#: CD3 ��—HOZ
Official use only. Do not write in this area,to be completed by city or town official.
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#:
S DATE ATUDNy"lly)
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9/201/2013
THIS CGMTIFl.CAT'_= M 19RUP _rt. T;4:zz
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OR AawLTl=R THE c-%Q';V=RAG_-_E AF_KURIDEID RY THE POLICIES
NOT AFFiQKLTFv_ELY OR NEGATUVIELY Ar t__ F_—--"D
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RtEPRESENTATNE tvk PRODUCER,AND THE CER TIFICAAIE HOLDEM
I !rnPQRTa%'T- If thn anrtifinatn hnider is in ADD!-, NAL INS-URED,th.-Policypes!rmmt hi,nnriampd. if S: ATION 'c UNWED,g_..Nll�ct to
of tha nrdiw cartoin i7oliriaG rr.—"of..i,.an and urgement. A stalernent on this ce-M-ficate -or-fer righ's-.0 the
f, noiriar in floij nf such enriors—ement(s).
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Pelham, INH 03076
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CERTIFICATE MA" P;: jQS [) �m PERTAIN, THE INSUR M�,E AFFORDED eY THP P01 ln!F:�; [�ESnMRFE) HEREIN IS SUBJECT To rt? THE
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Ciir"H PQIJCIESLIMITS SHOWN MAY HAVE BEEN,REDUCED F,-'PAID-CLAiMS
tINSR r"PE !N'SURANCE POUlcy Nulil"BER
I GENERAL LIABUTY i I EACH OCCURRENIE
7 AMAGE I
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PREMISES(Ea o. —1c AD
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E.L.CiSEASE-EA,�_,NIPLOYE4 S Soo,
�yes de=te Lm�c' rPtateu: tTK & W. E.L.USEASE-PI-111"!IMiT s 500,000l
ES6RIPTI-N,3.-OPErATIC',I"��b-st"',V;
FDESCRIPTION OFOFERWnONS, ;_,ttacu,ACORD iC-1,Addiffim.ma
nnRl Rerks-&-`:s_-`•a; -.mmm- i_-mmm
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F HOLDER GANCELLATIC)"'
277''o)n8 o'-7 5 92 R-HOI.11-0)ANY OF THE AKWE ESP-Ri-BED P-CAUCHES BE C.ANICELLEED-BEFORE
THE EXPURATION DATE THEREOF, NC."CE, UNKIL BE DELIVERED IN
A I'CORDANCE WITH THE POLICY PROVISIONS.
_.�wr_ of Nort", Andover
Peter Murphy
AU`nJ*:_-=_.._c ^--R=0 SENTAME
ivvv 0"Sqood -Street
iiorth Andover, VA 01845
Jim Harr_�.soi,/m-lu
7
ACORD 25(2040105) AHrip.1-ItsFeserved;
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.1= CORD name and logo are registered marks of ACORD
Construction Control Affidavit
Project Location Job No.
Project Name � �
Nature of Project
Architect and/or
Address Aci P-67 Telephone No.
In accordance with Section 110 and 116.0 of the Massachusetts State Building Code,I,
Registration No. being a registered professional engineer/architect hereby certify that I have
prepared or directly supervised the preparation of all design plans,computations and specifications concerning:
Entire Project Architectural Structural
Mechanical Fire Protection Electrical
Other
For the above named project and that,to the best of my knowledge,such plans,computations and specifications meet
the applicable provisions of the Massachusetts State Building Code,all accepted engineering practices and applicable
laws and ordinances for the proposed use and occupancy. I further certify that I shall perform the necessary
professional services and be present on the construction site on a regular basis to determine that the work is proceeding
in accordance with the documents approved for the building permit and shall be responsible for the following as
specified in Section 116.2
1. Review of shop drawings,samples and other submittals of the contractor as required by the construction
contract documents as submitted for building permit,and approval for conformance to the design concept.
2. Review and approval of the quality control procedures for all code-required controlled materials.
3. Special architectural or engineering professional inspection of critical construction components requiring
controlled materials or construction specified in the accepted engineering practice standards listed in
Appendix G. ✓���
Pursuant to Section 116.2.2,I shall submit periodically, daily, we ✓' RE s(specify)progress
Reports together with pertinent comments to the Town of :�k,�Q��GR'q?I Building Department.
z �
C.)
0 7 �y
Signature
T� OF
Subscribed and sworn to before me this *day of /'lt,Q.�'y
My commissi ir�e��ss
of Pu .rS Kl� ivN
+- NOTARY PUBLIC
f p. COMMONWEALTH OF MASSACHUSETTS
Vl MY COMMISSION EXPIRES
A., UST 13, 2015