Loading...
HomeMy WebLinkAboutBuilding Permit #726-13 - 36 EMPIRE DRIVE 5/3/2013TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: jam? Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page f LOCATION+ ,r 'Pnnta� PROP,ERTKY�QWNER'.''�_ Print. 100, Year,Old'Strucfure .yes, •no 1/l ZONLNGiDISTRIC,T !Historic�bis t"rict, yes no`. MAP,NO:_ PARCEL , ,. <:Machine�ShoprVillage .yes :riot,. TYPE OF IMPROVEMENT PROPOSED USE Non- Residential Residential ❑ New Building ❑ One family ❑ Two or more family ❑ Industrial ❑ Addition No. of units: ❑ Commercial Alteration ❑ Repair, replacement ❑ Assessor Bldg❑Others: y ❑ Demolition ❑ Other p'Floodplain ❑ Wetland s WatershedDistnct:. .. �.Septicr .�We�l OF WORK TO BE PERFORMED: DESCRIPTION Identification Please Type or Print Clearly) OWNER: N one: Z1� 28�-g6 f Addressf�2�t�� �2,11 yA C :CONTRACTOR Name: r�X Phone' �1 7 Address: �. / 7V Staperylsor's Construction License Exp: Date:` Exp. Dater Home,lmprovement License: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ �. /00 FEE: $ 2�Z-Da Check No.: t Receipt No.: 2—( +� — NOTE: Persons contracting w't re s contractors do not have access to the guaranty fund Signature of contractor Signature of A ent/Nvhe' r g n Stamped Plans Plans Submitted ❑ Plans Waived ❑ Certified Plot Pla❑ Location �0 L ry.-, P k L- e� -1��A a R— No.-77(9— t-�> Date Ls Check # 2 / (�t 26348 TOWN OF NORTH ANDOVER Certificate of Occupancy $— Building/Frame Permit Fee $-2.2 Foundation Permit Fee Other Permit Fee TOTAL $ 'Building inspector 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 PLANNING & DEVELOPMENT COMMENTS DATE REJECTED 0 DATE APPROVED CONSERVATION Reviewed on Signature COMMENTS �MTE:;ALTH "Reviewed on Signafure N -jMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes-.- Planning es__Planning Board Decision: Comments Conservation Decision: Comm tWater & Severer COMGGti®n Driveway Permit IDPW Town Engineer: Signature: a Located 384 Osgood Street FIRE DEPRTMfT -Temp Dumpster on site yeas no Located at'l24 MainStreet Fire Depamert 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 locations, mast or service drop requires approval of Electrical Inspector yes No ®ANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A "F and G min.$100-$1000 fine )oc.Building Permit Revised 2010 Building Department The folowing 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 10TE: 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 a 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 mIOTE: 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 a 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 a Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products gOTE: 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 apUral period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording Ynust be submitted with the building application Doc: Doc.Builfiing Permit Revised 2012 Enter construction cost for fee cal - North Andover Fee Cakulation Construction Cost 1%100.00 m $ - $ 229.20 Plumbing Fee $ 28.65 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 28.65 Total fees collected $ 386.50 36 Empire Drive 726-13 on 5/3/2013 Add bath, 3 closets, drywall, carpet basement 0 tAIII-I 6 LLA x U O o o m L O O LL E .a+ N U a Al (n a z Z m C O a' "6 7 O LL L � O d' C L U C LL O Wa z C7 Z m i d L 7 O 1' C LL a z Q u o—c G W W L � O LL' U N VI C LL oc a Z iuin O O K C . LL z 2 a a o w LL N 7 m O z +' ++ N a+ N O E h 0 cc cc o c ;c :1 U L N E am h — � c � ►1J 0 L dCLCc 3 CD o C CD o N v' .� O�V= N 0 •� E�� L c 0 a d z CL _ •� y o 0 CCL W L cc 0M Q L L c rL ~ N .V m N W = -0 .. O O LU I--- U) cL= M.2 V 0 W 0 d � ` V Q 0 _� a, N 0 > 4- C 2 o o C O H .c aoU F. Z m co z cnW CL W H W CL O LU Z z o m C0 N z V I.L N cn W Z I W O O O Z C W Q •E O v D O m O CL Cl- m am Q C4 r— O t a �v� c� 0-0 _z a O v � cc C cc CL N_ D "g, a ce 0 0 J LL Z LL z LL coQ v .6 -AL Z w o ¢ > w O ZLL, W y 0 O w ZLU W z V W d 2 DI O co w Ir Ix ¢opo CL co U cnZ c� ui 2 U H 2 N K w 4h6 LL LP 6 Z K 4l Z r � N fW/l U 3 � � o 5 a o � \ � z a �N 3 a z� vaav un in k.9 W.00 Gerald A. Brown Inspector of Buildings TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, -Suite 2-36 North Andover, Massachusetts 01845 Telephone (978) 688-9545 Fax (978) 688-9542 HOMEOWNER•LICENSE EXEMPTION BUJDING PERMIT APPLICATION Please print DATE: 5 3 JOB LOCATION: Number 5irdetAddress Map/Lot HOMEOWNER Name Home Phone Work Phone PRESENT MAILING ADDRESS —& f;01214� ©try 5 C" -+moi To,:m CtatP . Zip Code The current exemption for "homeowners" was extended to kiclude owner -occupied dwellings to two units -or less anrl to allow such homeoti;i- ,i ers to engage an individual -for hire who does not possess a license, provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s) who Qwns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two farm- ly structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliances with the State Building Code and other Applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Forth Andover Building Department minimum inspection procedures and require s ad tha e/ e will requirements, comply with said procedures and HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530~ + HEALTH 688-9540 PLANNING 688-9535 The Commonwealth of Massachusetts - Department of Industrigl Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: guilders/Contractors/Electricians/Plumbers Applicant Information Please Print Le0bly Name (Business/OrganizatiorAndividual): Address: City/Stat e/Zip:Vhlll/ G 1��� Phone #: i% 909 &476' Are you an employer? Check the appropriate box: Type of project (required): LK I am a employer with q 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner - have hired the sub -contractors listed on the attached sheet. T 7. Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance.9 5. El We are a corporation and its ❑Building addition [No workers' comp. insurance required.] officers have exercised their 10.❑ Electrical repairs or additions 3111 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' 13. ❑ Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they Lire 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. lam an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. , / / Insurance Company Name: L1�t1C� 41[ AVe V,4 L Policy # or Self -ins. Lic. #: SCA %li `j l-� Expiration Date: 16'2-.5 — �3 Job Site Address: 'At2we 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 requiredunder 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 cert rider thep*s and penalties ofperjury that the information provided above is true and correct. jy & S"76 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License S' Z-/,7 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 #: J 1 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." 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 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 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/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 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 burn 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 Commonmalth of MassachvsPtls Department of Indusbial Accidents. Office of Iuyestigatitons 600 Washington Street Boston, MA 02111 TeX, # 617-727-4900 ext 406 or 1-877,MASSAFE Revised 5-26-05 Fax # 617-727-7741 V UCFM MACO trnlnf'4io - NELSON CONTRACTING 978 374 6153 p.1 AC084D% CERTIFICATE OF LIABILITY INSURANCE E., —OUCER (970) 745-6464 02/2013 THIS CERTIFICATE 19 ISSUED AS A MATTER OF INFORMATION Rose Insurance ONLY ANb CONFERS NO RIGHTS UPON THF CERTIFICATE 66 Loring Avenue NOILOER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR TER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.C. Box 950 Salem MA 01970- INSURERS AFFORDING OOVERAOE NAIC 4 MUM PAURERAXTIC.iA NATION" R. laelson Painting INSwMM.14erc:harts ' 500 Nater street eA - IMOLMR Ii�►verlLill MA 01832- IHsu o: INeURER r:, CAYFR�GFS i 13 OES THE POLICIES OF INSURANCE USTED BELOW HAYS BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITIlSTANDIING ANY REQUIREMENT. TERM OR CONDITION OP ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS nF surw Orta Ir—v 8LY'.RFCJTF I II•rTQ CiarllHs,i iiev ue.Ie ecru w.........—......_.— 'RINSR TYPE OF DI MANCE FOLICYNUMMR. POLICY I M . PI RT �OJNOgTjOn . ! 6E•IER•�L UAlLAry LIMITS X £ACM oCCURpFNCE • 1,000,000 tOENEAALWBILITY 1`N O�D.C9 • 50,000 CLAIMS MADE OCCUR 4506060 02/3.1/2013 02/11/2014 MEPF,XP lAeyaaap a,,) 10 1,000 e ADV INJURr 11 1,000,000 GENI'L AGGREGATE UMT A. -PLIES PER; / GENERAL AGGREGATE Is 2,000,000 CY " _PRODUCTS - CO_MP/OPAGG • – 2,000,000 Loc / / / / AVTOIMMLE tIAbRM ! ANYAVTO COMBINED SING:: LIMIT (Ea moddenq ALL ONNCD' AUTOS BODILY INJURY HIREDAUTUS, / / NON-0*JWD AUTD6 60DEYINJURY (ply actlawl 1 PROPERTV DAMAG9 IFfl,wCo rIL) GARAGE LIABILITY ANY AUTO / r AUTO OM y • EA ACCIDENT N / / vTIaFR THAN -A ACC • AUTOONLY; 0RE66AIMORCLIAI]AYUTy / / AG 0 �l DCCUA CLAIMS MADE E(lCN OCCu�EIE Net GREGAT • _ 06DUCTIOLG / / / / --- -- N RETENTION I I EMPLD�� AIR L wC1►909B313 10/05/2012 10/05/2013 7� H X r�o& AIMRBI °Eft p 6NY PROCRIGTOR/f°ARTNliq/EXEC(JRVE OFF10Ewn►IEMB17t OUCUlOEC7 EL. UCH ACCIDENT 0 100,000 T 'RbO` sPEpAI new / / / / E.L. DISEAaE . FA EMPLOYEE c 100,000 OTHER EL. r."8 FA -POLICYLWAT 500 , 000 / / / / 1 374-6153 MR. MATT COLLAR 36 FmIRE DRIVE CROVRSEMENTI3PECIALPROVISION3 SNOULD ANY OF TUNE ABOVE; DE9cmew POUCIE3 BE CANCELLED 6EFORE TME El"RAYIOM DATE YMIZAROF, THE MUM INSURER WILL DNOCAVOR TO AMAIN, 30 DAYS will!" N NOTICE TO THE CERTIFICATE HMMR NAMPD TO THE LEFT, BUT FAILURE TO DO so SHALL "POSE NO OBLIGATION OR LW6ULRY Or ANY IOND UPON TME mJxrrL ANI)C1VlTiR MA 0),845–r CORD 25 (2001/08) 190251olm-oI A ACORD CORPORATION I 99 pam7012 NELSON CONTRACTING 978 374 6153 p.1 1. BUldhnsulate 2x4 walls at approved locations (taped on floor for viewng) 2. Build closets at approved bcations: A. At furnace and back wad. B. At water heater and side wad. C. Under steps. 3. Frame in ciekx#sotfits. 4. install healinglac ducts at approved locations. 5. Install electric outlets, switches, recessed lights and cable wiring at approved locations. 6. Instal;- tape - finish drywall on walls, cielings - interior of closet wads not included, 7. Install doors - trim - baseboard 8. Caulk - prime - finish all ceilings, walls, doors and trim. 9. Prep floor and the mud room area. 10. Design - build shoe storage bench in mud room. 11. install all 36` shower complete, toilet complete and complete vanity. Ceifng vent included. 12. The bathroom floor. 13. Carpet steps and total floor - minus mud room, closets and bathroom. Carpet allowance os $20 per yard including pad. 14. All materials - labor- insurances - paint all included.