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HomeMy WebLinkAboutBuilding Permit #773-2017 - 387 MASSACHUSETTS AVENUE 2/15/2017L LOCATION PROPERTY OWNER) MAP �_PARCE Print Print / 100 Year Structure ZONING DISTRICT: Historic District Machine Shop Village yes Ono yes yes \ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ A ltion ❑ Two or more family ❑ Industrial Alteration No. of units. ❑ Commercial ❑ Repair, replacement-- ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other )] Septic Well: 'F dpp`1Netlands. Watershed ®Istnct DESCRIPTION UI- WUtM I U tst 1-tM1-Urc1wtu: Identification - Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: A Email: ZAIJ M01 4`6/ CIE/ a.1,2 Address: _ fit,-� _ Cf11 C i •• � Supervisor's Construction License: Home Improvement License: IW -4 f SwExp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT. • $92.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ,OON,J$`125.00 PER S.F. Project Cost: $ y � �?0 � • 01z— Total'FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to�the guaranty fund J Plans Submitted 0 Plans Waived El TYPE OF SEWERAGE DISPOSAL Public Sewer Well El Private (septic tank etc. n Certified Plot Plan F1 Stamped Plans 1-1 Tanning/Mas s age/B o dy Art ❑ Swimming Pools ❑ Tobacco Sales El Food packaging/Sales n Permanent Dumpster on Site n THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING& DEVELOPMENT COMMENTS Reviewed On Signature. CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Planning BoaFd Decision: Comm Zoning Decision/receipt submitted yes Conservation Decision: Comments Water & Sewer Connection/Signature Driveway Permit DPW Town Engineer: Signature: PIRV ;7�PWONYMvii # JemPA)urnpsterpnNtp-,Yes L ,beated at,12-4 q41W` -,— .4LV1- intatreet ?,c Tir al[D -epagment-signAture/date 'h COMMENTS' Located 384 Osgood Street ou ov 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 lies No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine Doc.Building Permit Revised 2014 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 TOTE: 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/Cross Section/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 OTE: 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 2012 IECC Energy code Engineering Affidavits for Engineered products 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: Building Permit Revised 2014 Location 6 1 Ave No. � 1-5 - 2 CA Date L It r _- Check 4t 1 -� TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $��'J Foundation Permit Fee $ Other Permit Fee " $ ' TOTAL $ u Q = LL O D cc 0Q m cu u Y \ O LL Nm U Q N p W0 H Z Z O (O -O 7 U- t 0 d' N C E U F LL O H Z l7 Z m J a i 0 c LL N Z J V v J W t O d' U Z — LL W {n Z N C7 L O d' LL z LV cc Q w W LL N E 0 m Z a� v N + N 0 Y O N rmpO N J �m a > MM � L O =N > a .0) 0-0 > _ N Q a = s_ t O O I� O O Z a :-T.o An 3 a> > O = r Q CL CD m .r GO R 0 .r o - N CD o r c = c ~ w O V m O l!JG 'a w O O Li •=• C m C O y � O Z .E O-� Z O Lw • L V d '� a F- C-) (1) O -0CL F icc O Q H t � CLOC> > 5 O /V A J E Z 0 N .CD L CL O V CL V .N O V cc cc U) w L CL W 00 O Q �� CL cm Q i = cac J � O Z CLN _ C C O :Q •� L c m r E SE CL L � o E am 0 0 r rmpO N J �m a > MM � L O =N > a .0) 0-0 > _ N Q a = s_ t O O I� O O Z a :-T.o An 3 a> > O = r Q CL CD m .r GO R 0 .r o - N CD o r c = c ~ w O V m O l!JG 'a w O O Li •=• C m C O y � O Z .E O-� Z O Lw • L V d '� a F- C-) (1) O -0CL F icc O Q H t � CLOC> > 5 O /V A J E Z 0 N .CD L CL O V CL V .N O V cc cc U) w L CL W 00 O Q �� CL cm Q i = cac J � O Z CLN _ Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 253000.00 m $ - $ 300.00 Plumbing Fee $ 37.50 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 37.50 Total fees collected $ 475.00 387 Mass Ave 773-2017 on 2/15/17 Kitchen remodel 365 Saewn S;xest Norih Aii-do 3r, k,1,A 01845 1 *' Ciilll •^•�y v-.�...4.f:rw3 PROPOSAL 171 Proposal Submitted To (� / ZZ Phone Date 17 Address ` ' j2 Job Name ' 1 p Job Location Architect Date of Plans Job Phone we nereby suomit specincations and estimates Tor: { �- ,' - C ' - r i �l - ! - .( of �' � cr' . y. � /' , � J 1 / / • � s`� t � % f_i�s.;- r� �� 3,� / /7 y fi rIf,: ^:, � .lY� �' �. ' .� / T �J� •: ! / r ! WE PROPOSE hereby to furnish material and labor — complete in accordance with specifications below, for the sum of: Payment to be made as follows: All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders, and will become an extra 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 workers are fully covered by Workman's Compensation Insurance. dollars ($ ;? '7— f /" r Cr ). Authorized / Signature Note: This proposal may be withdrawn by us if not accepted within Acceptance of Proposal: The above prices, specifications and conditions are satisfactory and are hereby accepted. ' You are authorized to do the work as specified. Payment will be made as outlined above. Signatureiti Date of Acceptance L Signature days. ank ou — � 24" � pcff; ' � June L. E..`1952'Ddf t c��f�rs:tcrc��ticlla ' nr�r?zra�ttuecS S nlatioa r NZair & 3u5iness Reg I .0 ace of Consume CONTRACTOR i TYp. i - METy aegistration: 18L620 -IndWiduaf a1812V _ DAVID /MORIN iDAVID MORIN - - ;�.:.:c•,��'�:��,. 365 SUTTON ST 1 MA 01845 � Undersecretary } N. ANDOVER, Massachusetts Department of Public Safety rBoard of Building Regulations and Standards -License: CS -040898 Construction Supervisor DAVID M MORIN 365 SUTTON STREET.n � 'y NORTH ANDOVER MA 0184 �A lam- Expiration' Commissioner 0710412017 + The Commonwealth of Massachusetts z . Department of IlndustrialAccidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 ; ,-` www mass govfdia ,y. Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plimbers. TO BE FILED 'WITH THE PERVJJT TNG AUTHORITY. Name (Business/Organization/hdividual): Address: City/State/Zip: _ N Areyou an employer? Check t& ap�xopriatebox: Phone #: 1.Q I am ployerwith .:.. ! employees (full and/or part-time).* am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3-F] I am a homeowner doing all work myself. [No workers' comp. drisuraace required.] ? 4.01 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with— employees. 5. Q I am ageneral contractor and I have hired the sub -contractors listed on the attached sheet. These sub-contractorsliave employees andhave workers' comp. insurance.T 6.0 We are a corporation and ip o£ficers'have exercised their right of 'exemption per MGL c. 152, § 1(4), and we have na. employees. [No workers' comp. insurance require(L] Type of project (xequired): 7.. Q New cozisituction 8. j�'�Remodelirig 9.%❑1 Demolition 10 [] Building addition 11.❑ Electrical repairs oradditions 12: [( Plumbing repairs or additions 13: Roof rep airs 14. Q Other `Any applicant that checko box #1 must also fill out the section below showing theirworkers' compensation policy information. T Homeowners who submit tTvs affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors_ that check this box must•attac1aed an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, ley' must provide their workers' comp. policy number. I aim an employer that ispiovidiilgworaketrsI compensation insurancefor my employees ' Beloip is thepolicy acid job site information. Insurance Company Policy1# or Self -ins. lir,. Expiration Date; Job Site Address: _�S)! M — 'U e, City/State/Zip: A4/� Attach a copy- of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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 tine of up to $250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby ce nder the p ` landpenal ' ofperju.-y that the informationprovidedabove is true and cor; ect signafore: / Date: Phone #: '?) d —Z— Official use only. Do not -write in this area to be completed by city or town off ciaZ City or Town: PermitEicense Issuing Authority' (circle one): i 1. Board of Health 2. Building Department 3. City/Town. Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact 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 bf bnre, 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 commonwealtlq for any applicant who lias 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=contractox(s) 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 - 7industrial 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-iin'sur6d 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 Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-•2017 Tel. # 617-727-4900 ext. 7406 or 1-877•-MA.SSAFE Fax # 617•-727-7749 Revised 02-23-15 www.mass.gov/dia a CERTIFICATE OF LIABILITY INSURANCE Qti;7//2017DmYY1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER PAYCHEX INSURANCE AGENCY, INC. 150 SAWGRASS DRIVE ROCHESTER, NY 14620 CONTACT Paychex Insurance Agency Inc PHONE . 877-266-6850 FAX 585-389-7426 E-MAIL Certs@paychex.com INSURER(S) AFFORDING COVERAGE NAiC III INSURED INSURER A: AmGUARD Insurance Company INSURER B: David M. Morin 365 Sutton Street INSURER C: North Andover, MA 01845 114SURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF 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 OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TR TYPE OF INSURANCE DDL NS UBR POLICY NUMBER POLICY EFF (MM DD POLICY EXP (MMIvpfyml LIMITS �` ENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY �1CL41MSMADEr�OCCUR DA"A"DI 5270 06113/2016 06/13/2017 cnrw occuaocr.lrc , t 1 000 000 DAMAGE TO RENTED S 5Q 000 MED EXP (Any tine person) 4Innnn PERSONAL aADvINJURY EN'LAGGREGATELIMITAPPUESPER: X POLICY = PROJECT= LOC I I x71�nn TTI�n UCTG"""w`^'� rnoouerc-ooNIrvorncc x2,000000 c ($�OMBINED SINGLE LIMIT (Ea awment) i AUTOMOBILE LIABILITY ANY AUTO ALL OWNEDSCHEDULED AUTOS AUTOS BODILY INJURY (Per person) f i AON CAYNED HIRED AUTOS )AUTOS BODILY INJURY (vo. —.Ve.,f) $ PROPERTY DAMAGE �— UMBRELLA UABo(x,UR I EACH OCCURRENCE $ EXCESSUAS CLAIMS -MADE AGGREGATE $ DEO RETENTION S' $ WORKERS COMPENSATION AND EMPLOTERS' LIABILITY - AA'YPROPRIETORIPARTAEfLf7(ECUTIVE OFF-EL'MEMBER EXCLUDED? Y/N (M—dmf Y 1n NH) R aesart4 r I I ed .13P., sapw* OF OPI-7RATIONR bel— /A. E.L. DISEASE - EA EMPLOYEE S EL DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) CERTIFICATE HOLDER TOWNOF NORTH ANDOVER CANCELLATION 0HVVWAAT VtIncAtlVVCUCYLKtlCYrVL1{iltJtlt AnLtLLCVtlCPVltr111GeAn lIVN DATE TNEREDF. NOTICE WILL BE DELIVERED IN ACCOROA�CE WITH THE POLICY ACORD 25 (2010/05) @1988.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD