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HomeMy WebLinkAboutBuilding Permit #596-15 - 40 HITCHING POST ROAD 1/9/2015 V%OT BUILDING PERMIT 0 11 t) 6;9tio TOWN OF NORTH ANDOVER 3� y`''- - a ` .,OAPPLICATION FOR PLAN EXAMINATION O 4� Permit No#: VJ Date Received 3 RA�q.\TED I,PP �SSACHUS�� DateIssued: l IMPORTANT: Applicant must complete all items on this page LOCATION rint PROPERTY OWNER �✓� I— �C S, ,a r < ,i Print 100 Year Structure yes n MAP _PARCE6 ZONING DISTRICT: Historic District yes (SroP Machine Shop Village yes 4up TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building Wbne family ❑Addition ❑ Two or more family ❑ Industrial 4Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer D SC PTION OF WORK TO BE PERFORMED: no 0 d'e� DG CD 0 tOn Identifica�' n- Please Type or Print Clearly OWNER: Name: �Cr xL ('o'S ►t7� �' Phone: 27k-G'g Address: Contractor Name4-;K4 4,rro-o'keXeWhone: 3911 Address: !/ i,TVG Xtle5 T�h S UrPd, /YY� 015179 Supervisor's Construction License: 0 *'-6-7,$ Exp. Date: G- !G Home Improvement License: .2- Exp. Date: 3- .2� lb ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 4-17903- O'u FEE: $ Check No.: 35S--D Receipt No.:C;I& NOTE: Persons contracting with unregistered contractors do not have access to the guara ty nd Signature of Agent/Owner Signature of contractor 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 o Building Permit Application o Workers Comp Affidavit L3 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 o Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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 Li Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o 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:Building Permit Revised 2014 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.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 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. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS b Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments i r Conservation Decision: Comments Water & Sewer ConneCtiion/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS e Location N o� Date t . - TOWN OF NORTH ANDOVER • c�k�"tYTL�,D y . • Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ T Check# " �` ' Building Inspector Office of Consumer Affairs&Business Regulation-Mass.Gov Page 1 of 1 The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) = Consumer Affairs and Business Regulation Home Consumer Rights and Resources Home Improvement Contracting HIC Registration Complaints :r 1 Registration# 142324 Home Improvement Contractor Registrant Wilson Woodworking Registration Home Page Name Timothy Wilson Address 11 Jacques Road City, State Zip Tyngsboro, ma 01879 Expiration Date 03/26/2016 Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fund history. Back To Search ©2012 Commonwealth of Massachusetts. Mass.Gov@ is a registered service mark of the Commonwealth of Massachusetts. http://services.oca.state.ma.us/hic/licdetails.aspx?txtSearchLN=42563 1/9/2015 rvr_e Commonwealth of Massachusetts - - Department of ffid'OtTirtrAccicients Office of Investigations 600 Washington Street Boston,MA 02111 UV www.massgovIdia WQxkexs' Compensationbsurance Affidavit:BuRdexs/ContrcactOrs/Elec xxcxanslPZumb � Please Mit ams(B usiness/Oxganizationlfndividual): W t F •�1 W� �(/� (•V Ut�K' •� � C� . Address: City/State/Zip: ;?(J/-o Phone#• C 7 lv Type o£project(required): Are you an employer?Check the appropriate box: F 1.01 am a employer with4. ❑ 1 am a general contractor and 1 6. Q New cd ction —�� have 3iixed.the sub-contractors employees Gull and/or part time).• hated on the attached sheet.r 7. emodeling 2,[]T am a sole proprietor or parin er ship and` These su -contractors have 8. [[Demolition have no employees working for me in any capacity. wo s'comp.insurance. g, Building addition [No workers'comp.i s1 rano 5• e are;a corporation and its lo.Q Electrical repairs or additions required.] officers have exercised their night of exemption per MGL ll.[]Plumbmgrepairs ox additions 3.El am a homeowner doing all work and we have no 12.Q Roof repairs myself.[No workers' comp. e.152,employees. iusuxancexequired.]? employees.LN'oworkers' 131]Other comp.insurance required.] Any applicant$gat checks box#1 mustalso fill outthe section below showingtheir workers'compensationpolicy information. i Homeowners who submit this affidavit indicatingthey sre doing all and then hire outside contractors mustsubmit a new affidavit indicating such. TContractors that checkthis box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am cars employer that is providing woriters'compensation insurance for my employees: Below is thepoliey and job site information. Insurance Company Name: L�4-i - S,.Q� CIJ 6 C Expiration Date.----, Policy#or Self-ins.Mo. �1 b �L i /StateM /l0- job Site Address: LtO Gl Attach a copy of the workers'comp ensationir olley declaration page(showing the policy number and expiration date). Failure to secure coverage as xequiredundex Section 25A of MGL o.152 can lead to the imposition of criminal penalties of a tins up to$1,500.00 and/or one-year imprisonment,as wellas civilpenalties in the form of a STOP WORSE ORDER and a titre of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office-of Investigations of the DIA for insurance coverage verification. I do hereby certify r die s and alties r nary Mat file information provided alcove is true and correc4 - Date: la, Si ature• Fisons# Official use only. Do not write in this area,to he completed by city or town officiaz City or Town: Permit/License# issuing Authority(circle One): 1.Board.of Health 2.BuildingDepartnoent 3.City/Town Clerk 4.Electrical inspector 5.)?lambing inspector 6.Other 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 orimplied,oral ON written:' An epnploydis defined as"an individual,partnership,association,corporation or other legal entity,or any two ormore of the foregoing engaged in a joint enterprise,and including the legal representatives of a•deceased employer,or the receiver or trastee'of au•fndMdual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not m oro than three apartments and who resides therein,or the occupant of the dwalling 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 becausa of such employment be deemed toba an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shalt withhold the issuance or renewal of a license or permit to op erste 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,MGT:chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract fbr the p erformance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have b een presented to the cQntracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),addmss(es)and phonenumber(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 notrega1redto carry workers'compensation insurance. If anLLC orLLP does have employees,apolicy is required. Be advised that this affidavit-may be submitted to the Department of Industrial Accidents foT conAm ation of insurance coverage. Also be sure to sign and date the affidavit. the affidavit should be returnedto the city or town that the application for thepenmit 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 Departmenthas provided a space at the bottom ofthe 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 pemrit/license number whichwill be used as a reference number. In addition,an applicant that must submitmultiple permit/license applications in any given year,need only submit one aflxdavit indicating current Policy information(if necessary)and under"Job Site Address"the applicant shouldwrite"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. Anew affidavit must be filled out each year.Where ahome 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 NOTrequired to complete this affidavit. The Office of Investigations would like to thankyou in advance for your cooperation and shQuld youhave any questions, please do not hesitate to give us a call. The Department's address,telephone aird fax number: Tho Cotu gonmealth OfYfwsadhwetL Devat(tout QfJAdu a1 Aoldonta Qfee OffAvestigatsim. 600Wasbiugt fxeet }�pdton� ,O�xXX #617-727-49-00 Qat 40,6 or 1-877:UM8,M Revised 5-26-05 Fax 0 617-727-7749 wtM-Mangov/city Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS488573 {C =► TIlMIflTHY J WbN 11 Jacques RoadIt Tyngsboro MA 0 879 ✓..G.. ,11,61 . ,� ��� Expiration Commissioner 06/96/2016 A .4�SC TUISETZ' -� DRIVER'S .,. LICENSE - �OFYq ... fVA ss� ONE 4d HIM0 _ s Y _ •2014;. S5061 8 !0M �.7 , V.,Q9� 0646-1066. Utlslm NONE _7 il.d1010 y J a 11 JACQUES ROAD TYNGSBOROUGH,MA 01879.2429 Enter construction cost for fee cal- North Andover Fee Cakulat%on Construction Cost $ 47,903.00 m $ - $ 574.84 Plumbing Fee $ 71.85 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 71.85 Total fees collected $ 818.55 40 Hitching Post Road 596-15 on 1/9/2015 Remodel Bathroom NORTH Town of �. : : ndover G .. ;` 0 No. h ver, Mass, COCHICORW C" ^,rep S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT �l SSi �'�5 BUILDING INSPECTOR .............. .. ...................................................................................................... �' � Foundation has permission to erect .......................... buildings on Ao...-!..c .!�.. ...... s bAi"PAQ �/ -n � Rough to be occupied as ............... ......!...��!..t��C............................................................... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN "49N TIELECTRICAL INSPECTOR UNLESS CONSTRUC Rough �'w-- Service .............. . ............................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. i Michael 234E Pleasant Street Methuen,MA 01844 PHONE:978.689.4724 FAX:978.945.8808 James KITCHEN AND BATH DESIGN EMAIL: michael@michaeljamesdesign.com WEBSITE:ww%.mid-iaeljaniesdesign.com Design, Inc. I PROPOSAL - MASTER BATH REMODEL I Customer: Cindy and Karl Pessirds Home: 1-978-686-5349 Date: August 20,2014 Pages: 1 of 1 jobsite: 40 Hitching Post Road No.Andover,MA #1 Dunnpster services $ 450.00 #2 Vanity cabinets $ 4,400.00 #3 Vanity countertops $ 1,200.00 #4 Cabinet hardware $ 100.00 #5 Sinks $ 494.00 #6 Faucets $ 834.00 j #7 Shower column with trims and valves $ 1,200.00 #8 Tub $ 3,000.00 #9 Tub filler $ 475.00 #10 Toilet $ 515.00 #11 Glass shower doors $ 2,200.00 #12 Accessories $ 300.00 #1.3 Tile for the floor,shower and tub deck.areas $ 2,720.00 1 #14 Sale Tax $ 1,118.00 #15 Demolition and remodeling work,file work,cabinet installation and $ 28,897.00 carpentry work,plumbing,electrical and painting,building materials, permits,design work and project management. #16 Total $ 47,903.00 #17 Tile work includes:floor,tub deck,shower walls,shower cabbies and seat #18 Plumbing work includes:new copper shower pan,new shut-offs for all fixtures, #19 Electrical includes:outlets to code,a new Fantech exhaust fan with shower light and area vent, i three new 5"recess lights and installation of owner supplied light fixtures #20 Prices do not include:a stearal unit,new window,new bath entry door,mirrors,light.fixtures, body side sprays in the shower or labor for decorative file borders #21 Terms:5% non-refundable deposit due upon the signing of this proposal and mutually agreed upon scheduled payments thereafter. j #22 Signature: Date: ......... ___.. .....— _... _.....-............ _.._...... ........................................._........................._...... . ..... _.. _.._ . ._......................