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Home My WebLink AboutBuilding Permit #56 - 42 SPRING HILL ROAD 7/13/2010 BUILDING PERMIT o� "°pT" q 2 46tt ...ti6*6~0 TOWN OF NORTH ANDOVER _ APPLICATION FOR PLAN EXAMINATION p Permit NO: Date Received Date Issued: ` �gSSACHUS IMPORTANT:Applicant must complete all items on this page LOCATION 4- i/Vlq ' PROPERTY OWNER_ S+4�., Cir Print MAP 21 Ob-10-1—PARCEL: ZONING DISTRICT; Historic District yes ae— Machine Shop Village yes- aam. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ne ami Addition Two or more family .Industrial No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: 1 Identification Please Type or Print Clearly) OWNER: Name: ^J e YA. Phone: 90 7 0115-- Address: 1► >^Address: CONTRACTOR Name: ,,., -e 4-rA Phone: Address: A 4P l-P,tot,) S' Supervisor's Construction License: y / <1 _Exp. Date--(0/ ` -o 1: lIJ Home Improvement-License: 17� 0)_ � Exp. Date: � / 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: $_ I � (�, FEE: $/-j Check No.: L-q Receipt No.: 2 3 69 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner §Jgnature of contractor "" 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 CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature f COMMENTS a Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/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 I 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.$100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date i Doc.Building Permit Revised 2010 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 NOTE: 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).- Li pplicable)_❑ 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) ❑ 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 NOTE: All dumpster permits require sign off from Fire DepartmentP rior 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 I j Doe:Building Permit Revised 2008 I __ ORT#q TO" of Andover No. 05(o _ A K V . lover, 1Vlass., 1 • y COCHICHEWICK �� %p ADRATE D P, C) S V BOARD OF HEALTH Food/Kitchen Septic System .PERMIT T D BUILDING INSPECTOR THIS CERTIFIES THAT ! 1!.�./ .�i►.�.. .* .................................................. Foundation Ahas permission to erect .......... ......... buildings on �2 .vC..... .•.......... Rough ....... � �J v 6"N=000 Chimney to be occupied.as....... "rte...... ... 1. ........ .1�►.. ...........r.....�I�.......�........................... provided that the person accepting this permit shall in every respect conform to the tbrms of the application on file in Final 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 CONSTRUC S ARTS Rough .. ..... ...... ................... . Service ........ ... .. B SPECTOR Final Occupancy Permit Required to Occicpy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. Massachusetts - Department of Public SafetN Bo.u`d of Buildin!I Re!�ulations and Standards ConstructiodSupervisor License License: CS 54718 JAMES.M TESTA 5 APPLETON ST ik N ANDOVER, MA 01845 Expiration: 6/8/2012 Co mmissiuncr Tr#: 29825 Office of j Consumer Affairs HOMEIMPROVEMENT &Business Regulation ! Registration. 120 CONTRACTOR Expira296 tE%n_— 1A9/201 Typei. '' -la_i dual l Y,a T 290924 � TESTA BUILDING',r j REMODELING JAMES TESTA'..` • _ ` = I 5 APPLETONh• STBEET I N.ANDOVER,MA z �—•¢_ 01845 j Undersecretary � NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: Y-.)- J-c; r �) i f is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 1 OA. The debris will be disposed of in: (Location of Facility) S nature of Permit Applicant / 3 10 Date The Commonwe¢lth of Alassachusetts Department o f Industrial_accidents Office Of rnresligations ..600 iPashington Street 'Ut Boston, MA 02111 ' 'Orkers' Compensation Insurance Affidavit:masse ov/din Builders/Contractors/Electricians/plumbers Au licant Information PIease Print Le-o-oh, Name (Busine-WOTanization/Individual):"re 5+4 1 de Address: ;� l City/State/Zip: A) i� f J.�•- OA 0 12S b 3.S Are you an employer?Check the appropriate boa: 1•❑ I am a employer with 4. ❑ I am a Type of project(required): 11oYees(full and/or art- ' * b�e�contractor and I 2.L�I _ P fie) have wed 6• ❑Nea construction I am a sole the sub-contractors proprietor or partner- listed on the attached sheet I 7. Remodeling ship and have no employees These suU-contras working for me in an c aci tors have 8. ❑ Y capacity. workers' comp.insurance. Demolition e workers' comp: insurance 5. ❑ We are a c 9. ❑Building addition required.] orporation and its Officers have exercised their 1Q❑Electrical 3•❑.I am a homeowner doing all work right t of ��or additions Myself. [No workers'co exemption per MGL 11.0 plumbing rept or additions insurance c comp. a 152,§1(4),and we have no e required_] t employees. [No workers' 12•❑Roof repairs PomP•insurance required.] 13.❑Other `-at,=^plic:ut that ch:.�:box. , m,�c , 8.9G 211:UCr ECC 3ecf2Q_^t2~rrJA':.aQH^.^. T.^.«A'QI1:wS'cOmj.'•+..`—,ari��i'��:.�C,• 1QF1. Homeowne2s who submit this affidavit iadicafirtg thee caLm d 'doing , Contractors that check this box must attach-ed an wort and inm`hirt outside cua^toxs-as""�• , t"n addirtional sheet showing the on came of the s,+tt� .. :'workers,om''�da�'it indicating such. am an em I u w—�a and their -MP-Pohc,infer on. P�J'�that is psovi�fing workers'compensation insurance or information. f my emP10yees. Below is 'the o P �J andjob site Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: Attach a copy of the workers'compensation policy declaration. aae sho CRS/S� /Zip: Failure to secure coverage as required under Section 25A ofM p ( �the policy number and expiration date). fine up to$1,500.00 and/or one-year imprisonmen as well as Glc. 152 can lead to the imposition of criminal Of up to$250.00 a da a t' penalties of a Y gainst the violator. Be advised that a co Penalties m the form of a STOP WORK ORDER and a fine Investigations of the DIA for insurance coverage verification. PY of this statement may be forwarded to the Office of Ido hereby c or the pains and Penalties of perjury th4rt the information f maiion provided above is true and correct Signature: --._- Phone# Official use only. Do not write in this area, to be co mpletedb , J cujor town ofjgciaL City or Town: Issuing Authority(circle one): Permitucense# " Board of Health 2.Building Department 3. City/Town Clerk 6. Other 4.Electrical Inspector S.PIumbiap b Inspector Contact Person: Phone#: Information an- d Instructions Massachusetts General Laws chapter 152 requires all employs to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every pir--.rson in the service of another under any contrast 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 t3ae legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association ax-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 maintemance,construction or repair work on such dwelling house or on the grounds or budding appurtenant thereto shall not be:cause 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 comonpliance 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 contr=for the.performance of public work un-Itil acceptable evidence of compliance with the;,, ,,me 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 certificates)of insurance. Limited Liability Companies(II-q or Limited Lmab�itypartnerships(LLP)with no employees other than the members or partners,are not required to carry workers'comp Cnsation 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 r�-ned to the city or town that the application for theprtrrmft or License is being requested,not the.Department of Industrial Accidents. Should you have any questions regw*i:Prg the law or if you are required to obtain a wort ers' compensation policy,please call the Department az the number listed below. Self-insured companies should enter 9reir self-insurance license number on the appropriate lime. City or Town Officlah 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 pmmut/license applications in any given year,need only submit one affidavit indicating cmreat 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 pest 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 ffidavitThe Office ofInvestigations 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..fagmumbez;_._... The Commonwealth_ of Massachusetts Department if Industrial Accidents Office of 1myestigations 600 Washingbn Street Bastin,MLA 02111 Tel. # 617-72.7-4900 ext 4:06 or 1-877-MASSAFE Revised 5-26-05 Fay;#617-727-7749 urwrw-mass.-aov/din. TESTA Building and Remodeling 5 APPLETON STRET NORTH ANDOVER ,MA 01845 Lic. # CS 54718 HIC. # 120296 (978)682 2023 PHONE/ FAX Proposal July 12, 2010 Proposal Submitted To: Grace and Justin Benincasa 42 Spring hill Rd North Andover, MA 01845 JOB : New bath Obtain building permit Complete removal of all demolition and construction materials generated by Testa Building and Remodeling and its subcontractors. Work to be started week of July 12th finished week of August 9th 2010 CONSTRUCTION: Gut bathroom down to the studs and sub floor. Install new cast iron tub and rough the bathroom for plumbing and electrical. Insulate for sound all walls. Install new 1/2 blue board and plaster walls and ceiling . Install undedayment tile the tub walls and the floor. Install new vanity and toilet. Install new shower doors A finance charge of 11/2%per month(18%per year)will apply to all accounts over 30 days past due. In the event collection activity is required the customer shall be responsible for all costs associated With collection,including reasonable attorney's fees. I propose hereby to furnish material and labor complete in accordance with above specifications, for the sum of: $ 12,615.00 Twelve Thousand Six Hundred and Fifteen Dollars One third to start, one third after plaster,final third at completion . Authorized signature i I reserve the right to cancel this contra f�not a epted in 30 days i/ C /� Signatu a Signatu 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance-with the provisions of M.G.L.c.143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.GI c. 166,§32,an electrical permit shall be issued to the person,firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L.' Permits shallbe limited as to the time of ongoing construction activity,and may be-deemed-by the.Inspector_ofWires abandoned-and.irwalid,ifhe—. ._ or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entitystated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this puipose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending"through August 15,2012. Mule 8—Permit/Date Closed: r:�, **Note:Reapply for new permi 0 Permit Extension Act—Permit/Date.Closed: Location J No. S2 Date roRTM TOWN OF NORTH ANDOVER Of "eQ �,ti0 ' Certificate of Occupancy $ ;�s'••° E.� Building/Frame Permit Fee $ /S s�CHU's Foundation Permit Fee $ b- Other Permit Fee $ TOTAL $ Check # 2 3 0 y Building Inspector