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HomeMy WebLinkAboutBuilding Permit #565-14 - 43 BRIGHTWOOD AVENUE 1/28/2014 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: v Date Received Date Issued: Lkll -/ PORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Old structure yes no MAP NO: PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yesno TYPE OF IMPROVEMENT. PROPOSED USE Residential Non- Residential ❑ New Building ane family ❑Addition ❑ Two or more family ❑ Industrial iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ❑Well ❑ Floodplain 0 Wetlands ❑ Watershed District El Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: I'y1 Gc�C Sid(o 4 e Q'•b W �r/ �G fir }7✓rJrrc Uri 2 z5Aa,- ^ Identification Please Type or Print Clearly) OWNER: Name: �r,� ,/y de-Ac. Phone: ?_121-k9*c Address: CONTRACTOR Name: � � ei��/%t7 Phone: y _,i'S`� :- Address: / 6,-)-- T 1.1�isburt� M4 C//�l Supervisor's Construction License: CS - Oe 3--/4117 Exp. Date: 'Home Improvement License: aZ Exp. Date: 3 1-2 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ i1q300 0 FEE: $ �3 2-- Check Check No.: Receipt No.: NOTE: .Persons contracting with unregistered contractors do not have access to the uaranty fund SignatureofAgent/Owner Signature of contractor _ Plans Submitted [.j Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans Location 7G1! Inyy No. Date �! . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Z Building/Frame Permit Fee $ Foundation Permit Fee $ ` Other Permit Fee $ TOTAL $ Check# 't 2 7 2 61 Building Inspector Plans Submitted ❑ Plans Waived ❑ '. Certified Plot Plan ❑ Stamped Plans El 'T'YP OF=;SEWERAGEDiSPDSAL" Public Sewer ❑ Tanning/Massage/Body Art ❑. Swimming Pools ❑ Well ❑ Tobacco.Sales ❑ •Food Packaging/Sales ❑ Private(septic tank,etc.. ❑ -Permanent Di`inpster 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 COMMENTS 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'Tow;! Engineer: Signature: Located 384 Osgood Street FIRE DEPARTM;E"Nt Temp Dumpster on site yes no Located*at 124,Mair, Street .-Fire Depa`rtine4t-sign4tute`' re/da 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 chop 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 D Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The fold-3wing'ig°a Litt of the required-forms to be filled out for:the appropriate-permit to-be obtained. Roofivg, Siding, Interior Rehabilitation Permits ❑ ' BlAilding Permit Application ❑ Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or G.S.L. Licenses ❑ Copy of Contract o 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 o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And p p 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 ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract ❑ 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 cas<s.if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apnoal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.sted with the building application Doc: Doc.Buil,ding Permit Revised 2012 A Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 193300.00 m $ - $ 231.60 Plumbing Fee $ 28.95 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 28.95 Total fees collected $ 389.50 43 Brightwood Ave 565-14 on 1/28/14 Bathroom from Storage room on second floor I i i i The Commonwealth of Massachusetts - - Department of Industrigl Accid nts Office of Investigations 600 Washington.Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Orgadzation/Individual): Address: City/State/Zip: Phone#: Are y an employer?Check the appropriate box: Type of project(required): _1. 1 am a employer with�_ 4• El am.a general contractor and I 6. F1 Now construction PIoyees(full and/or part-time).* have hired the sub-contractors 2 1 am a sole proprietor or partner- listed on the attached sheet. �• F1 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. ❑ We are a corporation and its 10.F1 Electrical repairs or additions required.] officers have exercised their 3.❑ X am a homeowner doing all work right of exemption per MGL 11.F1 Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roofrepairs insurance required.]i 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. f'Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation p olicy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL o. 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. f do Hereby cer i n er the pains and penalties to tae information provided above is true and correct. Signature: Phone# 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#: � �10RTF� Town of t : 1, Andover No. 6— : - �o I , ver, Mass, 1 C OC NICMl WICK S u BOARD OF HEALTH Food/Kitchen PERMIT T LD A ' '� ............................................. Septic System THIS CERTIFIES THAT .........�.r!M.11.......0.0J ...................... BUILDING INSPECTOR ............ has permission to erect.......................... buildings ......:.............. Foundation 00 Rough to be occupied as ��ft� ta •.��T.....� -:1�........ � w� ............ 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 3a . PERMIT EXPIRES IN 6 MONTH ELECTRICAL INSPECTOR .. ... UNLESS CONSTRUCTIO T S Rough Service ................. .......... ................................ Fina BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Repuired 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. SEE REVERSE SIDE NORTH Town of tAndover h , ver, Mass, 1 SQA tot Nlt Ml WtC K ORATED 0'P,��y S u BOARD OF HEALTH Food/Kitchen PERMIT T LD A Septic System THIS CERTIFIES THAT Crx ft......�.`�. BUILDING INSPECTOR ......... .............................................................................. has permission to erect buildings on I � , .�, .,,.,,,,, Foundation .......................... .. ... .............. Rough ii /��^� to be occupied as — ! �t�,��.....�/.'1�........ �. . ����� ...... ..................... ........ ......................... 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 MONTHq ELECTRICAL INSPECTOR UNLESS CONSTRUCT0.. T Rough Service ..................... .......................... Fina BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildink 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. SEE REVERSE SIDE Valerio's Nome Remodeling and Construction Specializing In kitchen & bath Renovations Visit us on the www.Valeriosconstruction.com 205 Sladen St. Dracut, MA 01826 Cell # 617-201-0629/Fax# 978-957-7744 January 14 2014 Erin Nadeau 43 Brightwood Ave N.Andover MA 01845 erin.nadeau@gmail.com Storage room to full bathroom and laundry closet ... prepare finished storage area to convert to full bath and laundry closet care will be taken to save wood floors as talked frame in new door way from master bedroom to bathroom near new tub location close/block off old master bedroom closet door to create new laundry, frame new door in bath room side frame a new closet wall in the hallway cut in a new door into the master bedroom supply and install all rough plumbing hot and cold to tub, toilet, sink and laundry area with all drains supply and install new white steel tub and drain supply and install a new white Kolher wellsworth toilet and seat supply and install 2 vents outside for the bath room and dryer, bath exhaust fan supplied by electrician supply and insulate all exterior walls/ceilings as needed with proper R value supply and install all wall board and plaster all smooth where needed supply and install all new doors and knobs closets bath etc. supply and install all finish trim work doors, windows and floor di supply and install double vanity , 2 sinks and faucets medium grade Home depot on the shelve items install home owner supplied washer and dryer install all bath hardware such as toilet paper holder, towel bars, door hocks, supply and install 4 x4" shower area white wall tile and grout tilling in window to make it as water tight as possible all electrical work is being done by homeowners contact not included in this quote. we will work along with him to complete the project with ea e Total for services $ 19300.00 i L*MART . A R AMAY�LOW FRICES."I Directory Services Project Room ©Gni �` IvSG�" C►vh��" ---A Ll y xy C-P,•n NA D E A u �13 sr�qhk Ave Mail Receive Date: 2010-05-24 I i i i i i i i I I I i i i i i I i i i I I I I i i i I I I J I Nc w old, � /{/-,1N • K UPo Uva? t 0-01 8 ArT11 kooly C loaf' Wo4c r t. 0- 1 p� ,►� ej room F6'm NADEAU z13 3r,,hkurvaJ hve, Yor4h Ay7dover Mail Receive Date: 2012-03-03 005UNDEF