Loading...
HomeMy WebLinkAboutBuilding Permit #257-16 - 43 VEST WAY 8/31/2015 BUILDING PERMIT of t►O ", q • eD ib TOWN OF NORTH ANDOVER h 4a APPLICATION FOR PLAN EXAMINATION Permit No#: `,6 Date Received gSSACHus�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION -43 GsT ()JA""/ Print b PROPERTY OWNER n-AhiNa Sno Print 100 Year Structure yes no MAP Dy.& PARCEL:ZONING DISTRICT: Historic District yes. no Machine Shop Village yes: no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 54 One family ❑Addition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic ❑1Nell; ❑`Floodplain Weflantls ❑.1Natershed District; 00 ter/S6vVef —_-_- - - - --- DESCRIPTIONOF WO K TO BE PERFORM D: VCP Gni anom a ' L bN An Identification- Please Type or Print Clearly OWNER: Name: Phone: 9N M Address: (q78 Contractor Name: ' + Phone:T Email: e V3 Address: f\4 Ol Supervisor's Construction License: dyed Exp. Date: a Home Improvement License: I rs-1 Q34 Exp: Date: ISI ARCHITECT/ENGINEER J 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. CPO Total Project Cost: $ � 3 J 7 FEE: $ ` �' f Sew, i Check No.: /7 Receipt No.: 76' NOTE: Persons contracting with unregistered contractors do not have accetL ss t he g anty and -_ _ 1 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 F'OLLO'WING 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 1 . r 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: LocaFIRE DEPARTMEN.T ,Temp umpsteronsife' `yes ' t�d 3n4oOsgoo Osgood Street k 2,e i f L 'y� Located at 124 Main Streets Fire Department sgna ure%date �' 4 � " J.-n.a. .-a�x+� -1.....:....�..«.-,-,- lL...it�,..{.•':.i y-,.s.s,"'"a,.w.._...,+=,x+.}aa� «s�;„n7t'i�sdi.L..,.,._e=„`Jt •~ 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) it I I it i i i ` ® Notified for pickup Call Email Date Time Contact Name 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 OTE: 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) 4, 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 OTE: 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 Doe:Building Permit Revised 2014 11 Location No. �2S Date �l i . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $� " .. Foundation Permit Fee $ f Other Permit Fee $ < ' aTED TOTAL $ k=. Check# A/ ✓ Building Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 28,357.00 m $ - $ 340.28 Plumbing Fee $ 42.54 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 42.54 Total fees collected $ 525.36 43 Vest Way 251-2016 on 8/31/15 two bath remodels � NORTy Toven ofAndover No. Ilk _ uu T �o h ver, Mass, LAKI coc"ICHNWIc« 1• V BOARD OF HEALTH PERMIT T Food/Kitchen Septic System THIS CERTIFIES THAT ....-... ..' ,.,,••Sj BUILDING INSPECTOR has permission to erect .......................... buildings on � �S� e42 Foundation .................................... ........................................ Rough to be occupied as .... ... :`.�/.�.�Gf. ... t ,,,, ,L;,, ( chimney ...... ... .................................................... provided that the person accepting this permit shall in every respect conform to the terms of the application..... on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Final 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 CONSTRUCTION S TS Rough •.•••.••.•••••. Service UILDING INSPECTOR Final 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. COASTAL REMODELIN � �` Page No. of Pages Jin Jaworski Grave land, 834 Main Street � Remodeling Proposal Gland, MA 01 � A ACONTRACTOR LICENSE NO. _ JOB PHONE NO. E �1 �,` _ (978) 372-9862 `., �,. U`t� ��� j� JOB NAME/NO: Submitted To:...............-..........._.................-....... ....---- --- -- ..:.._..._._...._.._:._......_ -- JOB LOCATION f ................... k _.....__..__....._._.............__._....._..__ V t } 3 --- ARCHITECT DATE OF P LAhS PMO DATE APPROXIMATE StARTING DATE APPROXIMATE COMPLETION DATE d-1 fw�lia V6 oc We hereby submit specifications and estimates for. C (.. UI CIS �f 1 n•-� f.Jr f7 n �/q�'7 r� q`K�X �J tr}.. r••" i .�t.�_��_���N_'�'_►�.�(�e~'N_(�1._!I�UvT�_C�-��1:�.�t i l -1�¢'S1il .lUfZrC.'SC �t� '�Ja "'. 1 .ift`)*�:ru _t�3_t C� E w 1' tal f�i. ``. ....... ---...__..__........._ l This roposal does not include: ^' i.•� 1 .�:'.. f..., f.n-C^ "i t�f 0 �'''..i — mac. ~%'s, a^n ....... U � `- �J �''• vJ t1�t Atm C:.'�tl11P, 2i,0Ce' e)y<)w czC All material is guaranteed to be asspecified.All work to be com- pleted pleted in a workmanlike manner according to standard practices. We Propose hereby to fumish material and labor-complete in accordance with Any alteration or deviation from the above specifications involving above specifications,for the sum of: extra costs will be done only upon a written change order.The costs will become an extra charge over and above the estimate.This is to include,but is not limited to,hidden damages that are uncovered inng the course o t j jol?sand additional work local building ins s F All elements of this agreement are contingent upon strikes,accidents dollars($ Lv �. or delays beyond our control.The estimate does not include material Payment to be made as follows:. f price increases,or additional.labor and materials which may be 'SWI_ f -U&l l 8111�ii"AACE�� (—j(X r / required should unforeseen problems arise after the work has started. You,the buyer,may cancel this transactionat any time prior to midnight of the third _t 5t-i business day after the date of this trans- action.Cancellation must be done in writing. _ ` Note:This proposal may be withdrawn !1 by us if not accepted within lJ days. i>. Authorizedsignature Acceptance of Proposal: The above prices,specifications and conditions re satisfactory and are hereby accepted.You are aut orized to do the work as specified.Pay nt ill be mad as a abov . / SignaturSignature Date 7[2L_ / \ Datel �� . Page No. of PageB TO Nut;iii. �. i��►of 1 � modl� = r sad �Z a Submitted \•.-_ --—� CoNriwwmucem .DB NAME/No. To. v JOB LOCATION ARCHrrEa DATE OF PlI.: _ PHONE w DA APPPD)MATE STARTWO DATE APPROJa ,TE Cmfiww ION DATE W sBbrtiRspectff and .for. r .'. 4 : 01 s-°s..iVll.� 1s11 LtiC.t:... f� jdl, .i t..} OV„lid4 �!,f i�;/5.:. L . 5 g� _ �T`�i�'41�rt1,�.��' Q1.J�.� Rl i.i14 c�3 hyo('C6LC.)LA D S v ? O S This Frnposal does not inaude: 11- ro An materiel is guaranteed t6,1*as�edf d Ad.Work to be corn-, plated in a worigrtandlm manner according to standard pracdoes. �U@ PifOp08@ hereby to fumfsh tnaterfAl and tabor- compete in aocordartce with Any atteranon or"deviat(on fr om :above specifications imrolving above for the sum oft extra oosts.wdl be date only,upon a`wrflten;change order.The costs ` vA become an extra charge.ovar anit.abane.Uie'estimate.TMa Is 1,4930 but All siemems Of�agrtaernertt,are con6ngertt upon strikes,accidents _ dollars $ _� a �• ' or delays beyond our control The estimate does not:iridude material Payment to be made as folbm Price increases.or additional labw and materials vrltk9t may be r j requlmd should unforeseen' ems'arise probl atter,Ute:tvork has started. Y Y6%title buyer,ma cancel this tra f r q S`t f e r et any.#iihe'pHor.to midnight of tfle#Mind �'%`�� bu nass day after the dabs of this trans- .action.Canceiistion:musttia done in writlng. r AO �A� ; bei, rw '&-ar � b {Autho�fred stgnaAse by us a eaoePted �y8, ; ACCeptaPtc�Of P1'O�lOSg1 The above prices,specifications and:conditiorts are-sa00acto an a he author#z o:do ftte woifc as s ryy apt •You are peafied.Pa "ikbe mad i ed 1 Date �a `GTb)R The Commonwealth of Massachusetts z . Department of IndusttrialAccidents X Congress Street,Suite 100 Boston,MA 02. 14--2017 www mass gov1dza Workers'Compensation Insurance Affidavit:Builders/ContractorsfElectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUT)KORITY- Applicant Information Please Print Le 'bl`. Name(Business/Organization/Individual): PQM S, 1 .Address: 10 MA)N - City/State/Zip:gg & kit) �a b� Phone ��- Are yon an employer?Checktlie appropriate box: Type of project(required): 1.❑I am a employer with Q. : employees(full and/or part-time).* 7. ❑New construction 2.1I am a sole proprietor or partnership and have no employees working for me in $. El Remo delirig any capacity.[No workers'comp.insurance required] 9. El Demolition 3.F1 I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 []Building addition 4.❑I 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 11.[]Electrical repairs or additions proprietors with no employees. 12..0 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.; ' � 14.0 Other 6.Q We are a corporation and#s of�cers have exercised their right of exemption per MGL c. 152,§1(4),and we have nu employees.[No workers'comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. T homeowners who submit flus affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. rContractors that check this box must-attached 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,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my emplayees.'Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins,Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compepsation•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 flue 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert under ae ains a penalties ofperjury that the information provided/above is true and correct. Si nature: Date: Av-423 q 1 S Phone#: / �� O b 4 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#: 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, e arta xshi association corporation or other Ie al entity,or an two or more P .p> m . g ty9 Y 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 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=contractor(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 maybe submitted to the Department of Industrial Accidents fox 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 ox if you•are regrured 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(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 burn leaves etc)said person is NOT required to complete this affidavit. I ' 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-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia i I� A`ORE® CERTIFICATE OF LIABILITY INSURANCE DATE ) 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(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terns 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 CONTACT Victoria Lowes, CISR NAME: MTM Insurance of Greater Haverhill Inc. PHONE (878)372-1229 ac o:(976)372-1334 229 South Main Street ADRE :vickiel@mtminsure.com INSURER(S)AFFORDING COVERAGE NAIC# Bradford MA 01835 INSURER A:Safety Insurance INSURED INSURER 8: James Jaworski, DBA: Costal Remodeling INSURERC: 70 Main Street INSURER D: INSURER E: Groveland MA 01834 INSURER F: COVERAGES CERTIFICATE NUMBER:15-16 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. ILTR TYPE OF INSURANCE DDL B POLICY NUMBER MMMIIDD EFF MPMIDD EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TU X COMMERCIAL GENERAL LIABILITY PREMISES EaENTED occurrence $ 100,000 A CLAIMS-MADE Fx_]OCCUR BMA0021707 /6/2015 /8/2016 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea..dent $ BODILY INJURY(Per person) $ A ANY AUTO 250000 ALL OWNED X SCHEDULED 6212962 /15/2015 /15/2016 BODILY INJURY(Per accident) $ 500000 AUTOS AUTOS PROPERTY DAMAGE NON-OWNED ED Peraccident $ 100000 HIRED AUTOS AUTOS Underinsured motorist property $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ _ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIABILITY Y I N R ER ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) This certificate of insurance represents coverage currently in effect and may or may .not be in compliance with any written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Ron & Joanne Smith ACCORDANCE WITH THE POLICY PROVISIONS. 42 Vest Way North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Mike Traverso/SAMANT .v �— ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 oninns)ni Thu Arnpn n2ma anti Inn^2ru ronictaruri mnrke of Ar npn Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervi'-Or 1&2 Family' License: CSFA-045856 James JawonId 70 Main street Groveland MA 01834 VIC Expiration 12/11/2011 Commissioner � �e T{,+omrmrori-rueci.�.ff o' C�/r2rrrasacercae j Office of consumer Affairs&Basiness Regulation ME IMPROVEMENT CONTRACTOR egistration: 151234 Type: xpiration:; 5/2312016 1 DBA COASTAL REMODE>_ING,{ ` ! JAMES JAWORS 11 �}.t,.�I�� 70 MAIN ST GROVELAND,MAO 834 Undersecretary