HomeMy WebLinkAboutBuilding Permit #522 - 44 PLEASANT STREET 1/22/2013TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATIO
Permit NO: Date Received I
Date Issued I nt
IMPORTANT: Applicant must complete all items on this page
PROPOSED USE
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TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
D New Building
0 One family
El Addition
D Two or more family
D Industrial
El Alteration
No. of units:
El Commercial
'Repair, replacement
0 Assessory Bldg
El Others:
11 Demolition
El Other
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DESCRIPTION OF WUKM I U tit 1-tM1-UM1VJt:LJ;
kl lz-�e--Ll 5'— 5401g—
Identification Please Type or Print Clearly)
OWNER: Name: M'chaxt Phone: (V17-3 95
Address: Al
ARdfte
NQJRKACJTJOR09AK
'C "r, s s
on n—g�e�4-OZV�
fiF titer,
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: $ FEE: $ 2-0
Check No.: Receipt No.:
NOTE: Persons contracting W h u e'stere ontractors do not have access to the guaran
%fund
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g 0
Plans Submitted ❑ PI ns Vsive Certified Plot Plan ❑ Stamped Plans
Building Department
The foltowing 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
d Copy of Contract
o 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
❑ Building Permit Application
❑ Certified Surveyed Plot Plan
o Workers Comp Affidavit
❑ 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
Hydraulic Calculations (If Applicable)
o Mass check Energy Compliance Report (If Applicable)
o Engineering Affidavits for Engineered products
40TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
o Building Permit Application
o Certified Proposed Plot Plan
o 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
90TE: 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 submAted with the building application
Doc: Doc.Building Permit Revised 2012
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑
Tanning/Mi assageBody 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
PLANNING & DEVELOPMENT
COMMENTS
DATE REJECTED
L
DATE APPROVED
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
P
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comme
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Tovdp- Engineer: Signature:
Located 384 Osgood Street
*F IRE DEPARTMENT =.Temp Dumpster on site yes:_
no
Located at=124,Mar Street
Fire Deperfinent signature/date
COMMENTS
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Motor location, roast 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
Location .. �..
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Check #ZS.
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date
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To: Mike Suffoletto
Re: 44 Pleasant St. Estimate
1. Remove kitchen cabinets, patch walls as necc., install new cabinets and laminate counter
Install new laminate floor. This includes an allowance of $ 2000 for cabinets, $ 5/sf for flooring
material and $ 200 for counter material. Estimated Cost $ 4890
2. Replace 23 windows with Anderson vinyl replacement units. Estimated Cost $5750
3. Misc; patch/skim master bedroom ceiling, cover skylight at ceiling level only, install 3 %" base in
2 rooms, rehang owner supplied basement door, install new prehung door in living room, patch
1 gable vent with bondo, rehang 1 set exterior stairs, replace 1 exterior stair tread, install new pt
threshold at exterior basement access, rescreen 6 porch screen panels. Estimated cost $1830
1
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JEW Massachusetts - Department of Public Safety
Board of Building Regulations and
Standards
Construction Supervisor
$�
License: CS -031517
Fla
TODD S MAYO -`
69 CONGRESS STREET -1R r!
Amesbury, MA 0013
r -
�.•�w.+ i�/e ar i::
�Xpiration
Commissioner
05/20/2014
North Andover Board of Assessors Public Access
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Page 1 of 1
North Andover of Assessors
roperty Record Card
n1-1 n —0 nA.. --1 ♦ -A__._�
Location: 44 PLEASANT STREET
Owner Name: LOCKWOOD, PAUL N
LAURIE J LOCKWOOD
Owner Address: 44 PLEASANT STREET
City: NORTH ANDOVER State: MA
Zip: 01845
Neighborhood: 5 - 5 Land Area: 10.18
acres
Use Code: 104 -TWO -FAM -RES Total Finished Area:
2454 sqft
ASSESSMENTS CURRENT YEAR PREVIOUS YEAR
Total Value: 276,000 317,900
Building Value: 121,000 160,100
Land Value: 135,000 157,800
Market Land Value: 155,000
Chapter Land Value:
http://csc-ma.us/PROPAPP/display.do?linkld=2253616&town=NandoverPubAcc 1/22/2013
THE
MAIN Policy Number: MPTIO04E
STREET'
AMERICA
GROUP BUSINESSOWNERS COMMON DECLARATIONS
MAIN STREET AMERICA ASSURANCE COMPANY
4601 TOUCHTON ROAD EAST, SUITE 3400, JACKSONVILLE, FL 32245-6000
€tom 1. Named Insured and Mailing Address Agent Name and Address
'DD MAYO WEST NEWBURY INS AGENCY INC
3CONGRESS ST
1R 322 MAIN STREET
2ESBURY MA 01913 W NEWBURY, MA 01985
Agent Phone No. (978) 363-5285
Agent No. 200576
f�2 Policy Period From: 04-04-2012 To: 04-04-2013
at12:01 A.M., Standard Time at your mailing address shown above.
)1n3. Form of Business: INDIVIDUAL
flr4 In return for the payment of the premium, and subject to all the terms of this policy, we agree with you to
provide the insurance as stated in this policy.
policy consists of the following coverage parts for which a premium is indicated. Where no premium is shown,
-=e is no coverage. This premium may be subject to adjustment.
COVERAGE PREMIUM
Section I —Property NOT APPLICABLE
Section I I —Liability $ 874.00
Inland Marine $ 175.00
Total Policy Premium: $ 1,049.00
For Coverages subject to premium audit: Annual Audit Applies
Item 5. Form(s) and Endorsement(s) made a part of this policy at time of issue:
See Schedule of Forms and Endorsements
Countersigned:
Date: By:
Authorized Representative
THIS BUSINESSOWNERS COMMON DECLARATIONS AND SUPPLEMENTAL DECLARATION(S), TOGETHER WITH
SECTION III —COMMON POLICY CONDITIONS, COVERAGE PARTS, COVERAGE FORMS AND ENDORSEMENTS,
fL ANY. COMPLETE THE ABOVE NUMBERED POLICY.
D
1 1207
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
5. www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): 1,0-413
Address: Ca % _/I" eo- +, 5 7 r'
City/State/Zip: /llt�✓I t° s6vm_��� Phone #: g'� 8`'�7� —,2e:110
Are you an employer? Check the appropriate box:
❑ I am a employer with
4. ❑ I am a general contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
listed the #
I am a sole proprietor or partner-
on attached sheet.
ship and have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. ❑ We are a corporation and its
required.]
officers have exercised their
❑ I am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
c. 152, §1(4), and we have no
insurance required.] i
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. "Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
11. [J Plumbing repairs or additions
12.❑ Roof repairs
13.❑ Other
my applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
iomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such.
ontractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
im an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
formation.
surance Company Name:
dicy # or Self -ins. Lid.
b Site Address:.
Expiration Date:
City/State/Zip:
:tach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
ilure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
to 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
up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
vestigations of the DIA for insurance coverage verification.
'o hereby certify under the
ofperjury that the information provided above is true and correct.
/0
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, 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 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 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 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-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.
The Office of Investigations 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 fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or.1-877-MASSAFE
vicPA S_7F.(1S
Fax # 617-7277749