HomeMy WebLinkAboutBuilding Permit #1301-2016 - 450 CHESTNUT STREET 6/13/2016 NORTH
BUILDING PERMIT �:, o�t�(�E�..
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION ~ '°
1 �1 Date Received I 74A°Aa7[o t5
Permit No#: � gSSgCHuS�c
Date Issued: ,*1M
RTANT: pplicant must complete all items on this page
LOCATION 7�
Print
PROPERTY OWNER
Print V 100 Year Structure yes no
MAP PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
9 Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑Well ❑ Floodplain Wetlands ❑ Watershed District
❑W_ater/Sewer.._ _.__. _. __ _
DESCRIPT OF WO K TO BEP FO MED:
Low � �
1.
entif atio - lease Type or Print Clearly
OWNER: Name: AV Pho ri e: /"1 ��510502
Address:
Contractor Name: Phone:
Email: i J
Address: ry
Supervisor's Construction License: CS 04'�(9o2 Exp. Date: 141—C20J
Home Improvement License: / �M2? Exp. Date: q"02T—g20J
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.
MMco
Total Project Cost: $ FEE: $�TCx
Check No.: ®� Receipt No.: 1
NOTE: Persons contracting with unregistered contractors do not have acc he ranty, and
Location
No. � �Z(�/ Date
• - TOWN OF NORTH ANDOVER
Certificate of Occupancy $ y
Building/Frame Permit Fee $"
Foundation Permit Fee
Other Permit Fee $
TOTAL $
Check#i
304- 99 Building Mpector
Plans Submitted 19 Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer 13 Tanning/Massage/Body Art ❑ Swimming Pools ❑
Well ❑ Tobacco Sales ❑ Food Packaging/Sales ' 'D
Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
XONSERVATION Reviewed on �� l Signature
r
CO MENTS
_/)&,44Uv
HEALTH Reviewed ori Signature .
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
I
Conservation Decision: Comments
Water& Sewer Connection/Signature&Date Driveway Permit
DPW Town Engineer: Signature:
i Located 384 Osgood Street
AFIRE DEP AR1TMEhIT� �"Tmp4®umper onsite� Yesino .
r�`t d.atR12� - `*
ttLoca e r _�4'MainiStreetF � � { — '� • �. `f
s ,F�re�Depar`t�m ne t�sig atu%date }j _ � L � � i
r
T�S,
I
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
I
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
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NOTES and DATA— (For department use)
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® Notified for pickup Call Email
Date Time Contact Name
Doc.Building Permit Revised 2014
r
Building Department i
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
i
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
4, 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)
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
Doc:Building Permit Revised 2014
1
r -i NORTH 4
W, I )f
nc )ve" .
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2z 1062 2A
h ver> Mass
IC"1 .q-
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COCNINlWICM �
ASR.Areo
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BOARD OF HEALTH
Food/Kitchen
PER Septic System
IT T LD
BUILDING INSPECTOR �.
THIS CERTIFIES THAT .......... ..... .... .......... 6` + ................ .. .......... .
Foundation
has permission to ea'...,.
.......................... buildings on ..... ...... .. ..... ............
v Rough
to be occupied as .. .. 1 .... #... ....,* .... ........ chimney
provided that the person accepting this permit s 11 in eve respect conform to the terms of the application p p p 9 p every p pp Final
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspec ' n, 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 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONST TIO Rough
Service
. ..... .
BUILDI...... ...... ......
Fina
N SPE OR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final YY
No Lathing or Dry all To Be Done, FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
1) THE BOUNDARY INFORMAMON SHOWN HEREON WAS M
TAKEN FROM A PLAN ENTITLED "PLAN OF LAND
LOCATED IN NORTH ANDOVER MA PREPARED FOR mAp m; IAT A2
KENNETH�W//. REA'• SCALE: 1"-40'; DATE: 4/27/99
(NORTH ESSEX/RURY OF DEEDS PLANSERG. s 36 C.
547'03'48° 127.07'•..
2) THE INTENT OF THIS PLAN IS TO SHOW THE, AS— f
BUILT LOCATION OF THE FOUNDATION ONLY.
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f
$29
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MAP 23C LOT 1
r "
' �q ��• t MAP 98C LOT 3
t �
.�+ � �cl�c Fowro��•
N08'29 40 W 1
t,e3 GRAPHIC SCALE
CH
'''!! rt��+��?'+'--N07'34°43"W
T ST
I HEREBY CERTIFY THAT THE FOUNDATION SHOWN HEREON C$R'PM1D PLOT PLAID
IS THE MRSULT OF A FIELD SURVEY MADE ON MAP 98C LOT
DECEMBER 5, 2001. CHESTWT SWET
NORTH ANDOVER, MASSACHUSETTS
I+ roftD FOR
0 r RALRH R. JOYCE
90 MAIN '$T mT
CilfusTopp i"A NORTH ANDOVER, MASSACHUSETTS 01845
lie
FRdch1G ,os ma..asa s+n+am,
" 118 Iolsm.Mrr R OiOTo
(eC0)91RS.07lD
1 Dtl1Rn4 vonsum M. Ckmun•PIA g4g•whit"H/
$CJ1{.i<: t' a 40 00-YEI DF.:EMNS S. 2001 10AWi�l0
LICENSW LAND 5 JJW QWE ML ??4 149CPP2 DWG
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8 Manning Road
�0 Suite#2
Waltham, MA 02452 i
Office: (781)373-1966
Cell: (617)480-3233
davelhye@comcast.net
June 9,2016
Mahesh Narayanan
450 Chestnut Street
North Andover,MA
CONTRACT
HYE Interiors agrees to do the following work for the above Homeowner as per the
Proposal and agreed upon work stated in letter dated June 9th,2016.
HYE Interiors will pull required Permit for said work by Building Code requirements.
The rough and final inspections will be signed off for said work by inspector to meet
Payment terms of said contract.
HYE Interiors will begin work roughly on June 16'`,2016 and should be substantially
completed by July 18th,2016.
HYE Interiors agrees to perform the work,furnish the material and labor specified for the
total sum of$17,762.00. If there are changes to the proposal regarding cost for materials
that will be additional costs as well as any additional requested work.
Payment Terms: 1/3 first payment once work begins on June 16th,2016. 1/3 payment
after rough inspections have been signed off. .Final payment after final inspection has
been signed off.
HYE Interiors agrees to warranty all work performed by HYE Interiors for one year.
HYE Interiors agrees to be solely responsible for completion of the work described in
said contract.
Contract Acceptance-Upon signing,this document becomes a binding contract under
law.Unless otherwise noted within this document,the contract shall not imply that any
lien or other security interest has been placed on the residence.
HYE Interiors and Mahesh Narayanan hereby mutually agree in advance that in the event
the contractor has a dispute concerning this contract,the contractor may submit the
dispute to a private arbitration firm which has been approved by the Secretary of the
Executive Office of Consumer Affairs and Business Regulation and the consumer shall
v
be required to submit to such arbitration as provided in Massachusetts General Laws,
chapter 142A.
Mahesh Narayanan David Najarian
45 6- -?--���
Date Date
14 ji
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The Commonwealth ofMassachusetts
Department ofIndustrialAccY 1s
I Congress Street,Suite 10&
Boston,AM 02114-2017
www.mass gov/dia
Wokkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PEPMTTING AUTHORITY.
ApplicautInformation Please Print a 'bl
Name(Business/Organization/Iridi 'dual):
.A.d&ess:
City/State/Zip: V3 Phone 0: 6-1
Are you an employer?Cltecktlie appropriate box: Type of project(required):
1.❑l am a employerwith employees(full and/or part-time).' 7. []New coristraction
2.0 lam a sole proprietor or partnership and have no employees working for me hz 8. Remodeling
any capacity.[No workers'comp,insurance required.]
3..❑I am a homeowner doing all work myself[No workers'comp..insurance required.]t
9. ❑Demolition
10[]Building addition
44-11 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.
1�.[]Plumbing repairs or additions
5. 1 am a general contractor and I have hired the sub-contractlid thtthdht
ors listed on e attached see.
❑ 13.[]Roof repairs
These sub-contractors have employees and have workers'comp.insruance.t
6.Q We are a corporation and its officers have exercised their right of exemption per MGI,c. 14. Other
152,§1(4),and we have no,employees.[No workers'comp.insurance required.]
'Any applicant that checks b6x4l must also fill out the section below showing theirworkers'compensation policy information.
i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such.
fContractozs 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-c&!hcEors Have employees,tliey must provide their workeis'camp.policy number.
T aria an employes'that is pi'ovidiiag workers'compensation insurance for my employees.'Below is the policy and job site
Information.
Insurance Company Name:
Policy#or Self-ins,Lic.#: Expiration Date:
fob Site Address: City/State/Zip:
Attach a copy of the workers'compensation 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 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 Ene of up to$250.00 a
day against the violator.A copy of this stateme t may be forwarded to the Office of Investigations of the DTA for insurance
coverage verification.
X do hereb r tree ain a enalt es o pei jury Haat the information pro above is true and correct.
Si ature: / _ Date: ✓�J �D✓
Phone#: 67
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 Z.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone M
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."
t
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 lias 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 fillout the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub=coutractox(s)name(s),address(es)and phone number(s)along with their cerkificate(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. B e advised that this affidavit may be submitted to the Depai tment of Ihdustrial
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 ox if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self iiu ured companies shouldenter-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 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
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_ Office ofConsumer Affairs&Business Regulation License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: 170229 Type: Office of Consumer Affairs and Business Regulation
;7e Expiration: 9/29/2017 DBA ]0 Park Plaza-Suite 5170
Boston,MA 02116
HYE INTERIORS
DAVID NAJARIAN
8 MANNING ROAD 2ND FLOOR
WALTHAM,MA 02452 Undersecretary of vali wathout-si nal re
0t Massachusetts Department of Public Safety
? Board of Building Regulations and Standards
License: CS-049102
Construction Supervisor
DAVID M NAJARIAN
8 MANNING ROAD r
FLOOR 2
WALTHAM MA 045? V'
71. `
l
Expiration:
Commissioner 10/14/2017