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Home My WebLink AboutBuilding Permit #693-2017 - 456 SUMMER STREET 5/1/2018 V • � �OR7/y BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ', '- Permit No#: 7 Date Received °RATED 11T.0 SSACHU Date Issued: - LVIPORTANT Applicant must complete all items on this'p,age +{y a OV. �' i7«.+. ].�C� , t � y j i � �`� ` f+= .� PROPER�TYfi OWNER ► � r�-hi'_ t Sri y_�� t t+� 4Pnf- c t" 1DDpYearStr cture "R,�Y `#yesl� n0 » PARCEL DISTRICT� �"�` toricDistnct -t ., ryes o MAP — — •> �n r- , � _ Mach�ne.Sho Village _yes , _no TYPE OF IMPROVEMENT PROPOSED USE Resid ntial Non- Residential ❑New Building Pr6ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑Demolition ❑ Other D Septic `0 Well O.Floodplain VUetl'ands UVaterShed D►st�ief w- • Etwat_er_/Se_wer _ DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly �-. d 4 p OWNER: Name: F -"\ Phone: �l 7� 4 8` CSP ,��- ►� got q� Address: Contractor Nam 4 t_t '_. sJ: Phone Address: Superuisors.Construct�ori License Home liri .rovement=License: Ezp; ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.MOO PER$9000,00 OF THE TOTAL ESTIMATED COSTBASED ON$925,00 PER S.F. '-___,Total ProjeGt Cost: $ °��® FEE: $ C1 Check No.: ��3 Receipt No.: NOTE: Persons on e ' zt unregistered contractors do not have.access to the guar arty fund Plans Submitted ❑ Plans Waived 0 Certified Plot Pian ❑ Stamped Plans ❑ r_ F-TYPE bF SEWERAGE DISPOSALblic Sewer ❑ Tam 'ing/Masage/Body Art F] Swunming pools Elll ❑ Tobacco Sale ❑ 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 Reviewed On Signature .COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature COMMENTS Abning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Con nec#ion/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 signatureldate -imension Number of Stories: Totalsquare feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop xequires approval of Electrical Inspector Yes No ®ANGER 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 Call Email ate 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 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/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 V®TE: 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 I®TE; 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.AppeAk 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 s Doe:Building Permit Revised 2014 Location No. r 9017 Dat G/-7 • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#3/. Z 1406 � �� / ,building Inspector J �/ NORTOI Town of _ ndover 0 No. I 141 h ver, Mass Q coc"Ic«ew.cw 1• �,9s RATE 0 U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System DAvib ....... ,.. v .,..,. BUILDING INSPECTOR THIS CERTIFIES THAT ..... �.� C..... .......... ..... .. .�.��. has permission to erect .......................... buildings on ..... .to........5vmotke. ........� Foundation� Rough to be occupied as .... f in _mp Ig.......Im. r ................re.AmAA� ...... 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO S Rough Service .............. .. ..................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. • North Andover Health Department (ommunity Development Division Date: December 20,2016 Time: 2:00pm BOH Inspector: Michele Grant Tenants Name: Mike Flemming Phone Number: 978-893-6370 Location: 456 Summer Street Owner: Nassan Hussein Phone Number: 978-885-0448 Address: 8 Copperfield Drive Nashua NH. 03062 Regulation Findings Violations 105 CMR Deadline Corrected 410.750 Faulty and Inefficient Heating-Furnace, Baseboards, Radiant 24 HRS K,L, 0-3 Wall Boards co"er� Produce complete analysis on Heating System 24 HRS 410.750 No Carbon Monoxide Detectors,No Smoke Detectors 6 HRS Y (N) Fire Department was called 410.750 Drier Vent is not vented properly-Vent is routed into the 24 HRS (B) garage 410.750 Multiple Electrical Deficiencies throughout the home. 24 HRS 0-(3) Hire Licensed Electrician to evaluate and repair Broken Windows in Kitchen and Basement 48 HRS Fireplace has not been cleaned in 5 yrs. Yearly maintenance 48 HRS is required. Clean by a professional PER B UILING, FIRE,PLUMBING AND ELECRICAL �Y X PYX PER FIRE DEPT. AND PLUMBING INSPECTOR: Door must be removed in basement due to lack of makeup air All Plumbing and Electrical must be done by licensed contractors with permits. Per building code x xY� *xY Building Commissioner requests a building permit to be pulled by a Licensed GC xxxx Xxx Building Commissioner requests a copy of the sign certified letter that has been delivered to the tenants, regarding illegal bedrooms in the basement. Page 1 of 2 North Andover Health Department— 120 Main Street, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.9543 Copies of all paperwork from vendors. Inspectors Si'it'iture ,Date: Page 2 of 2 North Andover Health Department - 1600 Osgood Street— Suite 2035 North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 DAVID HOULE CONTRACTOR Invoice 15 Griffin St. Number: 1760 Methuen,Ma. 01844 Date: January 04, 2017 Bill To: Shio To: HUSSAN HUSSEIN IHUSSAN HUSSEIN 456 SUMMER ST 1 18 COPPERFIELD DR I IN.ANDOVER, MA 01845 1NASHUA, NH 03062 I ! ! 1 PO Number I LI USSAN Date Dept. Description Amount] 1-4-17 REPAIRS REMOVE DOOR IN BASEMENT, FIX TWO 400.00 HAVE VENT FOR DRYER VENTED OUTSIDE, REMOVE RADIANT I PLUG IN HEAT OFF WALLS, FIX COVER PLATES ON OTHER HEAT. ANY PLUMBING OR ELECTRICAL WILL BE DONE BY LICENSED PEOPLE f OWNER DATE I CONTRACTOR DATE y H.I.C. TL i ! t I f i I i i i 1 I I 1 Total 1 $400.001 The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 floston 11.4- )21I4a2017 - mY www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information I Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Q1 W1 Phone#: Are you an ployer?Check the appropriat box: Type of project(required): I.E]you/ a employer with employees(full and/or part-time).* 7. ❑New construction 2, am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling any capacity.[No workers'comp. insurance required.] 9. El Demolition 3.R I am a homeowner doing all work myself[No workers'comp.insurance required.]t 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 E] Building addition ensure that all contractors either have workers'compensation insurance or are sole 1 I.E]Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.M I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[:]Roof repairs These sub-contractors have employees and have workers'comp.insurance.* 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.a Other 152,§](4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicatingthe are doing all work and then hire outside contractors must submit a new affidavit indicating such. Y g g +Contractors 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 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 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 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. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: 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#: The Commonwedth of Hassachuseffs _ Department of IndustrialAceidents r Cofzgress Sheet,,5yi 100 = d Bostoa,AIA 02114 2017 c www mass.gov/dia W0, ke&,Compensation�Ce Affidavit-B� nA Os Y cxansl'lzouabers. tra TO BE _.1Pleas e Pruxt b bl A 0cant luform.ation Naum(B 1(� usiness/Ozganizaiz°nadividA Address: 1 - � City/State/zip: Axeyou an employer?Cjieck6e appropriate box: Type of project(requited): employees(fL and/or part time).• 7. ElN 'do"nsixuation 1.❑I aemployezwith___ in g. []Remo de 9 2, amasoleproprietororpartaerslupan hayenoemployeesvaorking formeiumu9 0DeA10 On any capacity [Noworkers'comp. 'ance required.] 3.E]X am ahomeowner doing altwoxkmysel£[N:oworkes'comp.insurancerequired]' 10❑Building addition ¢-�I am ahomeowner audwill be hiring ce tactors to conduct all work onmy property. X wiIl 11.[]Electrical zap g o. additions ensurethat all contractors githerhave workers'compensation insurance or are sole 12 g]-Plumbitg repairs or additions proprietcrswith.no emgioyees. 5_❑T am a general contractor and Y Have hiredthe sub-contractors listed ontbe attached sheet 13 ofzepairs These sub-contractors have employees andhaveworkers'comp.insurance t 14. Other 6.Q We area corporation.and its.offices =e exercisedtl e right of exemption per MGL c. 152,§1(4),andtive have nc employees.[No worker'comp.insurance required] cks bbX#1 must alsa fill outthe sectioabelo w showingtheu''orkers°compensationpoHcy mfozmaiion:• Anyapplicantthatche . are doingaIlworkandthenhireouisidecontractorsmustsabmitanewafridavitindicatingsuch I gomeowners who submit•this af$davzt mdicatmg��' the name of the sub-contractors and sfate whether or notftrose euGt}es have Coniractos that checkthis boXrimusf attached an additional sheet showing oris nrunber. employees. Ifthe sub-coutractors have employees,theymust provide their workers'comp.P yam to ees '13elory is tXierilicy ar2d j ob site X can an employee tliatisproviding -Workers'compensation iv�suraneefor my p Y information. Ingarance Company Name; ExpirationWe, Policy#or Self-in.Lic. / �� d` City/State/Zip' A 1�1'Q lob Site Address: declaration page showiag the policy number and e pit ation date). Attach a copy Of the woxke s' comipensa on po ey ?? g 500.00 Failure to secure coverage as required under MGL c.152,§25A is a criminal violation punishable by a fire up io o $ and/or one-year imprero as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against ilia violpi of Cement may b e forwarded to the Office of Investigations of the DIA.fox insurance coverage vexificatio Xao raer�eliy certify er't7ze " s p ties of Haat ae infor�xnation provided above:,Y true and correct: Date- Signature: ate•Si ature: Phone#: official use only. Do notwrzt0 in tllls a-eea,to Ire completed liy city or town official. • FexmiitlLicense# City or Town.- Issu-jugA,-athoxzty(circle one): actor 5.Plumbing sk7ectox x.Board of health 2.Building Depaxtm.ent 3.CitylTown Clerk 4.Electrical brsp 6.Other Phone#- Contact Person: 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,also dation,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 tr ustde Qf 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 ofthe dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelft house or on the grounds or building appurtenant thereto shall not because of such employment b6 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 comimonwealth for any applica&wlid has not produced-acceptable evidence of compliance with the insurance coverage x gi&ed." Additionally,l`/SGL 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 ofthi chapter have been presented to the contracting authority." .Applicants Please M 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)andphonenumber(s)along with theirceufificate(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 d6e's have employees,a policy is required. Be advised-that this affidavit maybe 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 regwxed to obtain a vrorkers' compensatiori.policy,please call the Department at the number listed below. Self-insured companies should enter their self inalrance 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 Min the Permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple pert/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 stamp ed 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. Anew affidavit must be filled out each year-Where ahomeowner 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 7.ndustrialAccidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.#617.727-4900 ext.7406 or 1-877 MASSAPE Fax# 617-727--7749 Revised 02-23-I5 wwwma8s.gov/dia �( • / License or registration valid for individul use only r «•��'cn�c'rL% _`6-._Office of Consumer Affairs&Business Regulation before the expiration date. If found return to: -= Office of Consumer Affairs and Business Regulation ME IMPROVEMENT CONTRACTOR Type,e 10 Park Plaza-Suite 5170 egistration: 181163 Individual Boston,MA 02116 -MMD50 X.expiration: 315!2017 KURT LEDOUX KURT LEDOUX �A_:. 126 HIGH ST -' Not vali without Signa, re LAWRENCE,MA 01841 Undersecretary (\ DRIVERS w rj �A Fa. x ....w - ;9&END' 4dNlIMB63_ ' �' •� 4a� 2 12; NONE, v� $ V. 15 SE7(« � it iT e y^ ll LEE I RTO a 126 HIGH$T ,.yL[►WRENCE,MA 018044. •-------- $ .m LICENSEt area eaNu *��r 2 NNE, .-� 1r i AM s 15 GRIFFIN STREET METHUEN MA 01844 ), _,S -24 3Rev07-ISM094 Massachusetts Department of Public Safety ` Board of Building Regulations and Standards License: CS-104457 • Construction Supervisor DAVID A HOULE ti 15 GRIFFIN ST ,METHUEN MA 01844 ^/t"'�^ Expiration: Commissioner 03/04/2018