The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #1076-15 - 486 WOOD LANE 6/19/2015 `W-1516 SyORTy �J �V"�� BUILDING PERMIT 01 �1ED bghO TOWN OF NORTH ANDOVER 3� '`- APPLICATION FOR PLAN EXAMINATION : ry w Permit No#: ' f Date Received gCHU5��5 Date Issued: 11f PORTANT: Applicant must complete all items on this page LOCATION G60 P PROPERTY OWNER Print 100 Year Structure yes n MAP �L' PARCEL: ZONING DISTRICT: Historic District ye n Machine Shop Village e- Y es no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential _ . 11 New Building_ _ ❑ One family . ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic ❑Well � p Floodplain Wetlands a W;4tershed District El Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: s Identification- Please T pe or Print Clearly , OWNER: Name: 19 Phone: Address: Co Contractor Name: V% le' (21? Phone: (9 76ZS7C� Email: Address: Supervisor's Construction License: o Exp. Date: 7�Z / Home Improvement License: zq3pz Exp. Date: 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: $ Z��- FEE: $_ l� Check No.: 2 I Receipt No.: �Q NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 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 FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS H.FALTM Reviewed on Signature 4 COMMENTS x Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Wafter& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: _ Located 384 Osgood Street FIRED�1R+TMENTe"m _Durnpster�onsite_;m dyes ori 4 - tpsi_ nature%d.,•�atepy . ,ssw.s�n��s�s-awasssQ�- 6 'COMMENTS' r Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. ' Total land area, sq. ft.: 1 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.$10041000 fine NOTES and DATA— (For department use) i f I I I ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 F 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 4, Building Permit Application 4 Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses :rE 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 4, 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 IN 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 I Doe:Building Permit Revised 2014 Location kd / , 1�1— No. J Date • - TOWN OF NORTH ANDOVER . - . Certificate of Occupancy $ b V . Building/Frame Permit Fee Foundation Permit Fee $ SA" ° n^ Other Permit Fee $ TOTAL $ Check# 28949 Building Inspector NORTF� . w: .. . . . ve. 0 No. 4��—I IL C, ver, Mass, coc.elc"tWICN A04"ATED s BOARD OF HEALTH PERMIT LD Food/Kitchen Septic System .. THIS CERTIFIES THAT .......... ....... .... .. ......?Mlt................................:......:.. BUILDING INSPECTOR Lf t Foundation has permission to erect .......................... buildings on ....... . .. ..... ..... ............• ... .. Rough to be occupied as ........ .... /� .......� .. .. ........................ Chimney provided that the person accepting this permit shall i very respect conform the terms of the application Final p p p g 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 NTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT A Rough Service .............. .. .... .................................................... Final 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. �✓I ► L �Nl fit' �I�1 Proposal 1 HOMEOWNER: Mathew Rogers LOCATION: 486 Wood Lane 781 249 6507 REGARDING: water damage repair PREPARATION: Remove damaged blue board,plaster and insulation in following rooms: Master bedroom 1 exterior wall and ceiling, 2nd bedroom small area under window, ceiling in entry/living room. DESCRIPTION: Electrical: N/A Plumbing: N/A Framing: N/A Insulation: Insulate exterior walls where needed with R-15 insulation. Insulate ceilings with R-30. Customer has contracted with Mass Save program and is having entire attic insulated after ceilings are fixed. Plaster: New blue-board and plaster will be installed with 1/8" skim coat and smooth finish where needed. Match and blend ceiling and walls where/if needed Trim: N/A Tile: N/A 4 -'hardwood Floor: N/A All permits included in pricing. Structural, electrical and plumbing to be completed according to MA State building codes. Price includes on site dumpster for debris removal. As with any home"surprises"can be found with removing walls. Any"surprises"that are found and that need to be addressed with be completely explained to homeowner and repaired on a cost basis. Quote based on a basic plan provided. Costs may change up or down when plan is finalized but new quote will be provided. Estimated Cost as per quote: $ 2,300 f Proposed Payment Schedule Payment upon finish ,r Frank Carta ew Rogers Micaven Contracing .k j f 1 f� i � ... � 1 � ;�4' ';r�`.•, .�. I .� i .t �� t ��=.. --- i The Commonwealth of Massachusetts _ Department of Industrial Accidents I Congress Street,Suite 100 _ Boston,MA 02114-2017 www mass.gov/dia Porkers'Compensation insurance Affidavit:Builders/Contractors/Electricians/'lum ers. TO BE FILED WITH THE PERlyI[TTING AUTHORITY. Please Print Le 'bl A ' licant Information Name(Business/Oiganization/fudividual): Address: tate/Zip: Phone 7 Z� City/S ) _... Are you an employer?Check the appropriate box: Type of project(required): em to ees full and/or part-time).* 7. ❑New'construction 1.Q I am mployer with P Y am a sole a sole proprietor or partnership and have no employees Working for me in 8. n Remodeling Y ca an i (No workers'comp.insurance required.] 9, ❑Demolition PactY LN 3.❑1 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 rairs or additions ep proprietors with no employees. 12_ Plumbing repairs or additions 5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13•.F]Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 14.10 Other 6.Q We are a corporation and its,officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no'employees:[No workers'comp.insurance required.] *Any applicant that checks bbic#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not thoseentities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. jam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Expiration Date:. Policy#or Self-ins.Lic.#: City/State/Zip: Job Site Address: 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. Y do hereby cerci er thepains ndpenalties ofperjury that the information provided above is true.and correct. • Date: � Si ature: Phone#: Official use only. Do not write in this area,to he completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): LLBoard ealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector on: Phone#: i 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 hlxe, 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(1)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=contractors)name(s),address(es)and phone number(s)along with their certificates)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 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-NUSSAFE Fax#617-727-7749 Revised 02-23-15 wwwmass.gov/dia Office of Consume Affa s&Busi>fes RegulaUon°ef ' OME IMPROVEMENT CONTRACTOR egistration: 143793 xpiration:_ 8/3L2QI.6, Type: Individual FRA CARTA _n - FRANK CARTA 107 GLEN RD WILMINGTON, MA �� - Undersecretary Massachusetts -Department of Public Safety Board of Building Regulations and Standards VVHILI[Il LIf11t JIJ�IGI`'111/1 ., License: CS-087608 FRANK E CARTA,JR 107 GLEN RD WH-A UVGTON 1RAj ., _ J