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Home My WebLink AboutBuilding Permit #1004-15 - 5 PERRY STREET 6/3/2015 L_ N O� ORTH 9 BUILDING PERMIT y��?`�D .,',64640 TOWN OF NORTH ANDOVER o ....,. APPLICATION FOR PLAN EXAMINATION- _ 4A eocwKwew `, Permit No#•, Date Received gSSACHUgfc� Date Issued: I PORTANT: Applicant must complete all items on this page LOCATION r' Print PROPERTY OWNER 761 /x 1 z zqI"'j &L,L-- Print 100 Year Structure yes o MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building a family ❑ Addition El Two or more family [I Industrial ❑Alteration No. of units: — El Commercial C<epair, replacement ElAssessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic o Well ❑ Floodplain ❑Wetlands Watershed District 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: NA41 Identification- Please Type or Print Clearly OWNER: Name: /4M 1 CA t"C0LL Phone:�7`7 " 33 - 5� r' � Address: /'✓` Contractor Name: Ric -lAr0 .iyql¢oi5oa( Phone: � u� Email: R)cH 4RIII)156/tl 9 ® A01— Address: 3 K?AQ ,56N /4114 Cv-✓'o ND Supervisor's Construction License: 3 G`e-c-Q Exp. Date: `� _ 9 1- J Home Improvement License: 11 5',!U 5 Exp. Date: J T 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: $ 56) , dt FEE: $ 2� Check No.:' L4 3`1 Receipt No.: uaran un d contracting with unregistered istered contractors do not have access to the g ty f NOTE: Persons cont g g - — - - -- - - - - r 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) 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) 4. Building Permit Application 4 Certified Proposed Plot Plan 6 Photo of H.I.C. And C.S.L. Licenses 4 Workers Comp Affidavit 4. Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 I ECC 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 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 11Pxivate(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 I CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COM, MENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes 4 f Pla ping Board Decision: Comments Conservation Decision: Comments Wafter& Sewer Connection/Si nature Date q Driveway Permit ]DPW Town Engineer: Signature: Located 384 Osgood Street @ "'- ;�'"'_.:"'.�.f: FIRE DEPAR�TsMENT ,Temp ®urnpster gnAsae ?yeses-17 ;,`_no 4 4 Lo ted at 12,4 MainStreet; FireDe i ��, s 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 DANCER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) 3 Ll Notified for pickup Call Email Date Time Contact Name F Doc.Building Permit Revised 2014 I - F Location No. 00 —' J Date • • TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee i Foundation Permit Fee $_ ` Other Permit Fee $� TOTAL $ Check# �. f'° 1 f? � Building Inspector t%O R TH Town of ? E ,, , Andover p '.. _ 0 / Z � o hver, Mass, I COCHICHM.C. �•9 A°R�+rE o Oki? �(5 S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .,rn.��r........ ...... ..,,. BUILDING INSPECTOR ............ �.�o.L ,.............................. ................. Foundation has permission to erect .......................... buildings on ...5......Pe-AiV1.6.1......... ....... ............................. .. Rough tobe occupied as ........ ...... ................... ...-................................................................... 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 a0q . PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI N4tn' Service Rough ............. .... ........................................................... 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. ----y 477---'i 1' INSTALLER SITE ANALYSIS NOTES: _ I 1.Sink centered 51"off the left wall,no disposal. 2.Drain same as the sink goes into the floor. SINK DW24 3.DW24 centered 78.5 off the left wall. zsL 4.Fridge 29w x 32d x 67 0311912015 I W12]Gal M036 BUT Dre:'7 ei 5.Stove centered 50.5"off the right wall,30"slide in,gas PRELIMINARY DESIGN FOR PRESENTATION seC Burr owe t G.No hood NOT READY TO SELL i og Dvm Bwor,s DB uE B, 7.Ceiling set at 99.25" <' Customers p ce g II the appliances. h I re la in a ap li FINAL DESIGN MUST BE SUBMITTED FOR (1 n INSTALLER SITE VERIFICATION ^ I Peninsula is 57.5"long off the right wall pipe chase b 2 AND FORMAL REVIEW PRIOR TO SALE. y 4 deep. „-T� " ee . Jamie Carroll y I DC Notes: (978)339-3519 3 #2685-230147 I I _,�_ 1.)Customer is replacing all appliances.All „rg CEILING HEIGHT:99-114"AFF appliance specifications must be provided. American Maoodmark -\ - TOP ALIGNMENT:90" 2.)Sink and faucet specifications to be provided. g p 3.)Customer does not have enough room for an island. ReaFull Overlay _ __ minimum of 36"of clearance needed for walkways Stone Finish —= :='�- J �. �1 i } ""Island would only be able to be 12"deep if Standard Construction I I _� 'DwrEaBa ! stationary,or could have a mobile island'cart""« Flushed Plywood Exposed Ends M !" k BLOCK 4.)Moving REF to 44-112"wall,eliminating the peninsula Glass:NONE I 7 I� m BEHIND and Range moving to interior wall,OTR Microwave to Top Molding:FSS396 � x be installed above new range,per installer and/or Bottom Molding:NONEstore designer notes. I -- " 5.)According to NKBA Guidelines: ---------------------- Countertops:LG Viatera i -i - -No 2 work centeres should be no less than 48" Snow Storm-Group t —E— and no more than 108".Actual distance between Eased Edgesink and range is 39" Sink:TBD �D7 -Distance between cooking surface and hood should 28 SF---NOT INCLUDING SPLASH Ci �Ip I' I be 24".Actual distance in this design is 22-318" i -No entry door should interfere with the safe L operating of appliances. -------....---------------._................ ---..._.__.... --- ------...---._..------- All dimensions-size designations This is an original design and must Designed:4/27/201 given are subject to verification on applicable fee has been paid or job not be released or copied unless Printed_5/4/2015 job site and adjustment to fit job conditions. order placed. All Drawing#: 1 No Scal 31806b63.kit i -------------- —-- , _.. —— — — —— — --- -- — y - - --- - - - 12112 - - X144 =12" --- -504 --- ---- -12 -�'--- 30 - --- ; -..-- ___ .--- --..._�/- -!'--- ---------------------�- ,�---- 2g 4 441411 -- - 4722-11 ! I I ,rn _ - - -- --- -- .... M -IIBLW30/3336R {F}3L - I , W12361 W3036 IUF342 {36 1/8} nv N M i i I M d' I �Ii lf) .—I" BER36R SB30 BUTT � DISH-1Q6 =BWBT15DB12� E3R Ch i � i .a -- - -= ----- i --___-____ __- --- -_I- i I 1,z 15 ; l21 /3'! I 51" -27" 43 ✓- _ -- ----- - - - - -� .... - - ;� - _ 2 - ------ _ ----____ ---- -_ ------- ---- -- -.._ -- All dimensions_size designations This is an original design and must Designed:4/27/2015 given are subject to verification on not be released or copied unless Printed.5/4/2015 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. 31806b63.kit El 1 I Drawing#: 11 No Scale.: �'------------------------------ - 1 11 ---------- i IQ 11 � X11 311 3 I,' n 4' 30 ------ - 32 i i i it i i 10) i i f W3015 (BUTT I i L ==WPC 1154Z30/3336R {F� c� MW.H00D °� i' --- CO LJ ---------------------------- i � NI\ r S a ' I ' i I i - �I00 LO -I" W1RANGE.GAS.30-f11 BER36R i � 1 i cY) - li i i =- — 3011 _---- -- 3611 {x,111 — 11 11 j i �1 i 11 2 2 All dimensions_size designations This is an original design and must Designed:4/27/2015 given are subject to verification on not be released or copied unless Printed:5/4/2015 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. 31806b63.kit El 2 Drawing#. 1 1 No Scale. ------------------------ --------- -------------8511--- A; 2__ -----------------33"- 3,2;i-t.-- -- ---- ----- ------- 44111 ----------------- - --37 ---/-1-V 10) ---------- -34 In- --------------- F CO W3318 X 24 DP BUTT �00 0 {36 1/8} 1-i I----------------- is VTkEi EP96 CO HI ,l I ,IN l 33" KLI 0) ----------....... 311 - ----------------- ---- -- 44 3 ----------------- ............... ........... All dimensions-size designations This is an original design and must Designed:4/27/2015; given are subject to verification on not be released or copied unless Printed:5/4/2015__ job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. 31806b63'kit El 3 Drawing#:_1._JNScale.o Apr231511.31a Richardli adison 9782770685 p.1 KITCHEII I INSTALLATION ESTIMATE WORKSHEET-USA 2886R J CONSTRUCTION. Jamie CI Irroll 412112015 C$Iti zM Domo and Haul AweyElectrical 00 Plumbing00Hadnwood Floor Rapalr00DrywalUltepalr00✓00 Addlticnai Cha ee/Pertnit000 Customer Signature: MT-- e Dote; Associate Signature: 7 1 Data; 00 Signature: /1 The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 021142017 .�` www mass.gov/dia r7M SV•v` Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY . Please Print Legibly Applicant Information Name(Business/OrganizationAndividual): (<o G H/4 r'1 �� ! t nl i Address: City/State/Zip: Phone#: r u�Y G/�tt I Are you an employer?Check the appropriate box: Type of project(required): 1.� a'm a employer withemployees(full and/or part-time).* 7. E]N6`c6nstr6ctlon 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ®.Modeling any capacity.[No workers'comp.insurance required.] 9, ❑Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required-]t 10 0 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11. Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole . proprietors with no employees. 12.�]Plumbing repairs or additions 5.FJ 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.insuranceJ 14.❑Other 6.FJ 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 box#1 must also fill out the section below showing their workers'compensation policy information. ng Homeowners who submib this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit entities have such. Contractors that check this box must attached an additional sheet showmg the name of the sub-contractors and state whether or not t , 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. Llid��t � iiy't7 Insurance Company Name: / Policy#or Self-ins.Lie.#: G it/ Expiration Date: tJ " �/ tQ �r City/State/Zip: Job Site Address. number and expiration date). he policy numb p Attach a copy of the workers'com ensation policy declaration page(showing t p y 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. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Date: fv "-'Z-> j Si ature: / 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#: 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(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-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 thai 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 i 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 14as_tiachuseyts pc3 a-iner*tf?l blit S #ekay�._ �''�°':�.53�as „r��i.ildl�a�`r.eg.ui�tiCri��a[�43�5t�nr�a�a�•=• .. • ' t�on,310,10ton SUP&Q'iyr r^ I_actknse: CS-030000 7' RIC J,MADSON �~ C,40"V EL�1]`iD�;1V 1'01 `# A; C ton TY !�9p 4 •� �` _� KI,r• �D,� 't _ .fes .t Y ��ze tpa�nvn�oarcuea�C�,a��crr�aac�craeGta ;' � '' ~ , 1 Office of Consumer Affairs&Business Regulation li Liceni ar-or registration,valid for individuF se only 1, befo,'re the expiration..date. If"found return to:. f OME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation ti egistration: c'1,-1-18509 Type: =�•�-�L 10 Park Plaza-Suite 5170 Expiration: 3/29/2017- DBA k Boston,MA 02116 R.J.CONSTRUCTION---- R � i L' RICHARD MADISON � 3 q• _ 3 MADISON AVE — GROVELAND, MA 01834 Undersecretary NotVai thout nature i