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HomeMy WebLinkAboutBuilding Permit #497-2017 - 57 HEWITT AVENUE 11/10/2016412bkky �'�✓ BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: 7 -x-01 -7 Date Received Date Issued: 0/104-C)16 ,�� IlVIPORTANT: Applicant must complete all items on this page OOCATI04 PROPERTY O'WNE MAP`__ PAR ZONING D15TR10-`T`�._ _ �_, Histone.. MachmE /O',�SfLEo i6i6N�` by no, . n09 no; TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑ Addition ❑ Two or more family ❑ Industrial ;Alteration No. of units: ❑ Commercial ❑ Others: ❑ Repair, replacement ❑ Assessory Bldg ❑ Demolition ❑ Other Septic >] Well, q Food � lain ❑Wetlands L7' Watershed. Dlstnct 4_ Wafer/Sewer_ - - - - - DEgC:KIF I IVN Vt- VVL)Kt\ I v 0t: rr-Mrvr-v1v1GLJ. H OWNER: Name: �ta Address: Co Identification - Please Type or Print Clearly i CZLA � `fin Phone: Supervisor's Const`rgc,tion,Lice nse Horne' Improvement License / �(w2,- Exp: Uate ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BOLDING PERMIT: $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $_ �� FEE: $ Check No.:©� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund inature of Acient/,Owne.r t _Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan El Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer El Tauning/Massage/Body Art ❑ Swimming Pools ❑ Well El Tobacco Sales ❑ Food Packaging/Sales El Private (septic tank, etc. El Pennanent Diunpster on Site El 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 Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: T Conservation Decision: Com Commen Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIREDEPARTMENT Jp , n,e I - Fire 0bp 'Jrh&fiti§id!jatijr6/date -COMMENTS., .._ .. , ._ ... _. _-r. -{ _ .__ .. _ - . . 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 DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$loo-$1000 fine Doc.Building Peimnit 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 NOTE: 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 NOTE: 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 y�./- . Location A VG No. o Date /l-/0 —o?Q/6 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #�� t / '! 17 V Building' Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 129000.00 m $ - $ 144.00 Plumbing Fee $ 18.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 18.00 Total fees collected $ 280.00 57 Hewitt Avenue second floor bathroom remodel 497-2016 on 11/10/2016 4 v E� 0 rA a y O O O O W� •� L r.L a) c = cua c o , 41 '� ,SN 4 Q A/ :Y jZ W,0 O Z t. "Q r : �rLO. c 0 P �: C t6 ING o C E Lm a � N O tel`' > r a� L o U) p �■■� tm No > �■■� _ V to � h a) Q = t t O E •�- c a Q U) J ..�■ •Noy O W:�3 cm a� > o = C �( 5 CCD D m w . • c LL 0 i V O = c O 2 O CL CD N F— N CO m co W G 'a +�•' O p w - LU d N o o O O N = -_ -� • _0"r o Z O MCD"2`~= O 0 f" 0 o U > Z m Z co w a W W CL IM O U :W :a C7 0 00 U w U) O U CO LUJ m ES li x J Q W x LL OC 0 pp c t E - W vai Z z Z m C W N Z z Z = J d W vai Z Q (� W W O c~.7 W Z Q W aQ W W LL Y -0 O LL Ln U N V) coN a a O LL L to O 2' C E t U C LL L 3 d' C LL L to O O 2' UJ N V1 C LL . 3 O 2 N C LL i m Z N i V) N O E O O O O W� •� L r.L a) c = cua c o , 41 '� ,SN 4 Q A/ :Y jZ W,0 O Z t. "Q r : �rLO. c 0 P �: C t6 ING o C E Lm a � N O tel`' > r a� L o U) p �■■� tm No > �■■� _ V to � h a) Q = t t O E •�- c a Q U) J ..�■ •Noy O W:�3 cm a� > o = C �( 5 CCD D m w . • c LL 0 i V O = c O 2 O CL CD N F— N CO m co W G 'a +�•' O p w - LU d N o o O O N = -_ -� • _0"r o Z O MCD"2`~= O 0 f" 0 o U > Z m Z co w a W W CL IM O U :W :a C7 0 00 U w U) O U CO LUJ m ES li Proposal Page No. of Pages CHRISTOPHER J. DAVEY 545 Sharpeners Pond Rd. NO. ANDOVER, MA 01845 Its a (978) 975.3736 LIC. #034690 HICR #110256 -0030 PROPOSAL SUBMITTED TO PHONE DATE STRE JOB NAME JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE We proPOSC hereby to furnish material and labor — complete in accordance with specifications below, for the sum of: dollars ($ . ) Payment to be made as follows: �''?Gyrrc-r' l�'���� `_'•yJ � �-/�'�! `�i c�'7� ��9/t`I�-�" All material is guaranteed to be as specified. All work to be completed in a workmanlike ;' i manner according to standard practices. Any alteration or deviation from specifications be Authorized -low involving extra costs will be executed only upon written orders, and will become an Signature extra charge over and above the estimate. All agreements contingent upon strikes, acci- dents or delays beyond our control. Owner to carry fire, tornado and other necessary Note: This proposal may insurance. Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within . / days. We hereby submit specifications and estimates for ................................................................................. _u �/................................................................................... v ...�..i..................................... .. �................................................................................................................................................,............................................................................... .4 ............... ..1.% /C'om............ .........�.t... /�' e U(�l .............................. ........... ._ ......(. ........awn ............... t ... ..... .... .... .... ................. ..__..._.._.................................................._.................................._..._........................... Acceptance of Proposal— The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Payment will be made as outlined above. / Date of Acceptance: r Z `t (b�,JI Signature To Reorder. 800-225-6380 or nebs.com The Commonwealth of Massachusetts Department of IndustrialAceldents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dza Compensation Insurance Affidavit: Builders/ContxactorsXlectricians/Plumbers. TO BE FILED WITH THE PERM TMG AUTHORI#— Name (Business/Orgauizationllndividual): Address: City/State/Zip; Phone #: Axe Y.... employer? Check the appropriate box: 1, ❑ I am a employer with _employees (full and/or pari time). 2. ;Q I am a sole proprietor or partnership and have no employees working for me in !—` ca acity woworkers' comp. insurance required.] 9 -IF- �CIK- oto any _r 3.E] I am a homeowner doing allwork myself. [No workers' comp. insurance required-] t <1 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 proprietors with no employees. 5. ❑I am a general contractor and 1 have hired the sub -contractors listed oa the attached sheet. These sub -contractors have employees and have workers' comp. insurance.t 6. Q We are a corporation and its, officers have exercised their right of exemption per MGL G. 152 91(4) and we haveno employees. [No workers' comp. insurance required] Type of project (required): 7. El New'donstrudion 8.emodeliiig 9. Demolition 10 [] Building addition I1.�ZElec-irical repairs or additions 12TjW:P]�uinbing repairs or additions 11 [] Ro6f repairs 14.Fl Other *Any applicant that checks bb.k 4j must also fill out the sectionbelow showing theirworkers' compensation policy information: 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 flus box must attached an additional sheet showing the name of the sub -contractors and state whether or not fhose entities have employees. if the sub -contractors have employees, they must provide their workers' comp. policy number. I ant an employer that is providing workers' compensation insurance for my employees. Below is thlicy arad job site e po information. Insurance Company Name: chi ?J_()ExpirationDate: /0 f Policy # or Self -ins. Lie. #:1 (_(a�� Job Site Address: Y G City/State/ZipAo Attach a copy of the workers' compensation policy declaration page (showing the policy number and expirat�io�u date). lation punishable by a fine up to $1,500.00 Failure to secure coverage as required under MGL c. 152, §25A is a criminal vio 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 DTA for insurance coverage verification. I do Hereby cert' der tl pains an/dp)enalties ofperjury that the in provided shove is -ue and, correct Official use only. Do not write in this area, to be completed by city or town officiate City or Town: Permit/License # issuing Authority (circle one): i 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." A.n. 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 enferprhe, and including the legal representatives of a deccae mployer, or the receivefor, 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 commonwealt7a 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 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 requited 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-MA.SSAFE Fax # 61.7.727-7749 Revised 02-23-15 wwwmass.gov/dia f = Christopher J. Christopher Ca 545 Sharpners N AndoVer, AAA C��e � �n�rzmrrcuerlf� � , office of Consume; Affairs & Bu t�ryS�Czr�Lzr1� J E=1�� `�Ts' CTOR Regulation HOME IMPROV �NT,CONTRA TY -- Individual Ex iration 10/13/2018 Undersecretary Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS -034690 Construction Supervisor CHRISTOPHER J DAVEY' 545 SHARPNERS POND RD N ANDOVER MA 01895 I �-j ZCK &-- Expiration: Commissioner 12/09/2017