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HomeMy WebLinkAboutBuilding Permit #382-2017 - 59 SALEM STREET 10/11/2016 &V A7"�t� BUILDING PERMIT O�SA40 TOWN OF NORTH ANDOVER - APPLICATION FOR PLAN EXAMINATION H !• mop 1` � Permit No#: Date Received /®�I - '2o/(v ADR^rED �5 gssac Huse Date Issued: 10 IMPORTANT: Applicant must complete all items on this page Fr-�int,- PR,O,PERTY OWNER - I l� a�'1 ' -Pnr�t 9 Dr©YeSt0uT c` `tu eye}f no �b, �� H � es) nod MAP' Irl —PAIR<CEL: =ZONING,DIS�TRIC � __ istoxic District y _ . _ yi �k. achene S,ho�aVij a`-eea nod TYPE OF IMPROVEMENT PROPOSED USE Resi tial Non- Residential ❑ New Building ne family El Addition ❑Two or more family El Industrial Iteration No. of units: ❑ Commercial 2❑ Repair, replacement ❑Assessory Bldg ❑ Others emolition ❑ Other ® Septit, C�7°Welly �I►Floodplainf� ®�Wflamds, ❑ Watersh4edlDistricf - DESCRIPTION OF WORK TO BE PERFORMED: :,Jdentification- Please Type or Print Clearly 9 OWNER: Name: - Geev► r,�o Phone: Address: 3�9 �� ��• /Uv `, �l '�_ �7 -�5� ��'l.. C.ontractor�Name, .._ 5 � wa _.Phone Addressl f uervior�s3Con - nd;Licersp _ �, i Home lmpr uementk Lice4nse? 17�-�I Exp.�: ®`a_te Zg _ Za l z ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. . Total Project Cost: $ 57- 5-0 FEE: $ Check No.: 19- Receipt No.: 3 I D NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund �-C•I- 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 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 . HEALTH Reviewed on Si nature j <-rOMMENTS -Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes e Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEP�ARPTFjME�NT� l�rne Dumpster onsite ye�` TM, o p a s Locatetl 92(0.4�Mai, eet r ,; Fire Dept ment!s gnature. ateiY:: � f v 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.$100-$1000 fine NOTES and DATA— (For department use) i F ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Location C A No. 201-7 Date • - TOWN OF NORTH ANDOVER ss mN b"' • Certificate of Occupancy $ Building/Frame Permit Fee $ �0 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ i i. Check# F 017 L,/Building Inspector E" NORTH Town of t sAndover O - ;` 0 s b oh ver, Mass, CONIC N�WKM �• S U'` BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ...................................... BUILDING INSPECTOR 0..09 has permission to erect .......................... buildings on ........$I.....J!?te. ......Aor...................... Foundation y ♦ ,.• Rough to be occupied as ��r ......l �!N..APA*�".... A It'.:...tor.f PC...rC�A Ar 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC N STARTS Rough \ Service .... ... ............ . ..................................................... Final BUILDING INSPECTOR 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. ACsFSales: 800.448.3636 Phone: 804.271.2363 NEXT GENERATION . Fax: 804.743.7779 0 LET'S GET IT DONE STORMWATER MANAGEMENT SOLUTIONS acfenvironmental.com Site Development and Retrofit . Low Impact Development . Green Infrastructure FOCALPOINT(high flow biofiltration) - R-TANK(modular subsurface storage) - PAVE DRAIN(paving,drainage,storage) - FABCO(decentralized treatment) id- O 1 i �I x 0 ISBELL GENERAL CONTRACTING 10 Korinthian Way Andover, MA 01810 CS#081684 HIC# 172105 October 10, 2016 Contract for the removal of the non load bearingwall between the kitchen and dining room g at 59 Salem St.for Cathy and Glen Johnson This contract is for the removal of the wall located between the kitchen and small dining room. The total cost for this project comes to $5250, and contains all of the following scope of work; • Remove existing cabinets along wall, save for future use along outside wall. Remove wall at countertop height creating a half wall for new granite to cover and extend over. j • Relocate electrical wiring as necessary. • Patch ceiling, wall and floor where needed. • Remove chair rail and crown throughout small dining room, patch and blend ceiling where necessary. • Relocate cabinetry along outside wall. Install new LED under cabinet lighting under new cabinets. • Paint ceiling and small dining room with Benjimin Moore paint, colors TBD. • Dispose of all old framing, cabinetry not being used. This contract includes all disposal and permit fees, and is estimated to take approximately two weeks. 1 Cathy and Glen Johnson Date Oet. lU 2-6 Robert Isbell; Date /� I PAP l G _ The Commonwealth of Massachusetts f Department of.�ndustrialAccidents _ I Congress Street,Suite 100 Boston,MA.02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERwrTZNG AUTAORIT Y. Please Print Legibly A licant Information Name(Business/Orgariization/Individual): ::;lj _LL ��C-2��✓� �O`� '"L '� C�� Address: le a✓;n �a n City/State/Zip: ✓�n��'✓c r i I7�L D`o't O Phone . ' PP P Type of project(required): Are you as employer?Check the ro riate box: em to ees full and/or part-time,).* 7. ❑ VST construction 1.❑�a.ma ployer with P Y ( P e ro rietor or partnership and have no employees Working foz mein $. ( Remodeling 2. P P any capacity.[No workers'comp.insurance required.] 9. ElDemolition 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole xep 11.❑Electrical airs or additions proprietors with no employees. 12TQPlumbing repairs or additions 5.❑I am a general contractpr and I have hired the sub-contractors listed on the attached sheet. 11[:]Roof re]iairs These sub-contractors have employees and have workers'comp.insurance.$ 14.❑Other 6.❑We are a corporatiori and its,officers have exercised their right of exemption per MGL c. 152,§1(4),.4 We have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#i must also fill out the section below showing their workers'compensation policy information. t Homeowners who shecks tbk affidavit indicating they aze doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors 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. compensation insurancefor my employees. Below is the policy and job site X am an employer that is providingworkers' information. Insurance Company Name- Policy#or Self-ins.Lic.#:. Expiration Date' City/State/Zip: Job Site Address: compensation policy declaration Attach a copy of the Vvorkers' 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. X do herehy certify under thepains a`ndpenalties ofperjury that the information provided wave is true and correct. Date: I D f! 1 �. Si ature: 224 Phone#: in this area,to he completed by city or town official, Official use only. Do not write l. 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 enferprise,and including the legal representatives of a deceased employer,or the receiver'or,trusted 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 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 commonwealth 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 ofpublic 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 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 insuraance 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 Iuvestigations 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-A ASSAFE Fax#617-727-7749 Revised 02-23-15 wwwmass.gov/dia ' Massachusetts Department of Public Safety IBoard of Building Regulations'and Standards License: CS-081684 Construction•Supervisor ROBERT E ISBEL.L 10 KORINTHIAN WAY O ANDOVER MA 0;1810 I 'Expiration: 0 0912017 Commissioner I Comm 1" ...--.,C��e ioaiiai�anirr�•ecrl(l ofC�ij� s i Office of Consumer Affairs&Business Regulation CONTRACTOR, .ONTRA (�-iOME IMPROVEMENT C WON, + 105 Type: q; IRegistration5 ' 172 Individual " Expiration; _520x8 - —` ROBERT ISBEL' ,. ROBERT ISBELL 10 KORINTHIAN WAY''f r k _ ANDOVER,MA 01844 Undersecretary 1 I