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HomeMy WebLinkAboutBuilding Permit #458 - 6 WATER STREET 1/15/2008Permit N0: Date Issued 4sy BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received / 10-67 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- .Residential New Building One family Addition (_qA__1ieratio Two or more family Industrial - No. of units: Commercial <Repair, replace t Assessory Bldg Others: Demolition Other Septic' hU1l°°ell. FloodplWir/etiands, Vllaterslaed.Distnct /bpv/4 Utbt;KIN I IUN OF WORK TO BE PREFORMED: 7111x)4,6E , -&o-z-d wilyv o-%) , B.J2r ce_ 0-a"�"bcfG�-rx�e� die?7s�� Si7�i'.,rtc eve. VK -f 17- //_r"a S Identification Please �ype or P}'int Clearly) OWNER: Name: i.tj %CX ,c.J Phone: Address:_ CfONTCTOR dame„ 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: $ /�. �� FEE: $ Check No.: 11 X17 5/S_"7 01; Receipt No.- NOTE: Persons contracting with unregistered contractors do not hav ace t t .$uaran nd 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 )(ANNING & DEVELOPMENT COMMENTS DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED .HEALTH COMMENTS r Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street ENT = Temp Dumpste. r .on site, yes no Street -/ , 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 NUTES and DATA - (For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 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 o Building Permit Application L3 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 o Building Permit Application ❑ Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/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 o . 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) o 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Location (a " -P/ "._- No. ���� Date NORTH TOWN OF NORTH ANDOVER 0 'A I Certificate of Occupancy $ Building/Frame Permit Fee $ A10-77JAGNUSE Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check CA< 417 { 2081/4 Bug Inspector �1 O H x w O uo -u O w v cn , a �C b O w O aG v ,.0 U G x a ato p c2 C w � w W p w cn C w U W O w G ir. W �W/ W w v w z cn L Q v v) W me :� :CcA A 000— m f o 0000, cc 0 � V •� c w W = Qv W � �• .r � $ A�c � OHO y C o V 10 ts cm fti \0 CD . o tc 'Z3 o ``•m3 w C y O � y � cm O vJ zip \� • y C C O \vv y w �.E 3 U av� m e y O =_ r ^ OpCD v` macs or m V y O i co o O C o c Q m y OC.C O = m mw 30 N COD Z = C •.. •N 0.,= O • Z •� Gi = ICD y O • V m VOA C CLy m 'o z �Hy= r- t 8aO-m 0 E CD • L O Z °D CL O y � C CD CM I � � y O .O 'E CO m CD 0 CD CL F- � CD �3 O Oca OL M O CL CM Q co o � C O Q 'C3 c Z CD v ' cc c C c CO)CL UA U) w U) ce W ui C9 LLIW U) 0 Z;.z z W, 00 rn 5 CCR, z oz 'j? '07 co Ca :0`2 z co 00 �0, cr 0 5 LU W, a- w 00> 00 0 Z;.z J ok J Date.. ............................ 3? ;•t�`` �,� TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that°-.:-!-�� ..............................:................................... has permission to perform ....:'.... .I ....... wiring in the building of .: ...........4-�'�--�:-....... ef ' ................. at .........`............. ........ .......... , North Andover, QMass. Feel? . 1.... Lic. No. ................................................. ELECTRICAL INSPECTOR Check # 7958 4 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers -_f!___..T n .. Name Address: ?) ��G�l� C1tV/�'tAtP./71r►' ll S Z7,5 - a Are you an employer? Check the appri 1. ❑ I am a employer with f eoyees (full and/or part-time).* 2. © I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp, insurance required.] , 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t ,� 4-YrIl /0 MPAVAII i uvuv.rr. date box: 4. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.$ 5. ❑ 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.] Type of project (required):. 6. ❑w construction 7. [C f�emodehng 8. ❑ Demolition 9. ❑ Building. addition , 10.7 Electrical repairsr or additions 11 -0 Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other -Any appucant mat cnecKS box *1 must also fill out the section below showing their workers' compensation policy information. t Homeow;ters who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new atiidavit indicating such. +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-contractorshave employees, they must provide their workers' comp, policy number. I am. an employer that is prov information. iding workers' compensation insurance for my employees. Below is the policy and job site 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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-riolator. Be advised that a copy of this statement may be forwarded to the Office of` Investiati f the DIA for itis , ce co era a tion. Ido here , i /under the pal s and p Waffles f r ury that the information providedjove ' true and 'COT o eco Si atlu`e: � u� Date: Phone 1#:CPM 1 9. 14S- 1-1 -.1 (�-)-�n — Offtetalwse 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 "ever state or local licensing agency shall withhold the issuance or renewal of a license or permit to,bperatte?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 of public work until acceptable evidence of compliance with the insurance requirements of this chaptf�r have been presented to the contrasting 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 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 laworif youare 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 y car. 'l yer a hone o ncr or citii,ea is obtaining a license of pernut not reiated to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone -and fax number: , The Cormnonwealth of Massachusetts Department of Industria Accidents Office of Investigations 604 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext.401,6 or 1-877-MASSAFE ` Revised 11.22-06 Fax # 617-727-7749 www-mass_govf dia F Jak / _a'✓- APy U r 0 l.ommonweaR olMaaeachuJeifa 2eparfinenf ofc�ire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only ry Permit No. and Fee Checked [Occupancy ev. 1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical,Code (ME , 527 1 . 0 (PLEASE PRINT IN INK OR TYPE ALL INFORAMT�N) Date: ;; ; i ) City or Town of: N ft ��/'�+ To the Inspector f W es: By this application the undersigned gives notice of his or her intention to perfornB.he electrical work described below. Location (Street & Number) Cn — W -4—a S Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes. 0 No ❑ . (Checkpropriate Box) Purpose of Building Util' y Authorization No� 1 Zai Existing Service 100 Amps C Z� Volts Over headUndgrd ❑ No. of Meters New Service Z00 Amps M / �(1Volts Overhead Undgrd ❑ No. of Meters -'Z-- Number of Feeders and Ampacity ` "D bw 04-S S W1 Location and Nature of Proposed Electrical Work: (' 1 (om,m 4 C Use., /' Completion of the following table may be waived by the Inspector of Wires. No. of Recessed LuminaireI L 4 No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above [I In- rnd. rnd. El o. o Emergency Lighting Batteg Units No. of Receptacle Outlets No. of Oil Burners • • FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Tonal No. of Alerting Devices No. of Waste Disposers p Heat Pum Totals: Number Tons KW No. of Sel Contained Detectio /Alertin Devices No. of Dishwashers Space/Area Heating KW Local Municipal El Other Connection No. of Dryers Heating Appliances KW Sectio. ourityf Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Eq uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value f EI ctrical Work: (When required by municipal policy.) Work to Start: ` 2 8 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE C VERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cov age is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Speci I certify, tin pains and pe<zah r, ry, that t matin o th' a plication is trite and completer.. FIRM NAME: ` LIC. NO.: Licensee: � `�Q C Signatu LIC. NO - (Ifapplicable, enter "exempt" i the license nwnber line.) Bus. Tel. No Address: SJ Alt. Tel. No. *Per M.G.L. c7_147, s. 57-61, security work requires Department of Public Sa "S"License: Lie. No. 7 717 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's a ent. Owner/Agent PERMIT FEE: $ Signature Telephone No. Y I Location No. Date TOWN OF NORTH ANDOVER f � 9 Certificate of Occupancy $ -TS cHU E 9 < Buildin /Frame Permit Fee $ � �^Mus � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # `/ 8 r 20899= f Building Ins&ctor pJER #"F� �p rro� s► 40 =a yN a. 0 s Ys O 67 00 N °0 N" O F+ U O io 5 O TA A A, 0 4.6 go .l� \C 0� Q U cd 0 .-M �I 9b c° I 0 z 0 0 M1 ami 0 p" — . U +�0-+ cUd o � U c� CAU " cd c{O to to toe cH O Cd O cid U U 'sem ,: O; U � cd o0�u,0 z ` in 3 n r-) ¢, o 0 � z �� a�°�n•�a 9b c° I 0 z 0 0 M1 RMGraphics Raymond M. Messina REMITTANCE: 8-A Clayton Ave. • Methuen, MA • 01844 26 ISLAND STREET • LAWRENCE, MA 01841 978-682-3913 PROOF iL— DESCRIPTION '?) 1, '& Tall x*9�1 Wide, COLORS - Dark Green, • Signs and Banners • Trucklettering • Offset Printing • Silk Screening • Graphic Design • Ilhnstrations & More TO; Rennies PROOF DATE 1/14/08 Custom Shaped, MDO Wood with Paint and Vinyl Sign. O© Green, Pink, White, and Black.... INSTALLED. fp�% COPYRIGHT © 2008 RMGRAPHICS DUPUCAnON PROHIBITED 50$ DEPOSIT IS REQUIRED FOR ALL WORK DONE. BALANCE AT INSTALLATION! ACORD- PRODUCER CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIDD/00 111 11 Zoos THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION M.P. 1060 ROBERTS INS AGCY INC Osgood Street ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. North Andover, MA 01845 POLICY EXPIRATION DATE MM/DD/YY (978)683-8073 INSURERS AFFORDING COVERAGE NAIC# INSURED CHRISTOPHER MACENAS INSURER A: EACH OCCURRENCE $ INSURER B: 316 MIDDLESEX STREET INSURER C: MED EXP (Anyone person) $ NORTH ANDOVER, MA 01845 INSURER D: ASSOCIATED EMPLOYERS INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADVL LTR NSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YY POLICY EXPIRATION DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMSMADE CI OCCUR nTED PREMISES Ea nce $ MED EXP (Anyone person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICYF_j PRO- JECT LOC PRODUCTS - COMP/OP AGG $ AUTOMOBILE LIABILITY ANYAUTO COMBINED SINGLE LIMIT (Ea accident) $ ALL OWNED AUTOS SCHEDULED AUTOS — BODILY INJURY $ (Per person) HIRED AUTOS NON-OWNEDAUTOS BODILYINJURY $ (Peraccidenl) PROPERTY DAMAGE $ (Peraccident) GARAGE LIABILITY AUTO ONLY- EAACCIDENT $ ANYAUTO OTHER THAN EA ACC $ AUTOONLY: AGG $ EXCESS/UMBRELLA LIABILITY OCCUR CI CLAIMSMADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY X ORY IMITS OER E.L. EACH ACCIDENT $ 100,000 D ANY PROPRIETORMARTNERIEXECUTIVE oPFIC/MEMeEXCLUDED? If yes, describe under un TO BE ISSUED 1/11/08 1/11/09 E.L. DISEASE - EA EMPLOYE $ 100,000 E.L. DISEASE - POLICY LIMIT $ rj00 000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS roor�onwr� un. n ..�-I - --M I � nvwr_rc CANCELLATION TOWN OF NORTH ANDOVER, MA BUILDING DEPARTMENT 1600 OSGOOD STREET NORTH ANDOVER, MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVF_ w ACORD25(2001/08)c ACORD CORPORATION 1988