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Home My WebLink AboutBuilding Permit #322-13 - 62 PARKER STREET 10/17/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION /L��/�� _ Print PROPERTY OWNERj JCplJ,�d✓1 _ Print 100 Year Old Structure yes no . MAPINO: hqq PARCEL:00 Y ZONING DISTRICT: Historic District es no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Res' ential Non- Residential ❑ New Building Xone family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DE RIPTION OF WORK TO BE PERFORMED: dentificat' n Ple a Type o riot Clearly) 57 OWNER: Name: Phone: Z Address: 1 yJ CONTRACTOR Name: /� Phone: d9�/�3 Address: S-141 Supervisor's Construction License: - � Exp. Date: Home Improvement License:—J Exp. Date: ARCHITECT/ENGINEER Phone: ° Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED C T BASED ON$125.00 PER S.F. Total Project Cost: $ � CJ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have.access o the guarantyf Signature of Agent/Owner Signature ofcontractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ I 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes ti Planning Board Decision: Comments } Conservation Decision: Comments z Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at'124 Main Street Fire Departinerit-signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Dieter 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 B Notified for pickup - Date I ' i Doe.Building Permit Revised 2010 Building Department The fohowing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Li Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses a Copy of Contract ❑ Floor Plan Or Proposed Interior Work o 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 o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract Li Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) i ❑ 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) I ❑ Building Permit Application u Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of BuildingPlans One To Be Returned to Include Sprinkler Plan ) nd ( ) p Hydraulic Calculations (If Applicable) ❑ Copy of Contract o Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products I 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 j Doc: Doc.Building Permit Revised 2012 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 UT. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information _ Please Print Legibly Name (Business/Organization/Individual): XA� Address: / City/State/Zip: -I�d 7 g Phone#: /� Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I m a employer with 4. ❑ I am a general contractor and I 6. ❑New construction mployees(full and/or part-time).* have hired the sub-contractors Z. I am a sole proprietor orr- listed on the attached sheet.# ? E]Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Ele trical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ umbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12. Roof repairs insurance required.]i employees. [No workers' comp.insurance required.] 131-1 Other kny applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Elomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :ontractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site formation. tsurance Company Name: :)licy#or Self-ins.Lic.#: Expiration Date: ►b Site Address: City/State/Zip: ttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). t ilure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ie 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 up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of vestigations of the DIA for insurance coverage verification. to herebyirtlirZIA Ides of perjury that the information provided above is true and correct. nature: Date: Lone#: 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#: Informati®n 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(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 boxesthat 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 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 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or. 1-877-MASSAFE -vised 5-26-05 Fax#617-727-7749 1, 1 OSHA .11-002637064 'i This card admowledges that the recipient has successfully completed a i 10-hour Occupational Safety and Health Training Course in Construction Safety and Health MITCHELL SAAB 4l (Ti iner name—print or type ( ursdiind date) �lassachusctts- Depattntcnt of Pttblic lfct} Board of Building Regulations and Standards Construction Supervisor License License: CS 20864 MITCHELL L SAAB 57 BRIDGE ST SALEM, NH 03079 1. Expiration: 7/23/2013 (unu»i�siuner Tr#: 1001 711.�onrmta�uoea�li o�✓UGaaaac/xtl Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration: ,;=171835 . Type: Expiration: --4f24/2014 DBA MI HELL SAABGENERAL CONTRACTOR MITCHELL SAAB=•,:. 57 BRIDGE ST Undersecretary SALEM,NH 03079 -- -- _ � NORTIy Town. of 2 E : ., 6Andover 0 . . No. soh ver, Mass, �� • • 1 L COC"K"RWICK y1' AERATED S U BOARD OF HEALTH Food/Kitchen PERMI�T T LD Septic System • THIS CERTIFIES THAT ........ ... .1.11101 ......... ............ rAINRO.....................................................:. BUILDING INSPECTOR Foundation has permission to erect .................. ...... buildings on .....L.Z.......Pa1.l.:. .... ..�....... Rough to be occupied as ..................... ...... :.............�........A/�v..�.0 . ...... ............................... Chimney provided that the person accepting this p rmit shall in every respect conform tot erms 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 PERMIT EXPIRESONT ELECTRICAL INSPECTOR (0 P UNLESS CONSTR N• S 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 No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE ROOFS MITCHELL SAAB SMOKESTACKS INSULATION GENERAL CONTRACTOR TOWERS PAINTING POINTING REPAIRING 57 Bridge Street • Salem, NH 03079 WATERPROOFING SIDING 603-893-6332 Tel/Fax: 603-893-3466 PROPOSAL AND CONTRACT DATE:.......` h.... .../. ...................:................ TO...,h. .�.e! .. `. ?4�.... �a'2..... Type of work......,/ . . . .. ... ........................................ ATTN... ...... .......... PROPERTY........ . ....... ... .. . ..... .......... 7� f 76 LOCATION.....,,�'f�'......... .��xZ.!. ....?0,4 ,44 We propose to furnish all necessary labor, material, and equipment (except as noted below) to perform the following work in First Class workmanlike manner. Roof maintenance is.required annually. Not responsible for water back up caused by snow and ice. r Scope of work. ,+!' h,f''' '...., 4 r....., .... 7.... . ........ r ' ? •+ " ' ve., .ela -.e,... ..... ... ...x,.... '"........ .. . . ............ ti ... < .f..:(...... .. .A.. ........... ...,/.��er .......i ... � ..�d......r ........?, 4-r.. Z. .. .fa' ...... +!° ••,--n. . ��%. .. . !� . �. . .. ..,,% ... For the Sum of''"............. .�..�,t.......................... eo& �J/� Signed by.,f .� .. .:.a.'.t: .:;,. �:1� : ...................... APR-06-2012(FR I) 15:06 (FRU 9785570 30 P.0011001 CER I IFICATE OF LUU31LITY'INSURANCEOp® � �- � m0� low OIL � Y� � T"HWE p.1 ,:num 34&A Elaaaak tAa. 1tOLOCR.ZtO tl�3NOTAMDO MOOR 1�7f1€!'�tttltl�lilllRt iNN xc`rt2= x�-iD18i5 -� - IN PACMs 978 ABS GM 1mn:978 557 2330 1 W i GtOMp%%M emekye=eat 2". E.b. 26018 as ma 3019 R _---�_2 NORM& i ME um�v'� L�/[BbYiOlllrlilBfl110iE�R�pI�tANC�OL4. -_ i sslL�F RAYS um tA0�t11r e a 300000 t fl S 8P3800469:4 08/3am 0124M C50000 -� QAYSIIRDL $ �Os'�graeaao0 3 moo i las ilk► a! s moon s c a-600 00 . ter'• MMM.aWWAW :.60100od p Pau m a ONG a�sts�Lan s ! �0 i ¢ � - 11Ca1Y AU[�d�Y•!#AT S AM 13 Aftr. coca Dammam : 1 � s F]MwMe - a iwoevtaa+aa uasnY ! t#a+r L • � view= FrILe� �pwvr u�+ou.a�.u�wwasrresd eB.FoAsrE�lao�r� ' t ti ldl'0:H1�um OMMEUAIM - axarananr��avo.naao�ro�aEearaaamaara�� . aatait�ta�t�memao�t�t.a�ras�aaum. ��a gtdbe3i zasa8 aeaeeao®e�a ascrosimoFiwr�muPoar�e insa�eswt 578 8gi c Sr. 'the A�ns�s�dMgosrs qed ms�vPACORD Location �j ,f��/LiJ No. zZ— Date A' �---� ® TOWN OF NORTH ANDOVER e ` 7 IAA • Certificate of Occupancy $ Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee $ ��k2rl:rr�5�t TOTAL $ Check#— �� 25850 1 Building Inspector