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HomeMy WebLinkAboutBuilding Permit #27 - 66 JAY ROAD 7/8/2009 i NORTH q BUILDING PERMIT 'e °c TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued:` �© IMPORTANT:Applicant must complete all items on this page LOCATION - J.A- 6 Print PROPERTY OWNERol , :.Print MAP NO: PARCEI_: ZONING DISTRICT: Historic District yes no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Resi Non-Residential New Building ne fa A ition orTfamily Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Identificatio , Please Type or Print Clearly) OWNER: Name: LG yy1 14L Phone: , �JT� Address: CDP z AJ)9 CONTRACTOR Name:— one: F Address: b 14111 i Supervisors Construction License: -� `- _ Exp: Date: Home Improvement License: 4/3 76P Exp. Date: 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: $ M FEE: $ Check No.: ®� Receipt No.: NOTE: Persons contracts g wit register ontractors do not have accesst e Mtyd _ entOwnercSStureof Ag 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 ��u i1�liTrg-Pet-�IicatFo n 2r' Workers Comp Affidavit on Photo Copy Of H.I.C. And/Or C.S.L. Licenses Lei Copy of Contract F ork ❑ Engineering Affidavits for Engineered products 9 9 9 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 E3 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 ❑ 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:INSPECTIONAL SERVICES DEPARTMENTMFORM07 Revised 2.2008 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 r 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: Comments Conservation Decision: Comments 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 Department 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 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) ❑ Notified for pickup - Date .......................-----....._........................._...._..._.................................................................................._............................_._............_..__..__.._....----.._............................_....._..........._............._-...........---...................._.._._..._........._........................_...._........................... Doc.Building Permit Revised 2008 Location -� No. Date `7 &GRT" TOWN OF NORTH ANDOVER G�� �w yah � 9 • ; ; Certificate of Occupancy $ o, ,,• . ,/ Building/Frame/Frame Permit Fee $ s,+cHusE 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 20 22198 Building Inspector NORTH Town of s _ 4Andover . o . 7 q..pw,ry . No. LAK dover, Mass., • COCHIC EwICK 11A- %p ADRATED pP0\ Cj `s E BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ��.� . ,. p .- ............................................... ......... ............. ......... .................�....... .. Foundation has permission to erect .............. .................. buildings on .....&.4 tir .#k. ...... ........ Rough to be occupied as... .� �. ......�.��� .. Chimney ....... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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 a PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUZ STARTS Rough ....................................... _ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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.. SEE REVERSE SIDE smoke Det. AGORA. CERTIFICATE OF LIABILITY INSURANCE OP ID CR DATE(MMiDDIYYYY) H21c07/08/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Thomas Gregory Associates Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 601 Edgewater Drive 5235 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Wakefield MA 01880 Phone:781-914-1000 Fax:781-246-2601 INSURERS AFFORDING COVERAGE NAIC 0 INSURED INSURERA Western World Insurance Co. Hammertime Construction Co Inc INSURER B American International group Kathy A. Weishaar INSURER C: 174 Lake Street INSURER Or. Middleton NA 02149 INSURER E: COVERAGES 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. "UK UJU-L POLICY EXPIRATION LTR NSRE TYPE OF INSURANCE POLICY NUMBER DAE P&MM DATE lW O LIMITS GENERAL LIABILITY EACH OCCURRENCE S1,000,000 A X COMMERCIALGENERALUABILITY NPPI179012 10/07/08 10/07/09 PREMISES Esoomwence $50,000 CLAIMS MADE X❑OCCUR MED EXP(Any orre Parson) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEM AGGREGATE LIMITAPPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY M P7RCT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per pan) $ ro HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per acciderd) PROPERTY DAMAGE $ (Per ecdderd) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EAACC $ _ AUTOONI.Y: AGG $ EXCESSNMBRELLA LU4BILTIY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ S DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITSIIVIM ER B AN�0�LIABILITY ANY PROPRIETOR/PARTNERlEXECUTIVE WCOOIOO8663 07/08/09 07/08/10 E.L.EACH ACCIDENT $500000 OFFICER/MEMBEREXCLUDED?doseribe E.LDISEASE-EAEbIPLOYEE $500000 SSPECIA PROVISIONS below E.L.DISEASE-POLICY LIMIT $500000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES i EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION NORTH-3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Town of North Andover NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Building Inspector FAX' 978-688-9542. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,RS AGENTS OR REPRESENTATIVES. AUTHORRED SENTA r ACORD 26(2001/08) 0 ACORD CORPORATION 1988 The Com nwealth of Massachusetts fi Department of Industrial Accidents �� '_ Office of Inwesd-ations i, . a 600 ITashington Street Boston, MA 02111 Workers' Cwww-hwcs gov/dna . ompeQsation Insurance Affidavit: Builders/Contractors/Eiectricians/Piambers A, iicant Information Please Print LeQibl Name(Business/Orgsniza6an/lndividuai): �{ Address,: City state/zip;-J� � . 0 Phone#: Are you an employer?Check the appropriate box: I. I°am a employer with 4. Type of Pre.1�(required): 11 ❑ I am s general contractor and I employees(full and/or part-time).* have bir ed the Sufi-earttractars 6• ❑New construction . 2.Q Tam. asole rietor or partner-, I' PToP p listed ort the attached sheet,3 7. ❑Remodeling ship and have no employees These stdi_contr�Ts have working for me in any capacity, worketz' comp.insurance. g' Q Demoiitiatl [No workers'comp.insurance 5. ❑ We are a corporation and its 9. Q Building addition 3•Q required.] Officers have exercised their 10.❑Electrical repairs or additions I am a homeowner da' nit work ri � t of Myself 'co � exemption per MGL J I.❑Plumbing repairs or additions Y [No workers comp. c, 152, §1(4),'and we have no insurance-required.]t employees.[No wortCers' 12 Q Roof Tnpairs COMP. insurance required.] 13 Q Other `f4try nppticartt tient dteeks bo>'#I must also SII out the section below showing their worker'iiompensetioti policy information t Fiomeownir¢who submit this affi'davh indjeaYing they we_tlaing all work and then ham outside contractors must submit a new afrtdavit indi ' j . �Ca" tors that check this box reustettaohed as additio�il ahee<show' . ° S such rug the mffne of the sub-c=tractors and their workers'cow.pcIic,irfom>ation. I air an employer Phar is prPrridcng:workers'compensadar7 i�ormadon. insuran,cefor enloyr=. Below rs 'he Potelmid o bstt site . Insurance Company Name: Policy#orC— Self-ins Lie. > Expiration f0 a Job Site Address City/state'Zip:�l�'G Attach a copy of the war rs'.compensation policy deciaratiou page(showing the policy number and expiration date -don 25A of MGL e. 152 canlead to the imposition of criminal Failure to secure coverage as required under Se � 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. Be advised that a copy of this statement may investigations of the DIA for insurancbe forwarded to the Office of e coverage verification. I do her'ehy ce gry under the pains and penalties of per &uy t*at the in ormago>1 f Provided above is true and coned ST tur e. Date: Phone#: Offichd uset write in ibis area,m he convicted or town.o ciaL City or Permit/License# Issuing one): I. Boardilding Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing fuvpecEor 6.Other Contact Person• Phone#; Information a nd Instructions , Massachusetts General Laws chapter 152 requires all emp Icy=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'foreping engaged in a joint enterprise,and includi"g the legal representatives of a deceased employer,dr the receiver ortrustee of an individual,partnership,associatioru 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 orrepair wont on,such dwelling hoarse 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 oar-local licensing agency shall withhold the issuance or renewal of a license or permit to operate a busfoess or *o construct building in the commonwealth for any applicant who has not produced acceptable evidence.oV compliance with the insurance coverage required." Additionally, MOL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public woric until-acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the carttracting authority." Applicants Please fill out the workers'compensation,affiidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractors)name(s),address(es):and phone numbers)along with their certificates)of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees othefthan the members or partners,are not required°to carry workers'ccsmpensation insurance. Ifan LLC or LLF 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.. Aiso loe sure to sign and date the affidavit The affidavit should be returned to the city or town that the appiicalion 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 rupimd to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self insurance'Iicensc number on the'appropfinte 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 permittlicense number which will be used as a referencc 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 oftbe 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 f&m permits or licenses. A new affidavit must be filled out each year.When a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a clog license or permit to bum leaves et:.)said poison is NOT.required to complete this af"ndaviL The Office of investigation 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 Departrnent of Industrial Accidents Office oaf Invesfiba>Eians 600 Washington Street BasE MA 02111 TeL #617-7274900 6=406 or 1-977-MASSAFE Fax#617-727-7741 Revised 5-26r05 wwW.mass.gov/dia �, .. `v�l D6 Y�9 '•,',..�f��/ R�lf(.!J.Q;k21(� i y y ij{. U17ttif� RCR f. , �;> rufut�oanii tai srds -� _ .Icsnse or registratign valid for judivia use on_1y l•IOME IMPROVEMENT CON RgCTOR " efo►.c the eapirat daft Xf fi0n4jj etutt�tow Registration 114376 Boardtoflu�din Re lahons and Staa#c�ai8s5< Expiration -3/3/2009 w.e P $1� 7r# 260846 ' One.Ashlrurton Plaieel2m 20�, .� fi Type i'r�vate Cor ora.Gon goston;111a 0�1fl8ar " f lAh1MERT1W9E CbN STRUCTIOWC6,1 ING RIHAF2D WE HAA' P 4 Y # " 4� 34-SRISTOW ST ti r M . ,�° r r'O'Gus,MA0ig06 ��:m ..., "'. t�dnaii�st�a4rr -Notvalid� �tFat±si R ature r SafetN jiC Massachusetts; Dep`tr um t ons:nd)St:n�dards . Board o .,f guildinOf P R(� supervisor License+ Construction R License: CS 56542 Restricted to: 1G RICHARD,A WEISHAAR 174 LAKE ST MIDDLE-TON, MA 01949 Expiration: 2J412011 Tr#: 1 14 69 ('unu»issioner --- 5 Licensee Details Page 1 of 1 The Official Website of the Executive Office of Public Safety and Security(EOPS) Mass.Gov Home Public Safety Department of Public Safety Licensee Complaints License Type Home Improvement Contractor License# 114376 Restriction Company Hammertime Construction Co.,Inc. Name Richard Weishaar Address 176 Lake St City,State,Zip Middleton,MA,01949 Expiration Date 9/3/2009 Status Current No Complaints found for this Licensee. Back'ro Search http://db.state.ma.us/dps/licdetails.asp?txtSearchLN=HICl 14376 7/9/2009 09-JUL-2009 THU 10:07 AM BOSTON KITCHEN DESIGNS MIDDLETON FAX:9787500617 P, 001/001 ilBoston itchen 101%tribut'oi-s Inc. W South Main Strw..Middtcton.MA 01 949 (P)978,750,1403 (F)979.750.0617 I Client: Kim & Carlo Aipuerto 66 Jay Road North Andover, MA 01845 project: 2nd Floor Bathroom Renovation Cabinet Door Style: 'Wellborn Forest Madison Honey Finish Hardware: Amlerock-400-ORB 0 A7) .Countertop: St. Cecilia i" radius edge Faucet: TBD Flbor Tile: Dal-Tile Floor Tile Brancacci Fresco Caf@ 12" x12" Bath Tub= TBD Tub Surround: TBD Shower Faucet: TBD Installation: Includes demolition of exiting vanity & plumbing fixtures with disposal : Replace existing sheet rock and finish ceiling to smooth finish. Kim & Carlo will paint the ceiling, walls & trim. Replace existing Door: TBD with trim':& wall base to match, Replace existing heating vent, install new vent with. light in ceiling and would like to look at the option to vent outside vers :s'in the atticLsupply & install vanity lights and upgrade outlet to GFCI-, '_up .1X & install beveled mirror, All budgets have been confirmed and approved and subject to selection choice. Materials: $ 6,657.00 Labor: $ 12,567.00 UAP-104V>TMIF- Total Project: $ 19,224.00 rjc +a✓'� qr�� azo Paid Visa $ 3,000.00 & credit $ 99.00 retainer Thanks! I i j� I i \ i I � I I � i Note: This drawing is an artistic Designed: 4/21/2009 interpretation of the general ILCHNOLOG I $ Printed:Printed: 7/2/2009 appearance of the design. It is ! i not meant to be an exact rendition. i 1 Final Option 3 A11 Drawing#: 1