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HomeMy WebLinkAboutBuilding Permit #397 - 671 JOHNSON STREET 11/21/2007 r►ORTH BUILDING PERMIT o`,t,�o bgao TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received pOAATEO ACHUS�� Date Issued: • - IMPORTANT: Applicant must complete all items on this page LOCATION (,,,'1 �,4 ) :�;c/? .57–" Print �` PROPERTY OWNER I i` -� Ri`") 'i- L144 Sa Vnx Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building _ne family� Addition Two or more family Industrial Alteratio 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: R t + --7 IYC jc —,Q2 /_,=,C4 7 � n c� h-r�;� / Ize�4 New Cz+b ;ne t34-S—c e dentification Please Type or Print Clearly) OWNER: Name: I`'/� �� .a<�i� .J�bi�e��t /��4hs� y� y Phone: g 1'S- Address: 62 CONTRACTOR Name: /1 S v y Phone: Sy 3')$= (26 ' Address: 5-7 /yc>tR`�� A,,1 D E Ve -- Supervisor's Construction License: /O p Exp. Date: " Home Improvement Licenser 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. / .00.0O Total Project Cost: $ 3.3, c;2�I� � FEE: $ 7��' � t r v Check No.: l U r� 3� Receipt No.: 0 �I NOTE: Persons contracting with unregistered contractors do not have access to the g aranty fund Signature of Agent/Owner Signature of contractor 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 DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH 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 Located at 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 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 ❑ 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/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 DEPARTMENT:BPFORM07 Revised 2.2007 Location No. Date / NORTH TOWN OF NORTH ANDOVER f , i • 4L ; , Certificate of Occupancy $ Building/Frame Permit Fee $ L/ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 208 'i 8 Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 f- ` M www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Le ibl Name (Business/Organization/Individual): Address: i City/State/Zip: /✓o127-;�, A}/_I� ,V Phone#: Are you an employer?Check the appropriate bog: Type of project(required)':., 1.❑ I am a employer with ' 4. ❑ I am a general contractor and I * have hired the sub-contractors 6. E]New construction mployees(full and/or part-time). g Cy�K 2 I am a sole proprietor or partner- listed on the attached sheet. 7. X Remodelin 2e L ship and have no employees These sub-contractors have g, ❑ Demolition workingfor me in an capacity. employees and have workers' Y P tY• � 9. E]Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.F1 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t 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 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. 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 violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify un r the pains and penalties of perjury the information provided //above //is true and correct. Si ature: Date: /V V F' O` � � _ Phone#: 2Y D — / 7 ?Q 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#: 1 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." i 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 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 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 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 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 Fax# 617-727-7749 Revised 11.22-06 www.mass.gov/dia V% T#j TO" of Andover No. 9 +�� P/ dower, Mass., 0 2-OC LAKE HICHEWIC RATED BOARD OF HEALTH Food/Kitchen PERMIT T -D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........ ........................................................................ Foundation has permission to erect..................... buildings on....&.71.........74A.01S.avt.....r�.Nrw Rough V &.- .- 0 0 Chimney to be occupied as.../...et . .....n provided that the person accepting this permit shall in every respeft conform to the terms of.t6 1.icat.ion..a.n.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 00 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST11' N S TS Rough Service ........ ... ..... ............... ......................................... ............ ..... BUILDING INSPEC 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. �& Board of Building Regulations and Standards Construction Supervisor License Liegr�se: CS 40927 B+i ate /4/1957 fpIra-on 51}1-009 Tr# 12542 ;I�estrir�ior� ROBERT W ALLEN 7�•- e, ti Yft 86 AND ST N ANDOVER,MA 01845 Commissioner Eno u ll Ine u atibns an an rg g a s One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Im rov p ement.�or�tractor Registration Reqistration: 109740 s` g Type: DBA Expiration: 9/24/2008 ALLEN CONSTRUCTION CO ROBERT ALLEN 86 ANDOVER STS` --- N ANDOVER, MA 01845 1 j - A i Update Address and return card.Mark reason for change. .-.Wt n Address Lj' Renewal ! Employment Lost Card DPS-CA1 50M-05/06-PC8490 PROPOSAL alien construction co. con truct.ion su eryisors t'ROPOSAI,NW: 86 andover s t. Z t-ense north andover,ma .(}1849 rrfa .Re:,. 1C)9�ia 976--6R2-4862 - SHEET NO. 978- 375-691.5cell DATE Sunday sept. 16 7 PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT: MAMBADDRESS t t e nC ren-a. "Faa 1 C3vED 671: :c?t 122]E o S l « ]C 1 a c i� C3 r1C3 . ADDRESS 671 Johns_z;oh st.'. ob description:Xitcften. ode �' north and(Nrer',ma .018d DATE OF PLANS PHONE NO. 978 -794--1 81 1 Y ome ARCHITECT 978-76.4-7575mik es cell none We hereby propose to furnish the materials°and perform the.labor necessary for the completion-of Xi t then remodel i.n - Scope of the arcij cta too relocate exA Sting ,k Itchen to op���.s� to :side of. t e= zeal. " 21 St«t"''L�SI"c} �r1 c"�s umes all responsi +nc rrl"fin t :Ot obtain ng a permit. 1f customer "wants contractor t.o obtain t1he ,etrrt t and .added, cost will, he appli t o tae q--u—o pri. e.C,uErCc3Iter "SoT3 urc a_ , .e al Z canine s,counters acwts ' asi _ .* q -' _ ' of the project. demolition, tot✓a1iy disr.antle the existing Yitchen .save existing kitchen s nk f ce .put all apf lances into tne Itying room areances will e -;:;A - newnc e v P t .ek ,.� s i? �+ �cih r r o � �n e i et sa ti t.na c a ��t r` i f y'r6mn �d and relocated to outside way. in tuture ain ng.;area .a new` an ersen :s dil :i` - e w-.. i. ♦ l +.» (�A. .-. V 4.. Et_ iftindeie pix r `,.. 4.x ♦.✓:. .- Y V 42ir.ches wide by 41inches h h. twoo-ubl 1jait:s will be installed in the outsicte wa. is of tne new dirilng .area.A double unit t,2 sfs ,s of two EW 28 sin,.w .... wiibA r.W s YW y..842 ...-u. Ki es 9140; n w d +.a11 near u�f tf:s b y w i.c e perma-shie.ld9 vi.nyl.��xt�riorsiclearJpine .F interiors,removable arilles,white insect full l screens©all are ttit-wash. Pll.um ingi Vlurti"_2ng work will l ! consist: o C: iscot�.>."ec -n- lllt i I r cn.en plum !n, pppqt � is 7 , 1 r 'i ;nt.s-to e-w k- tchertT ajr-e'a.Hao-in �u T a31_f i xt€gres and a.pp11ances.?IoVi n all existing piping in covnstairs ceiling area which is below present oljrl t"ai.r C°{? li3i®C`�as in TG}r exisEing outside sid CgrTl Twl�� ��� T�Ii�C��t.t'Z= All materia�tisguaranteg o'�W!aJ"s*p'ebfiE!�Fardtf e t88 e A& 0;$efR6TAe(TXc?Er'Wanteowl[40l 1&'?ngscoand ipecifi- cations submitted for above work and completed in a substantial workmanlike manner for the sum of Dollars ($ j with payments to be made.as follows. Respectfully submitted Any alteration-or deviation from above specifications involving extra costs will be executed only upon written order, and will become an extra charge Per over and above the estimate. All agreements contingent upon strikes, ac- cidents,or delays beyond our control. Note—This proposal may be withdrawn by us if not accepted within days. ACCEPTANCE OF PROPOSAL The -above prices, specifications and conditions are satisfactory and are hereby accepted. a are authorized to do the work asspecified. Payments will be made as outlined above. f' 1�oftei parties must sign proposal r prier to the start of the- =ion Signature Cufit€�zz�e'�, U41, Date Signature Contrac-to�.-/O c:`Y /._ '. f I f &. NC 3818-50 PROPOSAL PROPOSAL Allen const..ruction co. Constructit�n Supervisors 8 5 Andover St. lAce is,e#04092 f P�iOP©�ALh!©. ' north andover,ma .01845 tria .reg.#109740 97R-182--4962 SHEETNo 97 - 75-b9, cce5 1 DATEsu,ndtI.y .s`.ept. 1'6 PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT: n E�; < tl lie ; s rer a ovoy oh .§oma -tt. 'no rtrh a mdov,6t ADDRESS • a71 jt htz c . Ct»` Job Descriattian:Kitc' en Remodel ing DATE OF PLANS Forth andover,ma.018 5 PHONE NO. 8- 1 { --1 8 I t°tome ARCHITECT 978-764-7575mikes Cell We hereby repose to furnish the materials and perform the labor necemiryry for the con pletlon.of K1i foie,n r= 0delling ElectrfCalipemove ex sting ki.tcherz ottlets.Remove owrr devises an S.ane Asa - .� a *, u _.. u , _ W 11 6utle> i fn new clIning area tri„ c ; Oe _3tteE 1l .fir-v,41e �ge�� tiri oealirrcr high r e x tln NTeLRserl c n.Move the two. - ecessed eANS �in pre�qsent tch n area to ` e spots in same area.Ifo re andreconnect . all wiring and devices for trie new ki .c r _11tzrt�r �f �i i st�1 _w._-� f 1p� resc Ot s ri Cn� sw tch4t the ati d6o eQther by Relocate the pbomeact. _ - Plassf E'rl nCgs lnstr z:`blu2 pa ., 5 „i'et over tit? P 1 t� rtkY p �rS cel sz r2 tti : ,. 9 - .r r, ct c*I' � iasfer over entire ar a.Areas_ , 1 covered cbverP before p2 seri ng begins .#.. .L V-_ � Z set V ,.. Gh A.`. G * 1. ra� and t. a of counters onto the -wall-Customer to sup lv the and qrout Countertpps,contractor will include cast to Install laminate„ counters. it o tner 3 ,ra19" zncs� oafocir. 4 n:. w remazn.dcrai F� csaT b?ach;.arerxc fie- atch el area f customer v}ar trs enter area refin1shec`7sa`�f`166� .ng eczntM c o Fc. e re ommen eoowa ii an ainiled cos app ted �:o �;iz� q�z e p sce . c. o c, 11 E„r s y rc 1 new baseboart . wbere needed. Vor {Ff nxa out c-1 -7i e Tf winnows wC, stIOMPNr. cedar„ n no s cabdi net Wd'ea cast iri.i.1 ” a 1.1ed. T - contractor will Ins ll a.I1 new cabinets. nets. All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifi- cations'submitted for above work and completed in a substantial workmanlike manner for the sum of Dollars ($ j with payments to be made as follows. Respectfully submitted Any alteration or deviation from above specifications involving extra costs will be executed only upon written order, and will become an extra charge Per over and above the estimate. All agreements contingent upon strikes, ac- cidents,or delays beyond our control. Note—This proposal may be withdrawn by us if not accepted within days. ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work ads sp®tetcified. Payrnents will b- made as outlined above. e party es muffs sign proposal prior to the start of the job Signature Czzst.romc�r� f'��2 J �j�/f7��G1j�� Date Signature Contr'act✓cr%, ftr `.; .. NC 3818-50 PROPOSAL ROPOSAL Allen construction to. Construction Lupervisors ROPOSAI O... ,&6 and.ove r st. - license#040927 north andovermma..01845 ma..Reg.##it}9?40 SHI INo . 97-8-682-49624 � F� 978-375-6915cell PROPOSAL SUBMITTED T0: WORK TO BE PERFORMED AT: 2007 i NAME m ke; d Soren pinav, A ttnsn st. 777 ADDRES5 ;`671b� BCciic1eII" 1 �c3d1g ., oh, ajil " ` . North °An'rnver,M�..01645 SATE of PLAN PHONE NO. ."978-794-181 lHome AF3CHITECT 978-76#e7575 Mikes cell We hereby prepoe to furnish th+ metertals end:perform tle lakor necessary#or the,eopletion el l ttclxn, rmodel . .`" Contin�A atiori .: s. t4ifaval z Al i , ebr = enerat ec1 rt�"the M�rem14461 A: from '-tai es anc . d pos "cif: �� Ins oar ice 4A�.l,,cc0ntr�ctars yoking on t' .s . ro eft ins-drAnde,before w r starts, , + e s n, i 4., a F n -< v I All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specffi_ cations submitted for,above work and completed'-in a substantial workmanlike-manner for the sum of EictbteLen tho-usand two, Dollars ($ �297DO )_` with payments to be made as follows. 35 down 6pXr#000g13alance_ of , 11'8 8,00 to be divided intoL two payments 35% ,when job is ap rox.hal� complete(windows complete,elec and" plumbxmg roughs compl6te.plaster nz co;r�p te, ;1:-63.00 due sLrCo a due3 when job 1'ClO%compl'ete` '?730.00 �..:t Respectfully submitted r , Any alteration or deviation from. above specifications involving;extra costs' r` will be executed only upon written.order, and will become an extra charge Per a over and above the estimate. All agreements contingent upon strikes, ac- cidents,or delays beyond our control. Note This proposal may be withdrawn J r by us if not accepted within days. l <ACCEPTANCE QF PROPOSAL ' The above prices, specifications and conditions-are, satisfactory and are hereby accep"ted, You e ^authorize to `do the'work as,specifled. Payments will be made as outlined above., 1�oth, parties MU startsofn�,heo 'ob$� Si nature Custom e h St g P p Date f. , Signature 'Cor. - I; .. 8�,ad— NC 3818-50 PROPOSAL �.._$1 }_ ,ut �•., .,_,. .. fr _. .--.....t ht.... ..r.-..._. i.r....s, ..•. .,-...c ..... ,.r__-u._ ...e-o ..-_.�-,. .k::.i r .. t.�: ,....<. r,a.._a. .. . - -.......r... ..._.._'3.Y�_.