The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #253-2017 - 693 JOHNSON STREET 9/8/2016 NoRTN:.. - BUILDING PERMIT °�<�L`° q"�o I TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Z ae' 2� � z�` Permit No#: Date Received �'1s °R.,TE° gSSACHusEt Date Issued: � ` I ORTANT: Applicant must complete all items on this page /44 LOCATION G R Print PROPERTY OWNER �V.Q' Md--7- `,s Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT:-HistoricDistrict yes no Machine Shop Village yes no I TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition [I Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ R pair, replacement ❑Assessory Bldg ElOthers: molition ❑ Other El Septic EJ Well Fjoodplain ❑Wetlands El VVatershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: �-,z,�.,�vQ Poe L- L✓,,� l lS ,� 1--c i�-t/� jL �•5/I�� V Identification- Please Type or Print Clearly OWNER: Name: S4,.ev2 t�?� Z��``� Phone: 't'7 V a�S _ A'J" Address: Contractor Name: ��fe s�� .�.7 Phone: �78r �l — 7a 3 Email Address: 1/ At- Su r Su ervi or's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST {BASED ON$925.00 PER S.F. Total Project Cost: $ y5oo . o FEE: $ Check No.:— � Receipt No.: X07 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund _ r J Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL �Y-•c v,4 L Public Sewer ❑ Tanning/Massage/Body Art F1 »inmg Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. Permanent Dmmpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On jib 4V Si9 nature _4�M "� COMMENTS 4- P n1j jl(�T j i CONSERVATION Reviewed on Signature COMMENTS I HEALTH Reviewed on ?f f Si nature COMMENTS i i Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes I Planning Board Decision: Comments Conservation Decision: Comments Wafter & Sewer Connection/Signature& Dafe Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIREIDEPARTMENT .- Temp,Dumpster,on site .yes unrated 4A4,NIaM Street :T Fire+Departineiitsigrature/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.$1oo-$1000 fine NOTES and DATA— (For department use) LK ® Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 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 4. Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: 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 OTE: 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 2012 I ECC Energy code Engineering Affidavits for Engineered products OTE: 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 Location j O�r'7 UJ No. "� Z +� Date i . - TOWN OF NORTH ANDOVER INI Certificate of Occupancy $ Building/Frame Permit Fee $ — Foundation Permit Fee $ Other Permit Fee $ TOTAL $ y Check# Building Inspector / NORTH q Town of s ndover O ti. - 1 No. Z R ou is h ver, Mass � o� 7 7 "60 4900V I COC KICKt WICK X11,9 A°R�1TEo �Pa`,��(y S U BOARD OF HEALTH Food/Kitchen PERMSeptic System THIS CERTIFIES THAT ...,,,, ,, BUILDING INSPECTOR .. . ... . ... ..... . . ..... 6Foundation has permission to erect ...... buildin s on to be occupied as ..... � `... '.... � .�f�?y ..... .. .. 1. .. pf�ll'..... ..... Chimney Roughe provided that the person accepting this permit shall in every respec confork*the terms of the applica ion 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. ^�A ' PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSar S Rough Service ........ ........ .... " Final 6BUILDING INSP CT R 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. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ St amped Plans ❑ FPubJic SEWERAGE DISPOSAL ❑ r-,a%rATanning/MassageBody Art ]EI nm.ing Pools❑ Tobacco Sales Food Packaging/Sales ❑c tank, eta x Pennanent Dwnpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF o U FORM PLANNING & DEVELOPMENT Reviewed OnJI& Signature COMMENTS /� /CONSERVATION Reviewed on 1 Si nature COMMENTS HEALTH Reviewed on r Si nature COMMENTS (C e /,�;,, 1 eUo I Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/si nature&Date Driveway Permit DPW Town Engineer: ,Signature: FIRE DEPARTMENT Te .,�. . tmLocated 384 o Osgood Stree,, tRQIMpsteayesLoated otonsite Fir'eDe Monts ignure/date at `YY w COMMENTS t= 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 m1n.$100-$1000 fine N®TES and DATA— (For department used LK Le I �� { ® Notified for pickup Call Email Date Time Contact Name Doc-Building Permit Revised 2014 BATESON ENTERPRISES, INC 111 Argilla Road ♦ Andover, MA 01810 Phone: (978)475-1474 Fax: (978)475-5451 July 28,2016 Mr. Steve Mouzakis 693 Johnson Street North Andover,MA 01845 Quote RE: Pool Fill In Fill Pool Including: Permit Remove Walls, Liner, Shed and Haul to Disposal Site Remove Patio Block and Small Shrubs Fill and Grade Pool Area, Compact Prep Area with Stone Dust for Patio Stones Loam and Seed Areas of Excavation Total Quote: $4,500.00 Thank You for the Opportunity to Quote. I-ro'dd Bateson Approved By Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 693 Johnson St. Property Address Gaffny Owner Owner's Name information is North Andover MA 01845 May 26, 2014 required for every page. Cityrrown State Zip Code Date-of Inspection D. System Information (cont:) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately �o o j-- g�� or � ung A>�r; qbx 7bf u LAC � r eJ4 301 t5ins•3/13 _ Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 JdLly►Sdn 03-31-' 6 11 :50 FROM- 0785572130 T-267 P0001/0001 F-2bb A�e3R�a CERTIFICATE OF LIABILITY INSURANCE -- 08811/20 08!36 112016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMENQ, raXTFXD Oft ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCIER.AND THE CERTIFICATE HOLDER, IMPORTANT: If the cortificate holder is an ADDITIONAL INSURED,the poilcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement On this Certificate does not confer tights to the eertiltcate holder in lieu of sunt)endots Nn sh CONTMr- -- PRODUCeR NAME:. Michaud,Rowe&Ruscak Michaud,Rowe And Ruscak Ins. r'NONE 978 fi�8 888829 FAX .975 557 2130 P.O.Box 18$ — C NNou North Andover,MA 01886 Michaud,Rowe 8 Ruscak W8URER(B)AFFpRDWG COVERAGE NAIL• INSURERA;Hatleysviiis hwurance Company 26182 MOUReu Sateson Enterprises,Inc. 4 iNsuRERe:Ssfety Irmumnee Company 12808 Todd Bateson IHSURERC:NorGuard 111 Argilla Rd Andover,NRA 01810 INSURER D_ F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 18 TO CERTIFY THAT 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 Tows, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS$HQVVN MAY HAVE BEEN REDUCED BY'PAID.CLAIiS1S. _ L TYPE OF NSUPANCE POLICY NUMBER STs A JC cowERd1AL GENERAL LM1 UTY EACH OCCURRENCE i 1,000, ClaraSMADE OCCUR MpA79392E 05/01F2018'05/0112017 PREMM18E3 Esoeme"Womoa S 100,0 I MED EXP r 6MPe+ a) a 5,0 P' &R$OUAL A ADV INJURY_ $ 1,000,0 UITL AGGREGATE LIMIT APPLIES PER: I I I GENERAL AGGREAAT E 3 2,000,00 POLICY❑ LOC I PiRODUGIS-COMer/pP AGG S 2,000.00 OTHER, $ JAB AUTOMOBILE IRITY CSI R $ i'800'Dw ANY,4UTO2433971 0710212016 07102/2017 BODILY INJURY(Por Pwxn) S AAlJL 0"90 "X SCHEDULED i I IsODILY"JURY(For aeewwi) S PROPER — i OS X MIRED AUTOSAUTOS UMBRELLA BLAB X OCCUR I EACH OCO MENCE S 11000.00 A 7 mss LIAs cLlulas A(ADE ;CMB62700D 05101/2016 05101120171 AGGREGATE $ 11000.00 DED X m,— T' 0 � I $ WORKERS COMPENSATION TER ANDC ANY E�ORRiPt�tLVJILMY TNERtF.YA"IN A Y JN ;BAWC777632 01M/20151 0110112017 E,L EACH ACCIDENT $ 500.00 OFFICfi I:XCLUNDf a N l A j (Ma„�,y I„}Aq) I E.L.DISEASE-CA EMPLOY $ 500,00 N s,deecnbe under P TIO below E.L.DISEASE-POLICY LIMIT S r i �DUSCRIP11"OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101.Addliadal Rtreadts SdMMQ,tray be alraahae If wAn&ped*is"Red) gr;RTIFICATE H06DER TION NORTH13 { SHOULD ANY OF'LIME ABOVE DESCRIBED r'OLIGIEEi BE CANCELLED 6EFORi Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISION41. 384 Osgood Street North Andover,MA 018" AUr1ORMED REPRESENTATIVE -- (D1988-2014 ACORD CORPORATION, All rights reserved. ACORD 26(20141101) The ACORD narne and logo are tegistemd marks of ACORD The Commonwealth of Masso,chusefts z . Department ofkdustirialAccidexts 1 Congress Street,Suite 100 .Boston,MA 02114 2017 www mas,.gov/dia Workers,CompeaisationlnsuranceAmdavit:Builders/Con•tractors/Electdciam[Flwnbers- TO BE FILED WITH THS PE NaTTING AUTHORM' Applicant Information Please Print iegibl 1 Name(Business/Organization/Iudividuat): �•�Tz sa,�/ .� - —�N� Address: l 1 Z xl-n - 1 /14 City/State/Zip: A1S4-) Phone#: Y'Z- Are you an employer?Chat B appropriate box: Type of project(regwred): 1.�<a employervgth --?. employees(full and/or part ivne).* 7,• New eoaisixuetion 2.0 lam a sole propiietor or partnership and have no employees working forme in 8. C1 Remo delitig any capacity.[No workers'comp.insurance required.] y []Demolition 3Qlamahomeownerdciagallworkmyseli[No workers'comp.-insurancerequired.]' 10Euilc�ngaddition 4.n I am a homeowner and wiII be hiring contractors to conduct all work on my property. I will ensure that all contractors either have woikers'compensation insurance or are sole 11:❑Electrical repairs or.additions pro'p'rietors withno employees. 12:0 Plumbing repairs or additions 5.E]I an a general contractor and I have hired the sub-contractors listed on the attached sheet. 13:0 Roof iep airs Theso sab-contractorsliade employees andhave workers-comp. ; insurance, 14.E]Other 6.Q We are a corporatagn audits officers have exercisedtheirright of'exemption permm c. mployees.[No workers'comp.insurance required.] 152,§1(4),andwehavenc-,e -Any applicant that checks bdc41 must also fM out the section below shov&gtheir workers'comp ensationpolicy information t Homeowners who shliEitt1w afadavitindicalmgthey are doing allworkandthenhire outside contractors must submit anew affidavi'lindicating sack ?Contractois that check-this bog mnsl-a.Eaghed an additional sheet showing the name of the sob-contractors and state whether ornotthose entities have employees. Ifthe sub-conlricfors have employees,they must provide their workers'comp.policy number. X al`z an erriployer t1z at ispY0vzdiizgworker3'compensation insurance for my errzployeess'Beloxv is the policy acid job site information. _ . Insurance Company Name: [� SSS • �o „y 7 &3 it, Ea _ �7 Policy#or Self-ins.I,ic.#: ��'" 17 �irtionDate: �� _ Sob Site Address: I 8�NSor✓ - City/State/ ip:,0A�,.Q 1`'lef - 0l'(6 Attach a copy ofthevorkers' compensation policy declaration page(showing thepolicynuraber and expiration date). Failure to secure coverage as required under MCL 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 b e forwarded to'she office of Investigations of the DIA for insurance coverage verification.. Xdoherebycertifyu er zepainsand el tlzatthe informadonprovidedabove is,rueand cori et Signature: Date: g '3 Phone# Official use only. Do not write in this area,to be corrzpleted by city or foawn official. City or Town: Pennit/License# PssuiugAuthority-(circle one): ' 4-Electrical Inspector 5.Plumbing Inspector 1.Board of Health.2-Building Departmtent 3.Ci /Town Clerk 6.Other CoWtact Peirson: 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 bf hire, express or implied,oral or written." Ara 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 anotherwho 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 shalt withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in'wile commonWealtb,for any applicant who lias not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any ofits 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 le boxes that apply to your situation and,if necessary, supply sub contraa ox(s)name(s),address(es)and•phonemmber(s)alongwith their cerufcate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees-other than the members orpartners,are notrequired to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. B e advised that this affidavit may be submitted to the Depailment of-Industrial Accidents for confiunation ofinsurance coverage_ Also be sure to sign.and date the affidavit. The affidaavit 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 xequired to obtain a wbrkers' compensation policy,please call the Department e at the number listed below. Self-insur_d companies should•eenter 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 fi11 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 axeference 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"lob 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. Anew 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 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-MA.SSAFE Fax##617-727-7749 Revised 02-23-15 www.mass.gov/dia 1 CommOnN'eaith Rof Mass e a..n►enr of aches tts Ue .: •,,;Sfi;, n �u�3fic s eiy. �.�g;�ncr. of License: ,BDD J BATES r` 33250 n AIIEy AND J %'S ``,, Commissioner Q , �XPiration: 03/0g/2017