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Home My WebLink AboutBuilding Permit #420-11 - 700 MIDDLETON STREET 11/15/2010 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received 0 Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION BOO /��Py�1/ yy� Pr t PROPERTY OWNER 41,416h� s 4 eK Print MAP NO:/D ,0 PARCEL:00-2 ZONING DISTRICT: Historic District yes no I Machine Shop Village yes no TYPE OF IMPROVEMENT P OPOSED USE R sidential Non- Residential ❑ New BuildingOne family Y Addition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other [® ptic; �Well ° t��Floodplain� W,etlandsr T �WatersledtDistrlct i ®Water//Se�werm DFKRIPTION OF W BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name:-fr`,,J r�&e Phone: Address: i CONTRACTOR Name: Phone: Address: Supervisor's Construction Licen : n Exp. Date: Home Improvement License: /.!�: Exp. Date: f ARCH ITECT/ENGINEER- a�� Phone: -z- Address: Reg. No. FEE SCHEDULE.BULDING PE IT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COSEBASED ON$925.00 PER S.F. _ Total Project Cost: $ ��0 FEE: $ Check No.: ��z Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty f _- SignaturekofAgent/Ovvner , � _ of#contractors 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 i ❑ 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: Doc.Building Permit Revised 2008mi 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 Planning Board Decision: Comments onservation 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 i j 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.$10041000 fine NOTES and DATA— For department use I i ® Notified for pickup - Date 1� f� Doc:.Building Permit Revised 2008 1 A Location—/U No. Date V v NORT„ TOWN OF NORTH ANDOVER ,0 w 9 a ° Certificate of Occupancy $ MuBuilding /Frame/Frame Permit Fee $ s,ksE Foundation Permit Fee $ ` �^ Other Permit Fee $ �� 4 TOTAL $ Check # �� 23766 building Inspector ROOFS MITCHELL SAAB SMOKESTACKS INSULATION TOWERS PAINTING GENERAL CONTRACTOR REPAIRING 57 Bridge Street Salem, NH 03079 POINTING SIDING 603-893-6332 • Tel/Fax: 603-893-3466 WATERPROOFING PROPOSAL AND CONTRACT DATE:.....�/....... . ... ' ..................................... � -� TO r' ..../..-GC' ...�,�....................... Type of work......� -�-a.,.--........................................... ATTN...s✓• ..... .. ? ...C).. .�7C. ........ PROPERTY.,26.0........ ......� LOCATION....././-: s ......,�! We propose to furnish all necessary labor, material, and equipment (except as noted below] to pe['IOFr,. the following work in First Class workmanlike manner. Roof maintenance is required annually. Not responsible for water back up caused by snow and ice. Scope of work.....�o........ �r .�C....�....�.�..�...... ?.Irr�'� . ( r�. ... . . ,r_d--.. .?....r.-..�. .,.-z..-..z..l'... ..... . ........ 76-1Y. .�...-........ .. ... 2 ...... ... .... ..... ......ie- . � . , .. -�- ..... ...��.�..:-. .:. ...-......�4........ ........... .:....Vis'.'..- �;:•�.��: .... ........ ...�........ ..... e -...... .r-• �- a... ... :<-�, cf- ` For the Sum of ....'��/'. f, Signedby ................... ... ........ ........ ......... ......... ..........aL��'�e I ��:yz�-ups r � -/-- �-� �.�-? ORTly Tovm of Andover - A K E _O dover, Mass., ' 0L . !� COC NIC KF WICK V ADRATED BOARD OF HEALTH Food/Kitchen P. E �RMIT T D Septic System 00.0ft BUILDING INSPECTOR ^ THIS CERTIFIES THAT......... ...................................... ..................................................�....... .... ...................... ..... Foundation has permission to erect.............................. ......... buildings on ...�a......PwA4. .... .. ... Rough to'be occupied as...... 0 TPa � Chimney }'........................ .... . rovided that the arson acc tin this ermit shall i1ke res ct conf' orTn to the terms of the application on file in . P P P g P �i PP 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 PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRU O TARTS ELECTRICAL INSPECTOR 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 RLJ Smoke Det. 42) v 6 Office of Consume Affairs and Business Regulation 10 Pak Plaza - Suite 5170 Boston, Massachusetts 02116 Home improvement Cnnttctor Registration .hi Registration: 159331 Type: DBA y z Expiration: 4/24/2012 Tr# 295744 -MITCHELL SAAB GENERAL CO ICA I MITCHELL SAAB w 57 BRIDGE ST w SALEM, NH 03079 T 'F Update Address and return'card.Mark reason for change.[ED] Employmnt E] Lost Card DPS-CAt %r 50M-04!04-G101276 Address Renewal Too�avmoouuecal� Office of Consumer Affairs'&Business Regulation . k License or registration valid for individul use only. HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:. Registration: ,=159331 Type: Office of Consumer Affairs and Business Regulation '• 10 Park Plaza-Suite 5170 Expiration. 4/24/2012 DBA .- , ' j ""- Boston,MA 02116 MIT HELL SAAB,GENEi ;ZOJRACTOR r I �i iF n! >> ' MITCHELL SAABi: ; 57 BRIDGE ST SALEM, NH 03079 = —,�'' --��-5'�-� Undersecretary Not valid without signature k"-�. Mass:tchuset#s---- Dep:urtme p—�-- Board of Buildin�f Public Safet. Construction SRplery titins and Standards License: Cg peryisor License Restricted to: 00 X864 - .,y MITCHELL L SAAB, 57 BRIDGE Si-, . SALEM, NH 0§ J , --A (on,n,issii»,er Expiration: _ 7/23/2011 rr#: 1037 c CO� CERTIFICATE OF LIABILITY INSURANCE $I X-MIATTER Of INFQRMATJUfj ON-LY AND CONFERS NO RlCI4T.5 UPON THE CERTIFICATE a aud, Rowe And Ruar,.ak lns_ i 11�LG� .This CERTIFICATE 00218 NOT AfMeND.EXTEND OP 0. fax X139 (ALTER THE COVERAGE AFFORDED BY NE POUC CES BELOW orth Andover Nk 01845 phe".. 979 X89 9 929 Fax;a 78 SS? 2130 1NOURER8 AFFORDiNO COVERAGE MAIC 0 26019 >galans Fi 30 9 COVEMMS !PQt,01E5 OF lN94JRIrl i16TF�i$ELCt"J HAVE l9p;t1i t tiSJ�J TC TlIE fhSIJ> G t�I�iMlA AOr:NC!"OA THE POLI--y nJRI!�v NOCATED.NGTW'HSTAN(>,N0 I ANY RSOUIRBAr We TERM M WNDMON CF ANY CORTWT OR 07MCR 0(r-Vk ENT V1j'1T 4 RE9PEC 7 TC Y'XCP;r S MRTI�iCAT6 MAY des 96M OR !I PRAY aFFrAWN '� AF IKSWPANCE ORMO 8Y'HE POLOSS 02�IGRIDi:O HEREIN Si1gJF.C"TO A.6 me TI:RNM EXG:v31"APfiJ CON0;'IGWvs of S.cw ! PWOMS.AGGREGATE;-INNS S MAY MAvO ESN RCOtiC£0 Sy PAC C'.Apw8 nFP TIS n.rw T;ON' lNSR 1DOt MpLtCY NVM68P. J T T{ ,Rt1�#i Mlti fYTYt T— LIMITS _. I LM TYfE OP 41V�IRA41Cfi ff j 1 84MARAL LIA814ITY DAMAUt x !.v 'NLaarnf .:ail -r i x31 d 14i xC c3,t;14i 1� ",:WIVZ ifEaCtFwvnr%-;. x SCtr?6J .c. Wo cLAIP1511ADG s 17Gt:Lk I 'MELyE,(prAnynrercW, j S 8Q(7t? c�aanr."a 4�•'Inau 300000 ,fN L P.DORix�3ATf 6ltNl'"►r4•L ea r +e i 4T�tD4Y:'a•C4Y?�1F aCb , '600000 400NOBtLE LA04LITY CO►�611v€� Nti'i,L L;UI' i�� I �tF,R acc+ae+x; r ANY AL70 coxZri Air.01; i �t poreau � !3Ct?L�C��L2A�r.lTC9 I i �OSeY iNJUFi�' .4 (P4l,i<LGEPIi4; I.740%-nop=AU'TM I S I pFUP5�7�pAra.,4f)C 5 G4RA.M'iL#ARLITY ! ALTQ 7WY ' ANY krIC U'Hat"NRr. ICA AIX. 5 I $7t %r i UM&REU A LIABIUTY I QAC}!G�:UR c1iCF S At«aR "Ai"MAD'» AGSiaKt 'y �> i j L�AJGTI�k.6 � 1� 4No 614PLOyoks'UA&Afff ANY 4+4UPk4��e1FAe?'w�AxNCU?v�'�`? G+�FiG'�TAL'^AB@t P.nCtt'flW1C� 1 ix;. Jlvanh� S4,�pl CNKEI�; 1 tlflltld4{D!y!'1 I� j 1 r' ��iJu�•�^ T;': •� It/gs,dilGia6;lq�i' t rLi�"'Y�ivt � ,?►'E4tA` FfiOr!SQnB srt:r� . .._----.-..._ ..... _:r....... ......,,.,:;._....._..—.-.....-.... _ ._. _-.®_... OTtfl".>t� i I 1 RI.T v NR i CC 1 W6?Y@l51CL f 8}•CL4'9tON AD g�� :N'r9P tAL p91C RIO!+n..__• __..._...�_ .._.—._.... ........ ... , ..---. 1 I CERTIFlOATt:HQ3 DER �_____ CANCELLATION ,•- bk04A.D AN"Of AM£�+9d'!li OabORl6efSA0d.iCIFs BlCANQEL,LED B!'•OR&rN8 SilrrtRpTlQ� 1. D0!THEREOF,tN6 i;.uRr3 jon'vRi9t WILL UDCAVHM TO MAL _ OAY8WRIT'rt, 4! WT'CE Ytl 7144 HCLLER MAIMEC T C THE LEFT,BLit PAILVRE TO DC tD?i*A: 1 jIa+'0$E N4 0®U94T(OPt^fk UA t,ftY Of ANY YfND'Jpor. RI!M1 URER,IraACgNTSDM 1 i Mitchell SsAb RFAMNTATIY0. STS arid" st Salem = 03079 c1C0 2 ( 00910'i� T F To Pik s lesetvCd, vie AGORD norm*&nd ISO Sire registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents �'i ►�%L. 1's' Office of Investigations 600 Washington Street �U "11 1` Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print'Le ibl Name (Business/Organization/Individual): 4eze� (9-e� Address: City/State/Zip: Yz;111 Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction Vmployees(full and/or part-time).* have hired the sub-contractors 2. am a sole proprietor or partner- listed on the attached sheet. t 7• ❑ 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.] have exercised their 10.0 Electrical repairs or additions 3.❑ equired.] o I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' 13.0 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 add their workers'comp.policy information. 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: 2 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 fonn 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 maybe forwarded to the Office of Investigations of the DIA for insurance*coverage verification. I do hereby certify under the p and p nalties o peijury that the information provided above ' true �dcorrect.' Si na/tu/r�e: , Date: Phofli�# 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#: 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"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-contractor(s)name(s),address(es)and phone numbers)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 pen-nit/license number which will be used as a reference number. In addition,an applicant that must submit multiple penmitilicense applications inany 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. r cooperation and should you have an questions, The Office of Investigations would like to thank you m advancefor you p y y q , 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-MASSAFB Fax#617-727-7749 Revised 5-26-05 www.mass.govldia