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Home My WebLink AboutBuilding Permit #429 - 733 TURNPIKE STREET 12/14/2007 BUILDING PERMIT 0 "oRTH q t1lD 6 TOWN OF NORTH ANDOVER ol .,� APPLICATION FOR PLAN EXAMINATION * yy* H T Permit NO: 4 Q w.LMwK V Date Received l gDCL% RArlp 1 9SSACHUS�� Date Issued: �i'' •a T IMPORTANT: Applicant must complete all items on this page LOCATION . ' G/,% l G1L1�h. ;Punt PROPERTY OWNER Print PARCEL. ZONING' ZONING DISTRICT: .,lHistoric District yes no achine Strop Village', yes' no 'M TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: erci Repair, replacement Assessory Bldg Others: Demolition Other x Septic V1WeIl Floodpian. Wetlands Watershed`District Water/Sewer l DESCRIPTION O ORK TO BE PREFORMED, of cation le a Type or Print Clearly) OWNER: Name:_ � ,� Phone: Cell Address: CO:NTRAOTOR Phone: a, .Address,- OF Address Spperv�sor's Construction License. Exp. Dated �. Hine Improvement"License 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: $�� FEE: $ O�� Check No.: OO Receipt No.: 20k(o t NOTE: Persons contracting registered contractors do not have access t anty fund Signature of A-en ,O%n_, , _Signature of contracto 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,�/"' c��. Zu ., i2Gt.L✓7 �Oy 7� .�''ry�j's"► /L� ,lemic- G -rif Z//t•� i /�r nnorar/2P. V + DAT RE CTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS r 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 bf PARTMENT '-'Temp Dumpst-er.( n i yes no' Located at`124,-Main Street rte-, Fire"De artrnent si natureldate_ ,�r r r P 9 ` COMMENTS, :- Dimension Number of Stories: Totals square feet of floor area based n q o 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) or /yyy"0- Z4 f�t — M ❑ 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 Calculationslicable If Applicable) PP ) ❑ 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 j Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Location o No. # Date NORTH TOWN OF NORTH ANDOVER O N � 9 Certificate of Occupancy $ o0 — ;�s'""°' Building/Frame Permit Fee $ —!�`� ACHUS Foundation Permit Fee $ Other Permit Fee S«N $ 3`O TOTAL $ 2 �_ Check # �� 20861 Building Inspector VAORT#q Town of Andover 0 V" No. C' 011- over., Mass., 0 cocHICHE ICK 'ot ORATE D C2 BOARD OF HEALTH Food/'Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...... ...... ......................................................................................................... Foundation has permission to erect........................................ buildings on ..77..S I.... .ta!k,im-e-�-Lc.................................... Rough C C-C44 Chimney to be occupied as.....................I-........ ... C) 4 . ......................................................................................................... provided that the person accepting this pdimft 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ARTS Rough- UNLESS ........... Service ............ ......... ..... . ............. BUILDING ............�TOR 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. 1/4�oannaoauuea�t� o�✓j/�aalac�urve Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 151800 Expiration: 7/5/2008 TYpe: Private Corporation AROUND THE HOUSE BRIAN COOK 16 FARMHURST RD «sv PLYMOUTH,MA 02360 Deputy Administrator ✓fw t�a�n-rnQnu�er��i n��!!"'rrs:t�zcfiu<;P.t__%__ BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 092267 Birthdate: 02/23/1971 Expires:02/23/2009 Tr.no: 92267 Restricted: 00 BRIAN R COOK 1 TOWER AVE NEEDHAM, MA 02494 Commissiorier it r 18'1" Front Entrance Get Li Shape For Women-North Andover Jasmine Plaza 733 Turnpike St. 32' 43' 6' existing H.C. 51211 .7 L Bathroom 4!611 35 Exit to �A Batluvonns 2' -New Partion wall with 12' 4' 36"x 30" door existing H.C. 516" 9' Bathroom 4'6" g, The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 t www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual): vK� -- Address: w tlfLyG,,4'G, fvy` ;�hrone City/State/Zip: t/ G lkl /-7 , � e/ Are,you an employer?Check the appropriate box: Type of project(required):., 1.U-1 am a employer with ` 4. 0 I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition workingfor me in an capacity. employees and have workers' y p �'• $ 9. ❑Building addition [No workers' comp.insurance comp. insurance. required.] 5. E] 10.We are a corporation and its ❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.EJ 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 Homeow—hers who submit this aff da::t indicating they are doing all work and then hire outside contractors must submit anew 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. A. Insurance Company Name: Policy#or Self-ins. Lic.#:' 6 S o V 6 S-YI V C Y 6U D 7 Expiration Date: 7 Job Site Address: 7,-77 'rIi✓�t�'A "City/State/Zip:,(J(JVA lfidclo'; 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 D U&tAgMQcoverage verification. I do hereby ce . un a pa' and penalties of perjury that the information provided above is true nd correct. Signature: Date: �oZ ` _ Phone#: 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#: ti 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"ever 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 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 Connmonwe-alth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #6.17-727-4900 ext 406 or 1-877-MASSAFE Revised 11-X22-06 Fax# 617-727-7749 wwwmass.govldia Page SUMMARY OF INSURANCE Prepared: 09/26/07 For: r"—Around The House Home Roblin Insurance Agency, Inc. Improvement Corp., Brian Cook 144 Gould Street,Suite 100 400 Hunnewell Street Needham, MA Needham, MA 024942321 781-455-0700 02494 781-444-4810 Coverage Amount Company Policy No Eff Exp Premium Business Auto, Safety Insurance Company 2701515 06/27/07 06/27/08 11004.00 Liability CSL 11000,000 PIP Per Person Limit 81000 Medical Payments Ea Per 51000 Uninsured Motorists BI/Per 250,000 BI/Acc 500,000 Underinsured Motorists BI/Per 250,000 BI/Acc 500,000 Physical Damage Comprehensive Collision Towing and Labor Endorsements,Forms,-Conditions: Towing-$25,Rental-$30 per Day,30 day "See Attached Vehicle Schedule rkers Compensation The Hartford 6S60UB5414C86007 07/15/07 07/15/08 10300.00 Employer's Liability Each Accident 100,000 Disease-Policy Limit 500,000 Disease-Each Employee 100,000 Individual included/Excluded Brian Richard Cook EXCL MA Additional Coverage/Endorsements 'See Attached Rating Information Business Owners Policy Acadia Insurance Company BOA0191SI611 07/07/07 07/07/08 4329.00 I Liability Limits BI&PD Per Occurrence Limit 1,000,000 BI&PD Aggregate Limit 2,000,000 ftdical Expense(Per Person)Limit 5,000 ` cage to Rented Premises Limit 50,000 Location 001 Building 001 43 Crestview Road Needham MA 1p1111 Front Fntrance Get hi Shape For Women-North.4aidover Jasmuie Plaza 733 Timipike St. 32' 43' i 6' existing H.C. 5.2.. Bathroom 4'6" FAt to Batlll'oomS 2" -New Partion wall midi 12' 1 iA 4" 36'"x 80" door existing H.C. 0611 9' Bathroom J 4'6" 8' i I BOARD OF BUILDING REG -0 License: CONSTRUCTION SUPERVISOR Number: 'CS 092267 ✓ Birthdate; 02/23/1971 ` Expires: 02/23/2009 Tr.no: 92267 Restricted: 00 BRIAN R COOK . 1 TOWER AVE NEEDHAM, MA 02494_ G` Commissioner �� vnwizcvecr.�C� o��ac�rcaet�a Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration:• 151800 Expiration " 7%5/2008 § Type Private Corporation r AROUND THE HU�Er BRIAN COOK i;:u:i 16 FARMHURST PLYMOUTH, MA 02360 Deputy Administrator 18'1" Front Fntrance Get In Shape For Women-North Andover Jasmine Plaza 733 Tiunpilce St. 32' 43' 6' existing H.C. 5121 Bathroom 46" 3.5" F-ut to Bathrooms 2' -New Partion wallwith 4' 36"x 80'" door 12' existing H.C. 551611 91 Bathroom 46" 8' i