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Home My WebLink AboutBuilding Permit #944-16 - 74 MEADOW LANE 3/7/2016� 0 � WL A � L"151 Permit No#: Date Issued: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION.-,.,-_',"-. Date Received TANT: A-D-plicant must complete all items on this LOCATION :4 1 sjrz)A 7VI V V I PrirA PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes ( no TYPE OF IMPROVEMEN--T PROPOSED USE Exp. Date: Residential Non- Residential New Building kone family Exp. Date: El Addition 0 Two or more family 11 Industrial KAlteration No. of units: 0 Commercial 0 Repair, replacemE)nt 0 Assessory Bldg 0 Others: "emolition 0 Other ....... nlqp io UYIV A efla e ljj�dl n ffial. f/. OWNER: Name: Address: PRIPT119N PF VFOR�jqBE PERt�)K t= A I-,- - - Plea e Type or Print Clearly 1��?3 V�_Cj, Phone: 9,�� u� Contractor Na e: Email: =2 Address: 14 q-,_ Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: i Lk 1/ ('0 ARCH ITECT/ENGIN EER Phone: Address: Reg. No. FEESCHEDULE. BuLDING PERMIT. $JZ00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASED ON $125.00PER S.F. �) I FEE: $ Total Project Cost: $ Q��L — Check No.: . t �� Receipt No.: 6 t' NOTE: Persons contracting with unregistered contractors do not have access toj#egu—a_�—D)�tyfund r Plans Submitted 0 Plans Waived Certified Plot P Ian F1 Stamped Plans F1 TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Mas s age[B o dy Art El SWhRlaffig Pools Well F1 Tobacco Sales El Food Packaging/Sales 0 Private (septic tank etc. El Pennanent Dumpster on Site El THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM I PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature' HEALTH Reviewed on- Signature COMMENTS Zoning Board of Appeals., Variance, Petition No: Zoning Decisionlreceipt submitted yes Planning Board Decision: Comments Coriservation Decision: Comments j Water & Sewer Connection DPW Town Engineer: Signature: Located 384 Osgood Street el-mlp— ENj,�Ty W*--�.T gi— �o '6'� t e pd�4� pfl.' f,Sfte 2j§1050 e sigh4tur IDMT 04 i e n V 17 P14�,,MXT com, �S - N T Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. - Total land area, sq. ft.: ELECTRIGAL.- 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.$100-$l 000 fine 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 4, Copy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products 10TE: 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) I.. Eng i . n . ee . r , ing Aff - i - d . avi - ts - for - E - ng I ineere - d pro -ducts 10TE: 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 IECC Energy code Engineering Affidavits for Engineered products 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 I copy and proof of recording must be submitted with the building application Doe: Building Permit Revised 2014 I -1 1 Location N o. Date I ) -I Check# I �i TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee TOTAL $ Building Inspector Enter construction cost for fee cal - North Andover Fee Cakulation Construction Cost $ 16,895.00 m $ - $ 202.74 -Plumbing Fee $ 25.34 -Gas Fee 100 comm. $ 100.00 -Electrical Fee $ 25.34 Total fees collected $ 353.43 74 Meadow Lane 944-2016 on 3/7/2016 -Remodel 2 Baths CD Cl) z emt. o CD CL CL > -0 0 0 m CL cr CD 0 013 CD CL 0 S' = CO CD F U) 0 71 OW -A U) -0 0 0 U) 0 c U) CD 0 =r CD (D a. U) CD U) 0 0 0 CD a 0 CD < 0 0 0 = -.,o 0- r- U) > -. w a 'm -om wo mr m m z o -5- 0 S m an) CD U) 0 N S. SD CD 0 CD > o rIL to 10 0 CD COD CD z CL r— m S, 0 co M cc * — =r 0 CJ) CD 0 to --h C=n Ci) r Z 0 CD o rr 0 2L ;7, a �q C) M = >< CD j z > C.1) = 0 W= r.L 0 cc 2- O< COD - m U) CD U) Cl) CD CL C-) cn Z CD ch 0 Z to ::dOA 0 0 Z =r cn Z:.. CD CD CD > CD Cl) CD "0 @ m 0 0 ol 0 CL Ln 3 0 W, (D 0 CD Ln -- rD rD — z ou (D -n S . ;o 0. a an -n Ej' 2L Ln rD n rD ;a 0 a aq =r 0 n -n :;a 0 c m -n 5' 2L n 2: 3 =3 rD �io 0 , m zr -n 0 , 5 QL w 0 Un rD _0 LA < -n 0 0 m m M > m z > m 0 m r- m > z (A M m 0 M r- z (A M m 0 :3 w 2 z z fA "a m 0 (D 3 rD :3 ca 0 0 n m > M i"W, 79A 0 0 n M i"W, 79A Trepanier Remodeling LLC 14 East Capitol Street Methuen, MA 0 1844 Name / Address Ray Tudisco 74 Meadow Ln No. Anodover Ma HIC#122347 CS#069815 Date Estimate # 7/18/2015 3 Project Item Description Rate Qty Total Down stairs bathroom: Materials/Labor Demo bath to studs and rough and finish of new bath fan/light, GFI, firm up framing complete 5,000.00 5,000.00 firestop to code, install blueboard and plaster, install finish trim, one tower cabinet tile floor and paint walls and trim: Upstairs bathroom: Materials/Labor Demo complete bath, rough and finish of new fan/light GFI and medicine light, firm frame 11,695.00 11,695.00 and firestop and insulate, blueboard and plaster walls, install finish trim, install sublooring with tile floor and paint bathroom: 01 Plans and Perm... Approximate cost of permit: 200.00 200.00 "Customer to supply fixtures" "20yd dumpster will be on site for demo and waste from project" We look forward to working with you! Total $16,895.00 -jhe Commonwealth ofHassachusetts Department of IndustrialAccidents I Congress Street, SWte 100 Boston, HA 02114-2017 w.mass.gov1dia Etctors/Fleqtr1ciansJP1Wbers- Worke& Compensation Insurance Affidavit: Builder$ COntr! TO BE FILED WITH THE PEP2&T'�NG AUTECORITY- Name (Businss/Oigabizationftdividual):_ Address: City/State/Zip: Areyouanemp!oyer. .�'ecktbe app�oprlate box: if: I.F1 I am a employer with ' .__�mPloyees (Aill andlor part-time)'* �.V I am a sole proprietor or partnership and have no employees Working for me in V '-,any capacity. LNO workers' 'O'P- insurance required.] t 3.E] I am a homeowner doing all work mysplt [No workers, comp. insurance required.] <1 I am a homeowner and will be hiring contractors to conduct all work on my property- I'vVill ensure that all contractors either have workers' compensation insurance or are sole proprietors with no bm:p101Yees- :5.Fl I am a general contr4ot I pr'and I have hired the sub -contractors listed on the attached sheet. These sub-contract'o'-_ -iia�� ,$pjy,.s and have workers' comp. insuranc..: 0 exercised their right of 'exemption per MGL 0. 6. n we arc a c orp oratig# pmd �P, offic6rs.hav I r) P i tA,% ��d We hav,& no emp*8�s.� [No workers, comp. insurance required.] Type ofproject (Vequired); 7. E] N6Vd6nstr6ctlOn 8. )P,�kemodellhg 9. El Demolition 10 0 Building addition 11.0 Electrica,l rppairs or additi9xis, lZE1,prumDing repairs or additions 13-.nko6fre�air� 14. Mother their workers' compensation policy information., *Amy applicant that check§'�. OX01 must als 01 fill out the section below showing ail work and then hire outside contractors must submit a now affidavit indicating such. 'i Homeowners who sub ii�'this affidavit indicating they are doing or not thoseentitie have Iw- et showing the name of the sub -contractors and state whe�ther lContractors that check this box must attached iin additional she o' " ' have emPloVees, they Must Provide their workers' comp. policy number. employees. Tf the sub -c ntractors ro-piding-workeps, compensation insurancefff MY eynPlbYees- elOw is thePolicy and)Ob Slt� I am an employer that isp information. Insurance, Company Name`: - Policy ff- or Self -ins. Lie. Expiration DOe, Job Site Address* City/State/Zip- ira i n Attach a copy of the workers' co�mpejasation policy declaration page (Showing the policy number and exp t I o date). Failure to secure coverag . e as required under MGL C. 152, §25A is a criminal violation punishable by a ab up to$ 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 be forwarded to the Offico of fuvestigdtiOns Of the DIA for basurance coverage verification. r thepains andpenalties ofperjury that the information proVided h ve' true and correct Idoherebyc I u r -- I - -3, 0 /1 Of in this area, to he completed by cily or town officiaL fleialuseonly. Donot-write City or Town: Permit/License 9. issuing Authority (circle one): i 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical inspector 5. Plumbing Inspector 6. Other Phone#:. Contact Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their empkdy�es. Pursuant to this statute, an employee is defmed as "...every person in the service of another under any contract of express or finplied, oral or written." An employer ig deffied as "an individual, partnership, association, corporation or other legal entity, or any two or more ofthe foregoing engaged in ajoint enf6rprise, and including the legal representatives of a deceased employer, or the receiv6k'or trustdd 6fan individual, partnership, association or other legal entity, employing empl6ypps�. - However the owner of a dwelling house having not more than three apartments and who resides therein, or the occ �a�iofthd UP 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 b6 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 opdrate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage ieq*uired." Additionally, MGL chapter 152, §25C(l) states "Neither the commonwealth nor any of its political subdivisions shall enter intp any cont�qct for the performance of public work until accep'table evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Pleasb fill out the Workers' compensation affidavit completely, by checking the boxes that apply to your situationand, if nec6sary, supply sub-'contractor(s) name(s), address(es) and phone number(s) along with their certfflcate' (s) of insurance. Limited -Liability Companies (LLQ or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If anLLC orLLP do'6s have employees, a policy is required. 1�e advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmationof insurance coverage. Also be sure to sign and date the affidavit. The affidAvit should be retained to the city or town that the application for the permit or license is being requ�steq, not the Department of Industrial,Accidenis. §hould you have an y* questions regarding the law or if you are req*ed to obtain a W6rker.-' compensatioil policy, please call the Department at the number listed below. Self-insured companies shoWd enter their self -insura'nc'e license number on the appropriate lind. 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 0 in the permit/license number which will be used as a reference number. In addition, an applicant thai 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 fature 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. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAYE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia rn. !n. u3 "M C: 0 0 ran AD 0 > @ L'o m C) 00 o "U o g VM .... ......... l6r) -4 -4 0 �0. L z 4 to In t a Lwl EU K 0 4) (A M= r (mA 5, S. 3 CD a. 0 L4 ;o (D -T C-4 M K 3 (D CL r (n cr IM