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Home My WebLink AboutBuilding Permit #453 - 75 BARKER STREET 2/24/2009 BUILDING PERMIT O ftIORTFI r.C' ,6gti TOWN OF NORTH ANDOVER o� APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: "d IMPORTANT: Applicant must complete all items on this page LOCATION 75 ) }af 6Z Print t / T PROPERTY OWNER-,�� (�( � , l Print MAP NO: 3 C_PAIRCEL: ZONING DISTRICT: Historic District yes )no Machine Shop Village ye TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ✓ One family Addition Two or more family Industrial ✓ Alteration 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: Identification Please Type or Print Clearly) OWNER: Name:_ 14 N C!j- A77ER 1 Phone: /78 Address: CONTRACTOR Name: a SYS Phone: �7- 3 gP 5 Address: /S ! '' ffp RF 11.5 ,E O fid=�I[F L.P pig of Supervisor's Construction License: / 70 5' Exp, Date - - 0 Home Improvement License: ' Exp. Date: /0- /0-.),O f 0 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: $ / -�9>6 FEE: $_ , Check No.: g 'Do 4 Receipt No.: 0 b NOTE: Persons contra ,ting with unregistered contractors do not have access to the guaranty fund Signature ofyAgent/OwnecSi nature of contractor LL( Location S No. Date �oRTM TOWN OF NORTH ANDOVER F • C9 41 Certificate of Occupancy $ �'�s''•° E<� Building/Frame Permit Fee $ sACNUs 1 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2 t 8 J u ----- Building Inspector 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 a Reviewed on Signature i6OMMENTS 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 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 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 2008 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 o Building Permit Application Li Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Li Building Permit Application o 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) o 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 L3 Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract o 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 2.2008 NORTH own of 0 of over, Mass., a LAKE A. T COC MICMEWICK �70 RATED 7 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR � U+ THIS CERTIFIES THAT........ ........ kiw �,. � /.1. Foundation pk� has permission to erect............ .............I.............. bu"dings on . .... Rough . ....................................... t0 be occupied as...Id .44W. �I� l` +� Chimney ......................................�Rw....'........... ti provided that the person accepting this permit shall in every respect conform to the to sof 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 s; Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough v d q PERMEXPIRES IN b MONTHS Final IT ELECTRICAL INSPECTOR UNLESS .CONSTRU T S 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 Fina, No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. The Commonwealth of Massachusetts Department o P f Industrial ilJ6 Accidents e'r Lr Office of InvestiaationS w 600 ashin e ` aton Street Boston , MA 02111 { ' wwn'-mass.;ov/ilia Workers' Compensation Insurance Aff davit: guilders/Contractors/Eleetridia.ns/Piumbers A lieant Information Please Print Legibly Name (Business/organization/Individual): k/S k-1 rrs •^ � Address: rV ` l t City/State/Zip: Phone 7Areyouemployer?Check theappropriate box: mployer with q, ❑ Iam a aA Type of project(required);eneral contractor and I ees(full and/or part-time).* have hired the sub-contractors 6• ❑ New construction 2 1 am a sole proprietor or partner. listed ann the attached sheet 1 7• ❑ Remodeling ship and have no employees These stab-contractors have working for me in any capacity. workers' comp. insurance. g' ❑ Demolition [No workers' comp. insurance 5. ❑ We are acorporation and its 9. El Building addition 3. required_] officers have-exercised.their 10:0 Electrical repairs or additions ❑ I am a homeowner doing all work right of exemption per MGL 11.7 Plumbing repairs or additions myself. [No workers' comp. c. 152 §1(4); and we have no insurance required.] t employees. [No.workers' 12.❑ Roof repairs comp, insurance required-] 13•0 Other ----------- .Any applicattt,that checks box#I.must also fi;l out the section below showing tirair workers'compensation policy information, l o tneo ors that t who submit•ibis aritda.vit iniiieating L`iey art duiti�eF`lir:=r'r:ald Cher hir:,outside auntraciurs must submit a new amdavii indicating such. YConuactors that chest this box must attached an additional street showing the name of the s:b c-tsacton and their, workers'comp,Policy I am an.employer that is providing workers'co enation i P P � rnfonnation. information. in., for 'employees, Below is the policy and job site Insurance Company Name: Policy#or Self-.ins. Lid.#: Expiration Date: .fob Site Address: Attach a copy of the workers' compensCity/State/Zip: ation Policy declaration page(showing the policy number and expiration Failure to secure coverage as required under Se - p tion date). q Section z5A 1 ofMGL GL c. 15� P fine u to $1 500.00 an -can lead to the imposition P and/or - os' ' r one year imprisonment as well as civil penalties in the form of a STOP WORK crim10RDERnal land a fine of up to.5250.00 a day against the violator. Be advised that a copy of this statees of a ment may be forwarded to the Office of investigations of the DIA for insurance coverage verification. Ido hereby cern ,under the pains enaldes ofperjury that the information provided above it true and correct r S i�rtatttre: Phone Official use only. Do hast write in this area, to be completed b3;city or town off,-tciaL City or Town: Permit/License# Issuing Authority(circle one): L Board of Health 2. Building Department 3. City/Town 6. Other Clerk 4. Electrical Inspector S. Plumbing Clerk Inspector Contact Person: Phone th Information %nd 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 "...--Ver-y person in the service of another under any contractofhire, 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,orthe receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dweiiing house having not more than three apariznents 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 a r local licensing agency shall withhold the issuance or renewal of a license or permit-to operate s business or to construct buiidings in the commonwealth for any applicant who has not produced acceptable evidence o,f 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 compll-eteiy,by checking the boxes that apply to yow 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 nr LLP does have . employees, a policy is required_ Be advised that this affici<avit maybe submitted to.the Department of Industrial Accidents for confirmation of insurance coverage. Aiso be sure to sign and date the affidavit The.af iidavit should be returned to the city or town that the application for the pen-nit or license is being requested,mot the Department of Industrial Accidents. Should you have,any questions regarding the or if you are required to obtain a worken' compensation policy,please call the Department at the nmrnb n hsfed 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 appli=t. Please be sure to fill in the penmiMicense number which will be used as a reference number. In additiion,an applicant that must submit multiple pennit/heense applications in arty 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 starnped 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 burnleaves 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 far, number: The Commonwealth of Massachusetts Department of 1`rudustrial Accidents. Office of fnvestigatious 600 WashE ngton Street Boston, MA (12111 Tel. 4 617-727-4900 C=406 or 1-977-MASSAFE Revised 5-26=05 Fax 4 617-727-774'9 WWW-Mass.Dov/dia PROPOSAL y S Q I i U C ( 1 U (Y PROPOSAL NO. .. SHEET NO. es ► �= ,� Mvi 00-fe3 DATE PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT: NAME ADDRESS ADDRESS DATE OF PLANS ' O /+ c, �:� �'' PHONE NO. ARCHITECT We hereby propose to furnish the materials and perform the labor necessary for the completion of _ r 57 j f (f. f ;�-! r,t r r~ �!! //f� !r f �+�j'��''�r (^� �+ �//, lid" �,,e'•!� /l/!i� , fir+ r � ''f i ',� t• +� ! - (i��'t'! .i.'' ,J yr,; r�fr � r,! ( �� =a�f��/I �i�rte) t.�:ftJ f`�( •f� t '1/ '! :/ .GrJ . c J l r.,".,.r rs7l-,r "�/Mfr, y ��I�/f/ l 1 111 17��= �T r _! i �i?/"Y/, ,l 4 -f I •r UCG" • �,c- ;t •,� STx7)1_ . 4P,' '` --- 0 7 J f�,M , ,i5� ,,f,� ]-- �./ / }L(J ��/ }' 7 i ?'( ,L rY l•( � '�'�' ��L 7i`Cy"' (� r 71' ' -Alf(i2 (:2t)7—, -� _ P 7 ��,�r� � ,1i�-X! Ate T7��1I� All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings qnd specifi- cations submitted for/above work ar}d completed i` a substantial workman ike manner for the sum of 5 F ollars ($rl with payments to be made as follows. cf'av 4'."o-z- cJ't ( /`/•O' ' hespectfully submitted , n�alteration or deviation from above specifications involving extra costs P 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 as specified. Payments will be made as outlined above. - �_-- Signatur v Y f Date x Signature rjAda—NC 3818-50 Proposal MADE IN USA Bo��o u��gula�ioiSs a�nid-Sfan i HOME IMPROVEMENT CONTRACTOR P Registrafton 122739 Expiration _1p/10/2010 Tr# 278143 DSA f 44 ZYSK CONSTRUCTIONS , Q I MARIUSZ ZYS1'�� 15 ANDRESW RD��r,� TOPSFIELD_,MA01983 Administrator !iassachusetts- Department of Public Saferh Board of Buildim• �, Re-, Ulations and Standards Construction Supervisor License License: Cs 91705 Restricted to: 00 MARIUSZ ZYSK _ 15 ANDREWS RDy TOPSFIELD, MA 01983 Expiration: 2/18/2011 ('ummicci.�ner Tr#: 11479 i