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Home My WebLink AboutBuilding Permit #358-16 - 75 HILLSIDE ROAD 9/21/2015 C a� is BUILDING PERMIT of NORTH 16� 3� TOWN OF NORTH ANDOVER y6�tiED.+r6'6O APPLICATION FOR . N EXAMINATION L 70 �r � Permit No#: l Date Received Qq<OCr[M w rEv on I ��SSACHUS��S Date Issued: k I IMPORTANT: Applicant must complete all items on this page LOCATION �� #VAIde- Ad Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: Historic ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential M. ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg N/Otnhears: .- ❑ Demolition ❑ Other q Septic ❑1Nell ❑ FloodplainpWetlands ❑ °Watershed [7istricts. [TWater/Sewet . .� . 9 _ ? k DESCRIPTION OF WORT,TO PE PERFORMED: n f� 1 Ide ificatio ease Type or Print Cie ly �S WNER: Name- ,5' E� �lCYhone: Address: r �I Contractor Name: Phone: 9 -g Email: eo Address: - Supervisor's Construction License' C S 47 -Ra® fExp. Date: . 3I%SI o"zo) -Home Improvement License:.. o69 15 Exp. Date: 3 ,20 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: $ f0, gY-z FEE: $ T Check N .: j Receipt No.: � NOTE: Pers s contr t with unregistered contractors do not have access to the guaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOS.A.L 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 e U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS ' I CONSERVATION Reviewed on Signature COMMENTS i i HEALTH Reviewed on Signature COMMENTS I I 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 DEP�/�R MT ENT Temp=;Dumpst�eonse�es`� no n' located at 124 Main'Street , h .r'. `5` I' ' t•y, .z R � e Department sig tuir { date• * _ e �. 3 £,� {,.Mt s x r # w #' k• a a.y a -` - � Vit, +tit �� s caYak <v^t xK� rScP ry fx7fiY k ;ya'i t +?cF° � Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Deter 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 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 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 4, Building Permit Application 4, Certified Surveyed Plot Plan 4 Workers Comp Affidavit 4 Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract a. 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 No. — Date toe 'r . - TOWN OF NORTH ANDOVER ,,, � �.;��ate• . . Certificate of Occupancy $ o Building/Frame Permit Feeell f Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#` Building Inspector � NORTH . Townndover No. �An, h ti ver, Mass, COCHIC"IWIC �• IT 11 BOARD OF HEALTH PERM Food/Kitchen Septic System THIS CERTIFIES THAT .......5••• •„•••,• BUILDING INSPECTOR has permission to erect ... ..... buildings on76 Foundation g .......... .J .�� ...................... � Rough to be occupied as ....... oyl.l ..... .�.. .. `� . .. ... ..... ......... ... �............. ..... Chimney provided that the person accepting this permit shall in every respect c form to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteratio d Final 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 I3V ` UNLESS CONSTRUCTION TRough Service 04. . ................. BUILDING•INSPECTOR• Final GASINSPECTOR Occupancy Permit Required to Occupy Buildinz FBurner Display in a Conspicuous Place on the Premises - Do Not Remove No Lathing or Dry Wall To Be Done IRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Street No. Smoke Det. I ZALANSKAS CONSTRUCTION 34 BIRCH ROAD ANDOVER MA 01810 978-835-5194 GREG.ZALANSKASCaD-COMCAST.NET QUOTE# 32 Order# Date 8/18/2014 QUOTE SUBMITTED TO: WORK TO BE PERFORMED AT: Name Steve&Francine Jones Name SAME Address 75 Hillside Road Address city-state North Andover Ma Planned Date Phone 978-691-5385 /cell 617-755-4808 email francine.*ones@bnymellon.com ,Job Description: ;DECK RESURFACE The existing deck framing will remain the same. We will remove existing decking,remove railings,keep the 4'x4'existing posts,remove risers on the steps, INSTALL New 5/4x6 Azek Tahoe PVC decking,blind nail and screw&plug system to attach decking,new 4x4 Azek composite sleeve over the existing 4x4 posts, install Azek PVC post caps and bases,new 1x8 PVC risers,1x10 PVC skirt board around outside perimeter of deck,White composite Radiance rail system with square balusters, Decking is special order. Materials cost$5,257.00 Labor $5120.00 Disposal$250.00 Permits$220.00 Once the old decking and railings are removed ,the structure needs to be inspected by the town, if changes need to be made additional cost may accrue. All material is guaranteed to be as specified,and the above work to be performed in accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of: $10,847.00 PLEASE MAKE CHECK OUT TO ZALANSKAS CONSTRUCTION with payments to be as follows $5500.00 deposit to order product $2000.00 at start Submitted by: GREGORY ZALANSKAS 3347 due at completion OF ZALANSKAS CONSTRUCTION Acceptance of Proposal The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work specif' d above. Pay n will be made as outlined above. Accepted by: 25 A OG 2-015 Please note: is pro osal may bCwhhjdrawn by us if not accepted within 30 days S��S The Commonwealth of Massachusetts . Department of IndustrialAccidents I Congress Street,Suite 100 Boston,MA 02114-2017 yet www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information P Please Print Le 'b1 Name(Bu /Iu siness/Organizationdividual): .Address: 134 City/State/Zip: Phone#: �/7 g�s - 5�hc�ov � y"� f g Are you an employer?Check the appropriate box: Type of project(required): LF]I am.a employer with employees(full and/or part-time).* 7. ❑New construction 2.101 am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] ' 9. El Demolition 3_❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 ❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.[]Electrical repairs or additions proprietors with no employees. - 1.2.E]Plumbing repairs or additions 5. 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ t 13.[Roof repairs These sub-contractors have employees and have workers'comp.insurance. n ((R�1-^ 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑e Other 2e 1'�( t. e 152,§1(4),and we have no,employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit'this af5davit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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 pi*oviding workerscompensation insurance for my employees'Below is the policy and job site information. Insurance Company Name: . i Policy#or Self-ins.Lie.#: Expiration Date: 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 MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civilpenalties 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 Office of Investigations of the DIA for insurance coverage verification. Y do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. i Sign e: Date: Phone#: J V 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 Iocal 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'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 or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents fox 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 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 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.# 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia Office of Consumer Affairs&Business Regulation License or registration valid for►ndividul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 126875 Type: Office of Consumer Affairs and Business Regulationpiration , 8/3%2016 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 GREGORY J.ZALANSKP;S;=. IGREGORY ZALANSKAS°-- 34 BIRCH RD I ANDOVER, MA 01810 Undersecretary valid without signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen•isor License: CS-072201 10- GREGORY JZALANSKAS %. 34 BIRCH RD Andover MA 01810 r ya Expiration Commissioner 03/18/2016