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HomeMy WebLinkAboutBuilding Permit #402 - 82 MILLPOND 11/28/2007 NORT1# BUILDING PERMIT of t��o ,baa TOWN OF NORTH ANDOVER o? - ` ` �to APPLICATION FOR PLAN EXAMINATION Permit NO:12-7 Date ReceivedCHDate Issued IMPORTANT: Applicant must complete all items on this page tOCAT10N ^a�1 to Pt t PROPERTY OW9ER "+ hn MAP NO PARCEL 72- 0 G DISTs MachineShop Village; yes no 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 sSeptic VUetl tFlo�dplamWetlands Watershed Des#nct Water/sewer } . �A .. DESCRIPTION OF WORK TO BE PREF RMED:a&LL' CA K. t02) r , Iry Oath Ln A no Lc�) ax\A ,no, oL:n(-J I Identification Please Type or Print Clearly) OWNER: Name: pp � '�^ Phone: Address: LL�-�L i ) �T V 1 0.n6cen noa. U - 'CONTRACTOR Name � F&M e: q - tldress r Supervisor"sConstructior�ii :�cerrse Exp= °F. �Horn� l.mpr©vernent License ` :Expg FDate , 3 x I ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST A ED ON$125.00 PER S.F. Total Project Cost: 0 nA FEE: J $ Check No.: Receipt No.: C 2'0,�22 NOTE: Persons contracting witfi unregis er d contractors do not have access to the guarantyfund of Agtient/O nw a Signature of confractoV. 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 o 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 j New Construction (Single and Two Family) ❑ Building Permit Application . u 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 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 DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS oning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Con nection/s ig nature & Date Located at 384 Osgood Street Driveway Permit FIRE DEPARTMENT Temp Dumpster:bn si#e yes t ho, Located at 124 MainStreet -fire Department ignature/crate { , ,7,77 Revised 2.2007 J - - -- 1 ---!_---- NORTII DING PERMIT OFtt�ac Dimension -- Number of Stories: —� Total square feet of reafloor Total land a , sq ft.: area, based on Exterior-dimensions. ELECTRICgL: � Electrical ins Movement Of Meter locatio Rector n, mast or s DANGER ZO Yes e►vice drop MGL chapter 1ss NEr on 2ERATU No requires approval of Yes RE: and G min.$100-$1000 fine No NOTES and DATA_ (For departure nt use i I Notified for pickup - Date oc.Building Permi ---' `' t Revised 2007 i --- Location nn � Locationgfev— 29?z /.�.�y No. Date NaRT� TOWN OF NORTH ANDOVER f � Certificate of Occupancy $ NuBuilding/Frame Permit Fee $ �cs � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # l� 20823 _-- Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street 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): 1/ i ��i}i)^c Q (0 Address: / �)�)� ✓► C.JC�d�Jye City/State/Zip: h[4(Ie�b D l'913 0 Phone.M 4 2V Ci 9 4 S K,1 Are you an employer?Check the appropriate box: Type of project(required):, 1.El I am a e to er with ' 4. ❑ I am a general contractor and I Y 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. 7. emodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp.insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions officers have exercised,their ❑Plumbing eir 11. 3.El I am a homeowner doing all work hig 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 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. rContractors 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 workerscompensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#:' 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 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 DIAforinsurance coverage verification. I do hereby certi upains ena ies of perjury that the information provided a ove is t ue and correct 7_0 Si atuie: Date: Phone#: g 2,F `T c[ 6/ Y,3 Offcial.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." p 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, §25CM 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 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #6.17-727-4904 ext.406 or 1-877-MASSAFE Revised 11,22-06 Fax# 617-727-7749 www.mass.gov/dia �n Board of Building Regulations and Standards ,i HOME IMPROVEMENT CONTRACTOR Registration: 153690 a Expiration: 1/3/2009 Trak 253745 Type: Individual WILLIAM L BASLER, WILLIAM BASLER 61 JOHN WARD AVE'. HAVERHILL,MA 01830 Administrator. _ 1. t� �� Ronvhxoruuea� �✓G�,��,� `' oardofBuildin g Regulatlonstand Standards Constrpction Supervlsor Lice , e Li- 83658 fie,: CS' I :. t r Birt# .7 975 4gYratfon.z77✓3✓�Q '8 Ti* 1 Lc I RestrictionOD {{ r I WILLIAM L BASLER.-� i- 61 JOHN:-WARD, HAVER�HILL,M 01,830 I Co I mmyssionei• / I 14 RT11 0 o TAndover No. 40,%W �...�.„ dover, Mass., ' 0 A. COCMICKEWICK �A0RATEO P'P�\ �� BOARD OF HEALTH PER IT D Food/Kitchen Septic System BUILDING.INSPECTOR THIS CERTIFIES THAT........................................... Foundation has permission to er t.............:.......................... buildings on ..�.�......M. .1�.��i . ............................. Rough to be occupied as.. ....................�. Q. . Chimney provided that the person accepting this permit 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 CONSTRU T TS Rough Service R Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display Conspicuous Place on the Premises - Do Not Remove P Y �in a Final T No Lathing or Dry Wall 1 o Be Done Until Inspected and Approved by the Building Inspector.ector. BurnerFIRE DEPARTMENT Street No. SEE REVERSE SIDE Smoke Det. ACCEPTANCE OF PROPOSAL G Above prices, Specifications-and conditions are satisfactory and are hereby . accepted.. You are authorize&to supply the materials specified..Payments will be made as outlined above.- a ` = Signature 1-1 \ 16W Signature: ' THANK YOU FOR YOUR BUSINESS!!! " t b M I i. • n - _ r Y '� .. .. li._ � � / — r � ._ � —� \ \! _I � � � ` � —.. Y - _i i � � � � ' � i �' _ f � / ` ,� - - � ./� .a � _. � _ ii � � � � _ � ; - t. � '' • � - � , ' ' 1 ,.. _ - � + .. � � � � f t e _, i ` � - ^- { � - � � � ` _ �� ' f _\ , r -' i � � � � � � � ., �- J � � '� _ � � � 1. � � � � . � ,r' • �� i - O - � � � , � , � w �. c �� � i. A 2B CONSTRUCTION PROPOSAL 4, 61 Johnward'Avenue November 26,2007 Haverhill, MA 01830 978-994-8836 PROPOSAL SUBMITTED TO:Lisa,Johnson K a o We.hereby propose to furnish the materials and perform,the labor necessary for _ ° the completion of: 1 Framing out o basement into an office to include: -framing of floor up 4'TM -framing, sheetrock, insul'ation'and plaster of all,walls allselectrical-including installation of lights, switches, outlets, moving of existing garage he iter and electrical baseboard heat , -`replacement of existing basement door reP-using steel door in office N , -framing of closet and installation of closet door -fire rated sheetrock on garage side of wall Total - $12;000.00" Material-is guaranteed to be as specified, and the above work to be performed ' • in accordance with the drawingsrand specifications submitted for the above -work and completed in a workmanlike manner. Payment of all permits are included in the price. Respectfully submitted by, Bill Basler Alteration or deviation from the above specifications involving extra costs .executed only uponwritten order, and will'become an extra charge and7tabove,, _ the'estimate. All agreements contingent upon strikes or delays beyond our control. Payment of$12,00,0.00 to be made in two installments. -$6,000.00 xo,be paid as a deposit at signing of this contract to purchase all permits and materials. v $6,000:00 to be paid upon satisfactory completion of work stated above: L ^� • � , �, f. � - � r � i • � ` .. l `, � r � J v ' �.. .. ? � � � � � � � .. ,� � M / J .� Ili � / � ? I 0 _. s . .. � � ' - � ,. �. v � � ,� � � t ' ` � / T I � y ., 4 � � � � , � � ' a _ - ` 1 )� � � fY `� i �� ', ` _ � -� � r a 1 ✓ 4 r • l w � � � � � � � ,. y f .' - E � r � - ,. � ,� i 1 - ,�- � � ,. , < �� • � t o � � - . � � 11/27/2007 14:54 9782784008 GREAT NORTH PAGE 01/01 GREAT NORTH PROPERTY MANAGEMENT 182 Newbury Street Phone: 978-278-4000 Peabody,MA 01960 Fax: 978-278-4008 November 27,2007 Lisa Johnson 82 Millpond North Andover,Ma 01845 Dear Lisa, As we discussed,the Homeowners Association has no problem with your doing.interior work within,the garage-under portion of your unit. Should there be any other questions,please have the inspectors or your contractor get in touch with me. S' c 1 Druce er Property Manager Millpond Hnmeown,er's Association • r •F A• Z CONTRACT Customer Name L�'r� I � Customer Signature SKETCH Contract Date Sales Representative Signature ATTACHMENT Customer Phone Contract Price 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 1 2 3 4 i 5 . �I 6 ? G� 7 I - 8 9 10 � 12 13 14 15 16 17 _ 18 19 20 21 22 , i' 1! 24 25 26 27 28 29 30 31 J- 32 33 34 35 NOTES: *Each box equals one foot unless otherwise noted. This sketch is a good faith representation of the work to be done, it is understood that all dimensions derived from this sketch are approximate, and that all locations of outlets, light fixtures, plugs,jacks and/or switches are subject to change if necessary. r r .. .Y R .f' _.._._...... �Ct �111tort1a11tUseglt�� r1 E11�13a��i�li �CtX1� office Use Only / Uepartrrtent Df Public St4fefy reimil No. -- --� 9 CrULA11ONS 527 CMR 12:00 BOARD OFFIRE PREVENTION RE Occuparrry a Faa ChoCkod ...-...---- 3/90 (leave blanld APPLICATION FOR PERMIT�R O PERFORMrELEC:;T527 ChiR RICAL WORK All aork to be pe +;Pl EAS(: 1'RIN1 IN INK (7R 11'1'E ALL INFORMATION) A�2-base __01!�E_ G' (:Icy or Town of_...�.:.�•Alf�'-(.z� r.�._ fo the Inspector of Wiles► The undersigned.applies for a permit to perform(he �ieculcal work desc_ifbed below. , a fent �l. ------_-�-._-�------------�_--__�_---._.�....------------- �el�iedtlon tStrer:t & Number) Xnwner orTennnl p(Owner's Addresso✓��--�dC>tiCJ.___-_. 1 Yes L.J N° �+ - (Check^pproprlale Box) Is this permit in conlunCtion with a building perinil' p � _lJtility Authorization No, ----------•--"" Purpose of Ouilding --}� �...1-- _._ .. . ....._1 t-� t-� Existlnf! Service Amps�.- J_�?� C7 Volts overhead D Undwd 7 No. of Meters _-•�— �_.1Nn. of Meters._.__.____-_ New Service _ -------_11mpsVolts Vverhead Undgrd Number uP feeders and Mnpaiity ..---- I rx:ation and Nature of proposed Electrical Work �J`- - wr �r��� _- �-- ------ 7vTAl No. uP Hut lutes No, of Li hlin Oulle s - ,tve L_I ^ Generators KVA__ S,+vltnrmn Puul •„ No. of Li htin fixtures ,,,_•� ,-,,.. _� .-•---g--- o• o mergancy g ting No. of Oil Durners Battery Unir, _ .,. .....- - No. of Receptacle Outlets _ .••__,,.^,. '-^' No. of Switch Outlets A No. of GAS Durners -� FIRE ALARMS No, of]_ones - _ Outlet!___��------ ��a No. of Detecilon and No.of Air Conditionels Tons initiating Davlces --� No. OfR icy _ --• - eat olal'�T°tom- No. of Sounding Ucvlces rdo• b(Uii x)S11f �___ No of Pump Ton,�,ii�,,,,,,, K\V No. of Sul(Contained ��---M-•~-' (,will �--'" " t)eteclionlSnundfng Devices tdo, of [)I'll KW l1 Municipal ❑Other Heatln Ucces MV Connection No of IT o��07 ---------� K61.r Si ns Ballasts - lnrfrine _,_,_-_,____,_r. No. of Water Heaters tdo. of Motors Total lif _ --- Na. Hydro 1,lassa a Tubs.------ a..•-,.,.--�„ --- '- OTHER: INSURANCE CnY'ERAGE: i'ursuant to(lie requirements of Massachusttes Gentrral laws I have a current t.lablilly Insurance volley Including Completed Operations Covcragc of 6substantial equivalcnl. Y[S C)NO 1:7 I have submplad valid proof of same to this office. YES l..r No 1.1 If you have ch(eaedd YES, Pl(ease � Indicate tIle type of coverhge by checking the appropriate box INSURANCE lLef BONA lJ OT14ER11 (please Speclly) _ --.• --- ------�-- (Exphatlon Date) Estimated Value of Electrical Wort: S _-_---•-_--- _ __ _ Inspection t1ate Requested: Rough -_- T Final _ ----- Werk to Start ---•--•- Signed under the penalties of perjury( LIC. 140. FIRns NA /� - Signature IIC. NO. Licensee r�c.��t•L���--a"i- '^, _�� -�, ..�'�t .... lJ�l t Uv H __ Bus, Tel. No. -7i �. Address ..�,�_��2_�.����°� ---- -------•-..._...._, i At(. Tel. No. - lent OyrNER'SINSURANCC AiYrLu:I-tF wareilraltlitalielc� doe`nolhhyertepuirtentent�Owner g`urrAgets ritstantia`Iloaseacheck s ne)Ired ~f saclsua General Laws and that my signatute on this pe m s P _ Telephone Nu•- (Signature 0f Owner or Agent) Date... ...... 2805 kORTH OEt,�ao`eq�yO 3? TOWN OF NORTH ANDOVER t PERMIT FOR WIRING I,MP ,. ,SSACMUSE� L This certifies that ........ .. � .t...�.. �.0 �... .`......�.0.............- has permission to perform .....L.^.-.>..:..s... .. ......C. .:r. „�P wiring in the building of........����..(s.f� . . ................................................ at.... ................................ .North Andover,Mass. Fee..... Lic.NoX Z:? . . ELECTRICAL INSPECTOR C 01&2/,% 15:49 15.00 PAI WHITE: Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File