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HomeMy WebLinkAboutBuilding Permit #534-2017 - 855 SALEM STREET 11/17/2016ScnvAj F NORTH lr� BUILDING PERMIT n�1 Al4 V► TOWN OF NORTH ANDOVER } APPLICATION FOR PLAN EXAMINATION -46- riot Permit NO: 5 y -ol-o % Date Received b41 �9sslArea Date Issued: 7 — r� l (aCMUS IMPORTANT: ADnlicant must complete all items on this Dane LOCATION �.S SA le W I S-1- rrnt PROPERTY OWNER L 1 d) d cA 0 I cA_r<:1 Print MAP NO: 0 6 PARCEL ZONING DISTRICT: gi� Historic District yes 010Machine Shop Village ves TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building P�One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial 1 Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic C Well ❑ Floodplain is Wetlands ❑ Watershed District u Water/Sewer j�� h 791166-1c ' Identification Please Type or Print Clearly) OWNER: Name: 1 rid ct (2 l l'ft Phone: Address: CONTRACTOR sjName:l Phone: Address:z/ I -b llls /,f✓ I�Cf �� t"/il6l of ole-� Supervisor's Construction License: v $-�� Exp. Date: Home Improvement License: 0 31c�_ Exp. Date:` ARCHITECT/ENGINEER Phone: ` Address: Reg. No. FEE SCHEDULE. BOLDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost R, 000 O 0 _FEE: Check No.: Receipt No.: -31 a- ofi NOTE: Persons contracting Adh unr4i tered contractors do not have access tg the guaran d, BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION" Permit No#: Date Received Date Issued: 11; TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building 0 One family 0 Addition 0 Two or more family 0 Industrial 0 Alteration No. of units: [I Commercial 0 Repair, replacement 0 Assessory Bldg 0 Others: 0 Demolition 11 Other El eptic ❑Floodplain Wetlands Ea et8 -e Distr6i- E a,>",,Uyer—[ M4 DESCRIPTION OF WORK TO BE PERFORMED: Identification - Please Type or Print Clearly OWNER: Name: Address: Ph 0,dritractbr' Nb zfth Supervisor}s. G; "n *8 t �r�—u dense Horne Im_tqyen�" e xp.R .sE� 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. 1 rotal Project Cost: $ FEE: $ Check No.: Receipt No,, 4 NOTE: Persons contracting with unregistered contractors do not have, access to the guaranty fund -6t %Rgqf�t' -11 0 contractor Sigaqtur. of c Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. r 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/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 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 Calculations (If Applicable) ❑ Copy of Contract o Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products 40TE: 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 r Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ 'I'VPB 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 PLANNING & DEVELOPMENT Reviewed On COMMENTS Signature. CONSERVATION Reviewed on Signature 6 COMMENTS HEALTH COMMENTS Reviewed Signature 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: FIRE DEPARTMENT - Temp Dumpster on site yes Located at 124 Main Street Fire Department signature/date 7MMENT Locatea �jm usgooa Street no -)imension 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 ®ANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine No Doc.Building Permit Revised 2014 Location ?5-5– 5 r,,?T— No. 5 3 i( -90 1% Check # D g? .'1209 Date l I' / ? - d16 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 Calculation Construction Cost $ 19,000.00 m $ - $ 228.00 Plumbing Fee $ 28.50 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 28.50 Total fees collected $ 385.00 855 Salem Street 534-2017 on 11/17/2016 bathroom remodel v a C � U) n a O CD D O •a �. O CL ycn O < vCD MQ O C = cr CD M O �v �o � C O C- ��S/�, =/}� iii •V I � v a z CD 0 o CD O/ 1 CD O n fi :- m x -n To cn Z O —1 O 0O O 2 = N N y O, CCD CO's (D 0 0 rt Q n � m O �� N N O N rt CD TI O o .. a 0 m W�CD� 0 � c c� CD m CL = 0 co a N OCD n CD -a 0 < CO O O v, h z CDN 0 h a CD N > 0 a) 0Q= (A 2 �2)CD a� FL� N r .a CD `° R o _' o too _ O �D O U) CD :o CD n N D� o� rt O � rt 2) O Q 0 i J Ln B O 77- (D � V1 (DD Z O p7 C 3 T ]' O 000 S Z Ax O T j .Z1 O 000 S Ln B O 77- (D � V1 (DD Z O p7 C 3 T ]' O 000 S T 3 V1 .Z7 O 000 S T j .Z1 O 000 S T j' n _S 7 � Z7 O 00 S T O 3 Q r*. N N n •G T O Q \ M j- .rpt T m D m D '� N O m T n n 0 M C W m 0 W C ,- z Z n O 3 fD O O m 0 m = A L�l �,qm AMERICAN WOOD PROJECT NAME 91 p COUNCIL www.awc.org DATE PAGE# info@awc.org ti 10, ; i i f if fit.;. 14 —f' IF, �_'!__ e I 11/3/2016 Linda O'Hara 855 Salem St North Andover, MA �It yE 1',A�tJI fTE11 t�4xc� Residential & Commercial PO Box 3216 Wakefield Ma. Supervisor's Lic.#025603 MA Home Improvement #181312 E -Mail scolella2@comcast.net Cell # 781-258-6854 Contract Remove existing vanity, toilet, and shower unit in existing 2nd floor master bath. Replace with new vanity, toilet, and shower unit picked out by homeowner. Home owner to purchase, and provide, all fixtures and tile floor product Patch floor and install ceramic tile on floor. Plumbing cost to change shutoffs and reconnect new fixtures included, as well as cost to install dedicated GFI receptacle File permit with town as well Total Contractor Property 0 $19,000.00 Signatu e Date wrier Signature Date 4 J The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print C) I 1j1s City �7 W& Phone am a homeowner performing all work myself. — I am a sole proprietor and have no one working in any capacity 0 I am an employer providing workers' compensation for my employees working on this job. ComDanv name: Address City: Phone #: Insurance Co. Policv # Company name: Address City: Phone #: Insurance Co. Policv # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. # x//4` CJ Official use only do not write in this area to be completed by city or town official 0 Building Dept ❑Check if immediate response is required Building Dept p Licensing Board C] Selectman's Office Contact person. Phone #: C] Health Department 0 Other FORM WORKMAN'S COMPENSAMN rom:Chase & Lunt Insurance 978 465 6204 11/17/2016 13:56 #313 P.001/002 WESTM-1 OP ID: AC CERTIFICATE OF LIABILITY INSURANCE D11117ATE /20`16Y) 11117/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Chase 8r Lunt LLC 66 Parker Street Newburyport, MA 01950 Select Business Unit Select Business Unit Merchants Insurance INSURED Westminster Woodworks INSURER 6: David Drescher 8 Westminster Road INSURERC: Merrimac, MA 01860 INSURER D: INSURER E: INSURER F: rnvcoer_cc ecartctreTI= tw IFAR=P- RFVISIAN Nt]MRFR- 978-465-6204 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE POUCY NUMBER POLICY M/D EFF MM��D CY XP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR X Business Owners SOPI089098 04/08/2016 04/08/2017 EACH OCCURRENCE $ 300,00 DAMGE TO RENTEIT_ - PREMISES lEa occurrence $ 500+00 MED EXP (Any one person) $ 15,00 PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ 600,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- JECT LOC PRODUCTS - COMP/OP AGG $ 600,00 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON—OWNED HIREDAUTOS AUTOS COMBINED SINGLE LIMIT Ea ,,'dent BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ IPER ACCIDENT $ REXCESS UMBRELLA LIAB LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YNIA OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below I WC STATU- OTH- E.L.EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ EL DISEASE -POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) VSA FAX 978-688-9542 Town of North Andover Attn Donald Belanger 120 Main Streeet North Andover, MA 01845Y'.J4' eQ =: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE U 1885-ZU70 AGVKU t;UKr'VKA 1 IVIV. All ngn[s reservea. ACORD 26 (2010/05) The ACORD name and logo are registered marks of ACORD \\©/p ■�/ k$m � . 2r 0 mix �0 ©; .0 m■ &, ] }2 ; ) ! . �mn &@.a)E R f 0 .E $ E J~ C» p b 5= p �- w \ 872. . E KCL A):mR » � ,