HomeMy WebLinkAboutBuilding Permit #164-11 - 871 SALEM STREET 8/29/2011 I
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit iso: � Date Received
Date Issued:lJ l
1r MfPORTANT:Applicant must complete all
&P--/
items on this age
LOCATION ®1C�M 1
._ PA
IA
PROPERTY OWNER
Print
MAP NO: PARCEL:_1�7-70NING DISTRICT: Historic District yes n
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Resldentlal
❑New Building ❑One family
r❑Addition ❑Two or more family ❑Industrial
❑Alteration No. of units: ❑Commercial
❑Repair, replacement ❑Assessory Bldg El Others:
D Demolition U Other
Wetlands � p�7
f,p Septics 1 DWell
-- DESI_I^^JON OF, WORTS TO BE PE- i O-PT�UD: -
2t A-A) DC
p,�catipllPleaseXwe or Print Clearly) ���� �r i
OWNER: Name: A 1 Phone:
Address:
CONTRACTOR Name: [ � ( � Phone: lN'233-,035
Address: Of qo(o
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:B ULDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER s F.
Total Project Coat: $ 7� FEE: $
Check No.:�( 4Receipt No.: 5 `
NOTE: Persons contracting with unregistered contractors do not have cess to the guaranty fund
�'-'_-- _?� p_'h_ •y^- arr:o:-- - — ---:�.. _ _
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u�e::of• e'-`�/OwnerG: �; .'=_�-:��:: . _ _ --___=
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
j Roofing, Siding, Inferior Rehabilitation Permits
® Building Permit Application
❑ Workers Como Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
a Copy of Contract
❑ Floor Plan Or Proposed Interior Work
❑ Engineering Affidavits for Engineered products
MOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit.
Addition Or Decks
❑ Building Permit Application
❑ Certified Surveyed Plot Pian
o Workers Comp Affidavit
® Photo Copy of H.I.C. And C.S.L. Licenses
• Copy Of Corltrarjj
❑ Floor/Cressection/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
❑ Mass check Energy Compliance Report j
❑ 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: Doc.BuildingPermitRevised 2008mi
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Swimming Pools ❑
TanninglMassage/Body Art ❑
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
CONSERVAT 10N Reviewed on Signature
COMMENTS 1
HEALTEi Reviewed on Signature
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decislonlreceipt submitted yes
Planning Board'Decision: Comments
Conservation Decision: Comments
Water& Sewer Connection/Signature&Date Driveway Permit
DPW']Gown Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT -Temp Dumpster on site yes no
Located at 1.24 Main Street
Fire Department signature/date
COMMENTS
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
I
Total land area, sq. i.: _
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
i
NOTES and DATA-- For department use
i
® Notified for pickup - Date
E �
DomBuilding Permit Revised 2008mi
Location
No. A, Date e:�)5:w
NpRT1y 4
TOWN, OF NORTH ANDOVER
0
Certificate of Occupancy $
Mu Building/Frame Permit Fee $ ►
Foundation Permit Fee $
Other Permit Fee $
TOTAL
Check #1161
245'13 Building Inspector
NORTH
® of over
00%
No. /<o -t"- as/z
}( o , lover, Mass.,
Y O - LAKE
COC M I C ME WICK
X1,9
lea
°f�A'r5 D PPP�\�,4y
S BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
I
BUILDING INSPECTOR
THIS CERTIFIES THAT......... 5..........k........Q ...e. ............. .Q.. .........Ae...l...0.'�....................
Foundation
has permission to erect........................................ buildings on ..........� .4.1 ......S'. .......?......................... Rough
�►(�I/�a Chimney
to be occupied as..�_ .......... ... .......... ......... .......................................
.. ..............................................................
provided that the person accepting this permit hall in every respect conform he 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
1 Final
PERMIT EXPIRES IN 6 M - S
Z i ELECTRICAL INSPECTOR
UNLESS CONSTRUCT,
ONSTRUC T I N 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 Final
No LathingD Wall To Be Done � .
or � FIR_E-DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.
Estimate
EASTERN Date Estimate#
C O N S T R U C T 1 0 N 8/26/2011 5193
P.O. Box 2057
Woburn MA 01888
Phone: 781-938-5229 Name/Address
Fax: 781-854-0206 Robert Meikle
visit us at: www.easterneonstruction.net 871 Salem Street
e-mail me at: easternconstruction@comcast.net North Andover, MA 01845
License number:CS 75948 exp 3/6/13
HIC number:130307 exp 2/16/12
Federal I.D.number:01-0683412
The following dates are approximate dates and maybe changed due to circumstances beyond the contractors control such as but not limited to weather and
unforseen issues
Approx start date: 8/26/2011 Approx completion date:
Description Total
1---Tarp off house and yard as needed for protection against falling debris
2---Remove all existing shingles from entire roof of house
3--Remove and replace up to 25 square feet of roof decking at no extra charge
4---Resecure all exposed roof decking as needed
5--Repair and or replace all step flashings as needed
6---Install 6 feet of new ice and water shield on all lower edges and around all flashings
7—Install new 15 lb felt paper over all exposed roof decking
8---Install new 8 inch white aluminum drip edge on all edges of all roofs
9---Install new 30 year architectural roofing shingles on entire roof of house
10—Cut roof boards at peak of roof as needed to ensure proper ventilation
I1--Install new Cobra Ridge Vent on peak of roof
12--Install new architectural ridging on peaks and hips
13--Seal all flashings using fibrated roof cement and asphalt membrane
14--Remove all job related debris
15--Eastern Construction is responsible for all necessary permits
All materials are guaranteed by the manufacturer. All work is to be completed in a professional manner according to standard 7,700.00
practices. Any hidden conditions,alterations,or deviations from above specifications involving extra costs will be executed upon
written orders,and will become an extra charge over and above the original contracted price. All agreements are contingent upon
weather and/or delays beyond the control of Eastern Construction.
Total $7,700.00
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
*Payment terms: 1/3 deposit at time of signing contract, 1/3 due when job is half completed,and balance due in full upon completion
*All home improvent contractors and subcontractors shall be registered,any inquiries about a contractor or subcontractor relating to a registration should be
diected to:
Registration Division,Program
Coordinator
One Ashburton Place,Room 1301
Boston,MA 02108
Tel:(617)727-3200 ext 25239
*Add 3%for Mastercard,Visa,and American Express transactions
*All roofing estimates are based on removing up to two(2)layers,unless stated otherwise ?
*When your roof is being removed,please remember to cover and or move any valuables in your attic DateeBl 24 1 L.n I
*Workmanship is warranteed on new roofs for 10 years under normal conditions
*All estimates are based on current product pricing and are subject to change without notice
*Any changes,variations,or alterations to this estimate will result in additional charges
*Balance due in full upon completion of job Signature
A Division of AA&K Construction, Inc.
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
Number is that.the debris resultingfrom this work shall b
e
disposed of in a properly licensed solid waste disposal facility as defined by MGL
c11, S150A..
The debris will be disposed of in:
(Location of(Facility)
Signature of Permit Applicant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through.the Office of the Building Inspector
0.1
,'!��,' F'rjr.::�:,;1;u 1(�/r :.� ((•v.t•t:/I.Lir�l`t
License or,rei isU'ation valid for individul use only
:..
Office of Consunwr Affttirs S Business 11e91113tion before the expiration date. If found return to:
HOME IMPROVEMENT CONTRACTOR
.� Office of Consumer Affairs and Business Regulation
+= y
Re istration:
130307 10 Park Plaza-Suite 5170
Expiration: 2/16/2012 Tr# 291483 Boston,NIA 02116
Type: individual
EASTERN CONST.CO
i
STEVEN KALMAN 4 '
4 HEWt.ETT ST.
SAUGUS, MA 01906 lhder.cccrelar tint valid without signature
lic
eIN
Nlassachuscu�- Uc t,ulatiot>.:ndtStan illard•
11m Board of Buildin_
Construction Supervisor License
License: cS 75948
STEVEN R KALMAN
PO BOX 1266 " 'z R
SAUGUS, MA 01906
Expiration: 31612013
Tr#: 13553
('unuuiwiunct'
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' The Gorrimomvealthof Massachusetts
Department of Industrial Accidents
( Office of Investigations
r a 600 Washington Street
Boston, MA 02111
^ _ ` www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Build ers/Contractors/lElectriciaus/Plunibers
Applicant Information Please Print Legibly
��
Nm ae (Business'Organization/Individual): � 1 IlJ k) _
Address: A X1 1 J\
City/State/Zip S A O` Ob Phone #
Are vK an employer? Check the-appropriate box: Type of project(required):
1.V I am a employer with 4..❑ I am a genera] contractor and I. 6. ❑ New construction
employees (full and/or part-time).* have.hired the sub-contractors
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. $ 7• [�f Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance.
9. ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
officers have exercised their 10.0 Electrical repairs or additions.
_ required. .
3. 1 ani a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs of additions
�J g ,
myself [No workers' comp. c. 152, §1(4), and we have no 12.F-1 Roof repairs
insurance required.] t employees. [No workers' 13.❑ Other
comp. insurance required.] --
'An,,,r+pplicant that checks box 1 must also fill out the section below showing their workers'compensation policy information:
T Hcrneowners .vho submit this affidavit uidicating they are doing all work mid then hire outside contractors must submit a new affidavit indicating such-
tcortractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy infonnation.
I ain an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
Insurance Company Name:_,
Pokey#or Self-ins. Lic. ;`.': ,3e3 / "C� � kxpiration Date:
Job Site Address:_ C1 I.SL�'` �\ City/State/Zip:0/'7 wee.
Attach a copy of the workers' compensation policy declaration page (showing the policy number and'espiration date)..
Fai.ure to secure coverage as required under Section,25A of MGL c.,152 can lead to the imposition of crinunal penalties of a'
fine up to 51,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDERR' d a fine
of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to.the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby ce %inder the pains andpenalties of perjury that the information provided boveeiis true and correct:
Sienature.: Date:.'.;. l __
Phone#:
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.;Cify/Town Clerk.::4::Electrical Inspector..5.Plumbing Inspector
6. Other
Cont.tct Person: Phone#
Information '...and nstructions
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 ofhire,
c�,press 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 thelegal 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
d Nelling house of another who employs persons to do maintenance; construction of repair work on such dwelling house
or on tl;e grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
NIGL 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'cornm6nwealth forlany, .
applicant who has not produced acceptable evidence of compliance with the insurancecoverage 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-contractor(s) 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 for confu-mation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be rettu-ned to the city or town that the application for the permit or license is being requested, not the Department of
ndustrial Accidents. Should you have any questions regarding the law or if you are required to obtain.a workers'
compensadon policy,please call the Department at the number listed below. Self-insured.conipanies should enter their
elf-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 of the bottom
of the affidaVnt for you to fill out i-Olie 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'subnlit'multiple pern-tVlicense applications in any given year,need only submii one affidavit indicating current
policy ilrformation (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 oi`mark'ed by the'city'or to'vn may lie 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 affidm6
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: „•� r
The Commonwealth of Massachusetts ' r
Department.of Industrial.Accidents
Office of Investigations
600 Washuigton.Street
BostonMA'02111
Tela#-617-727=4900 ext 406`6r' -877=MASSAFE
Fax # 617-727-7749
Revised 5-26-05
www,.mass.govldia
:r
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
fer t t ai i s� ill . -4
BUILDING PERMIT NUMBER: DATE ISSUED: X
SIGNATURE:
Building Commissioner/12EeeStor of Buildings Date Z
SECTION 1-SITE INFORMATION O
1.1 Property Address: 1.2 Assessors Map and Parcel Number:
Map Number Parcel Numb
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(so Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required Provide Required Provided R 'red Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn
2.1 O er of Record ���
C.1 �7 IQ
Name(P Address for Service:
Len
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service: O
Z
rn
Signature Telephone
SECTION 3-CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: n Not Applicable ❑
--7 S9 Lf 1;
Licensed Construction Supervisor: O
l 1 J ♦ l 0S !1f V'r O 1 QIVA� License Number M
Addre 'S
1'�J J r ✓°� Expiration Date
Signatu Telephone r
3.2 Registered Home Improvement Contractor Not Applicable ❑
�inow yxtka',
Company Name C J��� rn
r t f
sa�)
�s' Registration Number r
Adjt
v 0 r
Z
Expiration Date n
Sin re Tele hone Y
SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6)
Workers Compensation Insurance affid it must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the buging permit.
Signed affidavit Attached Yes....... No.......❑
SECTION 5 Description of Proposed Work check all applicable)
New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ 1
Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:
,aV �P A-A) 0�0P of
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be QFFICIAL ITSE:ONLY ,
Completed by permit applicant
1. Building -7 0o 1 (a) Building Permit Fee.
tl
Multiplier
2 Electrical (b) Estimated Total Cost of
Construction
3 Plumbing Building Permit fee(a)X(b)
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5 Check Number
SECTION 7a OWNER AUTHORIZATI N TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, _V,0bQ,�_ V_ ,as Owner/Authorized Agent of subject property
Hereby authorize 'OA l 4'ka1� to act on
My behal A a v o w authorized by this building permit application.
zo Ls
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
«�.7I, Pla'. \ as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief ,r,� ( � p
k � Y_rq t kA-10
Print Name i —1-2-C,
Signature of O er/A ent Date
NO.OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TINMERS 1 ST 2ND 3PD
SPAN
DINIENSIONS OF SILLS
DIMENSIONS OF POSTS
DuU\ENSIONS OF GIRDERS
DIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE