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HomeMy WebLinkAboutBuilding Permit #286-13 - 9 Waverley Road 10/11/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: (��` Date Received I Date Issued: /O IMPORTANT:Applicant must complete all items on this page LOCATION _ 'e, v� not . 4= ' PROPERTY OWNER Pint 100 Year Old'Str-cture yes no MAF NO: PARCEL ZONING DISTRICT: HistoricFDistrict yes no Machine Shop-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: gCommercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well 0.Floodplain El Wetlands ❑ Watersheds District] E Water/Sewer DESCRIPTION OFORK O BE PERF MED: r Identifica>ion Please Type or Print Clearly) OWNER: Name: SMOA Phone: Address: CONTRACTOR Name: VI Ira Phone: f 7 82 2 Address: ro Supervisor's Construction License: Exp. Date: Home. ImprovementLicense: /"/ 2— ?_ / -a. Exp. Date: I ARCHITECT/ENGINEER Phone: Address: Reg. No. 'y FEE SCHEDULE.BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �, &o v ' FEE: $ Check No.: 700 5 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signafure of Agen�t/Owner '' Signature of contractor Plans Submitted ll1/ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Swimming Pools ❑ Tanning/Massage/Body Art ❑ i 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 Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments e—onservation Decision: Comments ,,,Vater & Sewer Connection/Signature& Date Driveway Permit ]DPW Town]Engineer: Signature: Located 384 Osgood Street DIRE 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. i Total land area, sq. ft.: I r 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 B Notified for pickup - Date Doc.Building Permit Revised 2010 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 (VOTE: 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/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 (VOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New ConstructionSin le and Two Family) � 9 Y) a 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 ❑ 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.Building Permit Revised 2012 Location ! u No. ��1� li Date /0// /L ti • • ' TOWN OF NORTH ANDOVER ILL i 1 Certificate of Occupancy Building/Frame Permit Fee $ y� --. Foundation Permit Fee $ Other Permit Fee'A TMIVA AN $ TOTAL $ Check# U/Z 25808 Bwirdc4i—nnspector L— ONO nT•1h � a • e i �SSIC NUSEI CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 286-13 Date: November 9, 2012 THIS CERTIFIES THAT THE BUILDING LOCATED ON 9 Waverley Road #2 MAY BE OCCUPIED AS a music studio IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Doug Small 9 Waverley Road North Andover,MA 01845 Building I spector Fee: PrePaid Receipt: 25808 Check : 5012 i � NORTf� o-wn of t E : t, sAndover No. o h ver, Mass, °4�£ COC NIG N�WtCK y1. U TEco) S U BOARD OF HEALTH Food/Kitchen PERMIT T L D Septic System BUILDING INSPECTOR 'I THIS CERTIFIES THAT .....ye '. . . :,.....� C :.: ....................... ...� :.� ...r�:1�. . .� 7 ..�s !4. 1.f�.................. has permission to erect .............g. ...... buildings on .E ....'��y:': :rte,'�:::�.�.. 4� .................................. Foundation'" <Rough 15;1 l r to be occupied as ...................................... ( ....... ............ ......: Chimney provided that the person accepting this permit shall in every respect conform'to the terms of the application n on file in 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 CONSTRUCTION STARTS Rough Service ....................:......*.•:L.. .. .:: ..:.:7..�.,.,,................. Final _ BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE NORTIi own Of ndover o �wK, h ver, Mass, /'0 `r j . coc...c..ew.c.. �d AERATE O S V BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT 4.0.Cf..,5;fo .��.................... ? .../��'`?./��..��' �.� BUILDING INSPECTOR ..... ......�a ..................A� 064,� Foundation has permission to erect .......................... buildi son Y .................................. n(��--� / Rough to be occupied as ............\...... K... �! .... ........� ,(!f ...... `�.�!.!.Q... Chimney r r c. provided that the person accepting this permit shall in every respect conform erms of the application. Final on file in 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 CONSTRUCTION STA S Rough ... Service ................... ....... .� "' ........ .............. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough Display in a- Conspicuous Place on the Premises - Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE 1 i ------------------ A ry c1 nn /I ci Ax kf ; t [Sp t { ,t t VSfr/ ea nnpv The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: Lsj-)ee_1-4 J/ City/State/Zip: 4,w4,.,- M4 a/ rlo j Phone#: &-2- if 2 3�t 7 Are you an employer?Check the appropriate box: Type of project(required): 1.2-" am a employer with 1 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors Z.E] I am a sole proprietor or partner- listed on the attached sheet. E]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 required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13.❑Other comp.insurance required.] kny applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :ontractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site formation. / tsurance Company Name: y :)licy#or Self-ins.Lic.#: a�"oco Z e g)'7 Expiration Date: z z ►b Site Address: fr' Gv/w-k-lt, City/State/Zip: 4^,),.,-e_ /)-"A G/d y� ttach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). tilure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ae 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 'up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of vestigations of the DIA for insurance coverage verification, to hereby certify der the pains and penalties of perjury that the information provided above is tree and correct. nature: Date: 2— tone tone#: �� a2?° �6 y 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#: Informati®n 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 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, §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 boxesthat 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 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 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. #617-727-4900 ext 406 or 1.877-MASSAFE wised 5-26-05 Fax#617-727-7749 RZl issa husett 11c partinew of Public S.fen !�/�e �arrerucrrrrefr�l�nll<rt cmc% lLt 3rtattl of ltiiltlttt+, � atl ttiErt. ,rttl.St�talfl�Ef k#.<, Office of Consumer Affairs&Business Regulation , id HOME IMPROVEMENT CONTRACTOR �'-- Construction Supe vAsbr- egistration: 112212 Type: I t License: CS 60816 .� Expiration. ..3;412013 DBA P.V.BUILDERS PAULA VILIOTT -85 LONGWOOD RD PAUL ViLIOTT READING, MA 01861 85 CONGWOOD RD. READING,MA 01867 Undcrsc:rxtCry' Expiration: 12/25/2012 — — t, aiitii,•eni�ra Tr#: 10315 Vii.A PJ#1: TER-�11I`JRESTRICT D. ISSUES THE ASOVE'LICENSE T0: : PAIL ;A VILIOTTI ST : N �,.. ut Ct l3 U R N t-1/a .1'_5119 12/28/1'2 I'i7 i:1 Paul Viliott QOM © CAMR@1V2=i3 COMMERCIAL 617-828-3647 RESIDENTIAL 85 Prospect Street Woburn,MA 01801 CSL#060816 HIC#112212 Proposal Ed Antonelli Job site:Same 9 Waverly Street North Andover,MA 01845 978-500-2619 Date:10/09/12 Re:Drum room. • Construct new 2"x 4"lumber partitions to create approximate 6'-7"x 9'-0"room. • Construct new 2"x 4"lumber partition to divide existing room. • Provide(3)openings for new doors(to be specified by customer). • Insulate all wall pockets with sound attenuating blanket. • Apply one layer homasote board to each side of new partitions. • Apply one layer X"sheetrock to each side of new partitions. • Apply joint compound to new partitions as needed. • Furnish and install 2 Y:"colonial casing to door jambs. • Furnish and install 5%"colonial baseboard to new partitions. • Install new ceiling wall angle and re-install existing ceiling tiles. • Provide labor to paint new partitions and woodwork. Job total:$4,000.00 *NOTE:Pricing includes(3)36"Y glass insulated door.Adjustments shall be made if owner uses existing slider. �v5knt+.c/ 'SP RC2 / ACS CERTIFICATE OF LIABILITY INSURANCEDATE(MWVVNM 0811412012 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 PONCy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to' the terms and conditions of the policy,certain policies may require an endorsemenL A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER J.A.Corson Ins.Agency PONE (781)248.5077 FAX (7B1)248-2811 380 Lowell Streetjudy@corsoninsurance.COm Wakefield,MA 01880 INSURE AFFORDING COVERAUS NAIc A INSURER A. Arbella INSURED INSURER 8: PAUL VILIOTr INSURERC: P.V.BUILDERS UNSURERD: 85 PROSPECT ST INSURER E WOBURN,MA 01801 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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, INBR POLICY EFF POLICY EXP TYPE OF INSURANCE POLICY NUMBER LIMWS A GENERAL LIABILITY 8500044977 12119/2011 12/1912012 EACH OCCURRENCE § 1.000,000 COMMERCIAL GENERAL LIABILITY DAIWAGE i'ES IEE Orrin nrre al & 100,000 CLAIMS-MADE M OCCUR MED EXP(Any one person) S 5,000 PERSONAL S ADV INJURY S 11000,000 GENERAL AGGREGATE E 2,000,000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG S 2,000,000 POLICY M PRO- LOC $ AUTOMOBILE LIABILITY COMB I I ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per aoc&lem) S HIRED AUTOS AUTOS WNEO PROPERTY DAMAGE 8 § UMBRELLA LUU! OCCUR EACH OCCURRENCE S EXCESS LIAS I CLAIMS-MADE AGGREGATE $ DEP F RETENTION $ A WORKERS COMPENSATION 9113781010 12/19/2011 12/1912012 ST oTH- 1AND EMPLOYERS'LIABILITY Y t N 18 ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT S 500,000 OFFICERIIMEMBEREXCLUDED? NIA (mandomy In I" E.L.DISEASE-EA EMPLOYEE § 500,000 If desa�e under —0 1_TMO IONSbelow E.L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES{Attach ACORD 191,AMWoml Remarks Schedule,it more apace Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE P V BUILDERS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATW-N JUDITH A CORS(xV ACORD 25(2010/05) ®1988 29.10 ACORD CORPOWTION. Ail rights reserved. The ACORD name and logo are registered merits 0('�A ORD 77 q};n�n i f j 31lak0 vW