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HomeMy WebLinkAboutBuilding Permit #201-2017 - 93 MARTIN AVENUE 8/26/2016 "\cel p10ED , BUILDING PERMITS o�<t0!° �6A't'o TOWN OF NORTH ANDOVER 3? hE;:t• APPLICATION FOR PLAN EXAMINATION y �c° ey 4 ©1 �" Date Received M Permit No#:� gSSACHUS�� Date Issued: 74-4 / IMPORTANT: Applicant must complete all items on this page LOCATION AS) _ Print PROPERTY OWNER S7Q"V Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes n Machine Shop Village ye TYPE OF IMPROVEMENT PROPOSED USE ` Residential Non- Residential ❑ New Building IV One family 11Addition 11Two or more family 11 Industrial IVAlteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: s ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District N�Nater/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: M wLek Phone:�SOcb-7 b3-79 Address:ct3 V✓AMtJ �y Contractor Name:,S-lQ0AF,--_C, MUV,�P—Q(LCPhone:0l8"(4 -� Email: P Vyl opkAG��, (5- C < t\-� Address: jai \,QA S"�Z— Supervisor's Construction LicenseCS-03-70 Exp. Date: 05 L 0 t-7 Home Improvement License: L061�s—a Exp. Date: 7 12L4 8 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: $ FEE: $ Check No.: Receipt No.: Jogt24 NOTE: Perso s contracting with unregistered contractors do not have access to the uaranty fun ��ature of Aqent/Owner SignJ 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 Building Permit Application iL 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 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 Doe:Building Permit Revised 2014 1 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 Dmmpster 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 HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Wafter& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: hFKIREDEP'ARaI`MEN N = lerYip k@ Li on sites s Located 84 Osg�odee `SY Loc 3 Osgood t Z f e f i;Lcatedat 124 Main#Str et y," COMMENTS I Dimension I Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: 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 NOTES and DATA— (For department use) r ® Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 r Location No.2-0J r ( Date • - TOWN OF NORTH ANDOVER { sY Certificate of Occupancy $_ ► Building/Frame Permit Fee $ w..•-- Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# ziU 7 9 d"' Building9nspector 'F '� r1 � � NORTH � - . ..,� 6A­. .c . . ver O No. ti C%6 h ver, Mass, j?"Oera 'Q cocnacnlw.cw 7s u BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ........5.TP01—��...... ...................................... BUILDING INSPECTOR has permission to erect buildings on ....... Foundation Rough to be occupied as 4VA&....4*V.W.P.!!Pnoeovej ........... Chimney provided that the person accepting this permit respect conform to the terms 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 CONS STRough S L OlArvice .... .... ... ............ ..................... .. Final BUILDING INSPE R 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. Munroe Builders Estimate 131 washington Street Methuen, MA 01844 Date Estimate# 8/25/2016 2016-27 Name/Address Stuart Miller 93 MARTIN AVE. NORTH ANDOVER MA Project Description Amount Total REMOVE BACK WALL OF HALL CLOSET AND ADD ONE FOOT FOUR 1,800.00 1,800.00 INCHES OF FLOOR FRAME TO ALLOW FOR WASHER AND DRYER TO FIT INSIDE.FRAME WALL TO CEILING AND INSTALL 518 FIRECODE WALL BOARD TO GARAGE SIDE AND CLOSET SIDE OF WALL.INSTALL INSULATION IN FLOOR AND WALLS.ALL WALL BOARD WILL BE TAPED AND PRIMED READY FOR PAINT.TILE FLOOR WILL BE FILLED IN WITH TILE BY OWNERS TO MATCH EXISTING. PLUMBING,ELECTRICAL AND DRYER VENTING BY 071-IERS.ALL 0.00 0.00 WORK WILL BE INSPECTED PRIOR TO CLOSING UP INSIDE WALLS AND CEILING.GARAGE SIDE 5/8 FIRE CODE WILL BE INSTALLED AFTER FRAME TO PROTECT OCCUPANTS. '2��;� ��5`�2 �To#al $1,800.00 Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-037698 Construction Supervisor /"' N JAMES G MUNROE,JR 131 WASHINGTON STREET-' M -� ETHUEN MA 01 844, Expiration: Commissioner 11/08/2017 Office of c Affai&Bu ness aaaac%ucae ow HOME IMPROVEMENT CONTRACTOR ation Registration9a08658 Type: Expiration.=iI212f118 DBA MUNROEBUILDERS- James Munroe 131 Washington St Methuen,MA 01844" Undersecretary i . The Commonwealth ofMassrechusetts . z F Department oflndustrial.Accidents � F - = a I Congress Street,Suite 100 Boston,MA 02114-2017 www mass govldaa workers'Compensationlnsurance.AfJadavit:Builders/Contractors/Electricians/Plmnbers. TO BE FILED WtM THE PERN.(1:'I'TING AU'FHORI7.`Y. , Applicant Information Pleaseprint I,ea)ly Name(Busyness/Organization/Individual): Y-AtA� - A d&ess: Wk LU AS"lu 522,3 ' City/State/Zip: MeU*.JQ tRl 4 0`d 44L( Phone#: 00 8 4 Z�Ct b:�,3 Aseyou an employer?Cheektlie appropriate box: Type of project(re e . �. l.FJI am a employervvRh employees(full and/or part-time).* 7.- []New cozistcuction 2.RI am a sole proprietor or partnersbip and have no employees Working forme in $• p4Remodelilig any capacity.[No wormers'comp.insurance required.] I Q I am a homeownerdoing all work myself[No workers'comp.nm�n sce required.]f 9. [I Demolition 10❑Building addition 4.[j I am a luomeownerand will be hiring contractors to conduct all work on my property. Iwill ensure that all contractors either have workers'compensation insurance or are sole Mr]Electrical repairs or a ddition s proprietors vdhno employees. 12: plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13. Roof rep alr5 These sub-contractorsliave employees andhave workers'comp.insurance.T 14. Other 6.Q We are a corporation-and ifs pfricers have exercisedther right of exemption perMGL c. Q 152,§1(4),andwehageno•,eanployees.[Noworkers'comp.insurmcerequired.] -Any applicauttbat checksbox#1 must also-fU outihe sectionbelow showiugtheirworkers'compensation policy infonaiaiic n. T Homeowners who subijhtj�z affidavit indicatingthey are doing all work and then hire outside contractors must submit anew affidavit indicating such tContractors[hat check"box pu#altaghed an additional sheet showing the name of the sub-contractors and state whether ornot those entities have employees. If the sub-tonin dors have employees,they must proAide then-workers'comp.policy number.' I ain an employer•tfi at is-piovidingworkers-compensation insurance for7ny employees:'BeZoiv is thepolicy acid job site information. Insurance Company Name: policy or Self-ins.Zic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy ofthevorkers' 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 civil penalties 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. I do hereby certify uncle•the pains and penal es ofperjrrry that the information provided alcove is Prue and correct Sim Date:5 a, -qo 1 Phone#: Official use only. Do not-write in this area,to he completed by city or'town official City or Town: Permit/License# Issuing Authority(circle one): i 1.Board.of Health 2.BuildingDepartment 3.City/Town Clerk 4.Electrical Inspector 5.Pluxnbingliaspector 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 bf hire, express or implied,oral or written." An employer is defined as"an individual,partnership,asso ciation,corporation or other legal entity,or any two or more Of the foregoing engaged in a joint enferprise,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 b6 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 common7alth for any applicant who Sias 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 leboxes that apply to your situation and,if necessary, supply sub=contractox(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)withno 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-comb mation of insurance coverage. Also be sure to sign and date the affidavit. 'Ac 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 oz if you'are required to obtain a workers' compensation policy,please call the Deparkmnt•at the number listed below. Self-insured companies should'enter their self-insurance license number on the appropriate line. City or Towa Officials i Please bo sure that the affidavit is complete and printed legibly. The Department has,provided a space at the bottom of the affidavit for you to pill 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 areference number. In addition,an applicant an en ear,need only that must submit multiple permit/license applications m y given y Y 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 fitted 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 xequired to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts - Department of 7ndustdal.A-ccidents 1 Congress Street, Suite 100 Boston,MA-02114-2017 Tel.# 617-727-4900 ext. 7406 or 1-877-MA.SSAFE Fax#617-727-7749 Revised 02--23-15 www.mass•gov/dia