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HomeMy WebLinkAboutBuilding Permit #739-13 - 95 PHILLIPS COMMON 5/7/2013TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: ' f'? Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page ----- L®G%4�T1®Nlk.. Print'".. PRO'PERT_1(OW,,NER� -lt u� �,/ ' L % �1 f✓� ..n - T _ T Print � 100 Yea OIdlStructurei 'sl - ,no; Y MAI?�NQPARCEL 0� _ INGDIS,TRICT HstoncDistncf y s nog Ad _ v _ TYPE OF IMPROVEMENT PROPOSED USE esidential Non- Residential ❑ New Building One family Ph`one.�_� U��" ❑ Addition ❑ Two or more family ❑ Industrial Iteration No. of units: El Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑Septi ❑FWell1 �Floodplarnt ❑�1%l/etlands, M, 1Natershed�District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: k / r— Identification Please Type or Print Clearly) OWNER: Name: LIQ X !Yu j Z t'r Phone: 'M'- 2j�- 16-36 AdrirP-qg- 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: $ 07) FEE: $ Check No.: �� �� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund X11 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ 9tamp'6"Plans ❑ fi I C®NTRACT;®Rf °Name �t +� t -f �r:✓;O I�G9 �ISU� Ph`one.�_� U��" ��.3 ; �(�o a� � ' S Supernaso.r= C otructi6MLlcense_ _ _. r C3_3a 7rZ�_ Expo Date - ` a/ (.3 Homed lmprovementLicense / / �f 5�c7 �7 `- Ex Qate�," S l5 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: $ 07) FEE: $ Check No.: �� �� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund X11 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ 9tamp'6"Plans ❑ fi I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/BodyArt ❑ ... 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 PLANNING & DEVELOPMENT ❑ COMMENTS DATE APPROVED 11 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: Com Conservation Decision: Commen Water & Sewer Connection/Signature & Date Driveway Permit DPW Towo Engineer: Signature: Located 384 Usgood Street FARE :DEPA►RTME"iWT ' Temp Dumpster on site yes no Located at 124 Main Street Fire Depakinerit signature/sate COMMENTS .: T " Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, rust; or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A -F and G min.$100-$1000 fine NOTES and DATA— (For de ® Notified for pickup - Date Doc.Building Permit Revised 2010 use No Building Department The folawing 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 o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o 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 Li 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 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 ❑ 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 app; al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm:ated with the building application Doc: Doc.Buil Jing permit Revised 2012 Locatio'��� No. - Date I� Check # ` 169 26361 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $2fp3•C� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building Inspector a S� Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 21,900.00 m $ - $ 262.80 Plumbing Fee $ 32.85 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 32.85 Total fees collected $ 428.50 95 Phillips Common 739-13 on 5/7/2013 New Kitchen Cabinets and Counterto s E9 * WN rA _ 2 LL O O m ' u +' O LL0 u O. a) N °o Z O Z J m O a+ 7 LL t 7 ? c E U _ IC LL 0 W Z Z J n s j 0 f0 LL 0 W Z J U � W � :3 0 ?� v N C LL O LLI CL N Z O K C I..L W Q w LU LL v C ? 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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 boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone numbers) 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 maybe 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: Tho Commonwealth of Massachusetts Depadmeat of hadustdal .A,ccldonts offlee ofIavestigatious 600 Wasbingto» Stroot Boston} MA, 0211.1 T01, # 617-727-4900 oxt 406 o.>r=1.-877�,MA.SSAFB Revised 5-26-05 Fax # 617-727-7749 v�.mace anis/A;a Office of Consumer Affairs & Business Reeulatiori - Mass.Gov The Official Website of the Office of Consumer Affairs & Business Regulation (OCABR) Consumer Affairs and Business Regulation Home Consumer Home Improvement Contracting Home Improvement Contractor Registration Lookup You can search/filter the registration list by any of the criteria below. Search by Registration Number 118509 Search Page 1 of 1 Search by Registrant Name Search by City Zip Code Search Registrants Click on the registration number to view complaint history. You can also view arbitration and Guaranty Fund histo!y. The list is current as of Sunday. March 31, 2013. Search Results REGISTRANT RESPONSIBLE REGISTRATION ADDRESS EXPIRATION STATUS NAME INDIVIDUAL NUMBER DATE R.J. CONSTRUCTION MADISON, 118509 3 MADISON AVE 03/29/2015 Current RICHARD GROVELAND, MA, n1AAA © 2012 Commonwealth of Massachusetts. Mass.Gov® is a registered service mark of the Commonwealth of Massachusetts. INIa Ss," 7Chuictts -- r Bo iid of B llc I►zti7n2ent n1' puf�l...�.c ti uildin! Rc(j =ifct� Construction Su uf.itir�n5`.irid -S t; rfa pervisor License, 7 License: CS 30000 RICHA''` MADISpN 3 MADISpN y� GROVEAVE ' f r LAND MA 8+ t` w 01 34 ,ono @ Expitio� n: 7/21%2013 —� .� `.,."�,...w•---,-, ir#.: -18274 .. http://services.oca.state.ma.us/hic/licenseelist.aspx 4/1/2013