HomeMy WebLinkAboutBuilding Permit #492 - 953 JOHNSON STREET 1/22/2010TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: A Date Received ^ Z -f IV
Date Issued: :Z� e
IMPORTANT: Applicant must complete all° items on this page
LOCATION RC1 SG it 45— ZQ Lv ier
PROPERTY OWNER _ J
Print
MAP NO:t o -i, PARCEL: 1 '� 1 ZONING DISTRICT: Historic District
Machine Shop Viilai
yes no
yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
QOne family °-
Addition
Two or more family
Industrial
Alteration
No. of units:
Commercial
Others:
Repai replacem # -
Assessory Bldg
Demolition
Other
Septic Well
Floodplain Wetlands
Watershed District
Water/Sewer
i2o-maae
I 1U14 Ur wUKK 1 BE PERFORMED:
0- 01 e-6-, -)►cul S I JJV A) 6
CKOCr
Identification Please Type or Print Clearly)
OWNER: Name: SC"yI4fW- Phone
Address: --9253 :)o k^s&n S—j A�) Do Utl
CONTRACTOR Narne;�'1 CP4tAJ Phone:/
Address:
5004,
Supervisor's Construction License: % S 9 Lfcq Exp. Date: A 12-0 It
Home Improvement License. J - Exp. Date. I
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.:�j ��5^?�— Receipt No.:
NOTE: Persons contracting_ ith unregistered contractors do not have access the uar&Ound
Signature of Agent/Owner Signature of contractor
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 Dumpster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed
• i, /iiii®(R_ 7%ir_
',, HEALTH Reviewed on
COMMENT
//Zt ho
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:
uocatea %4 us ooa street
FIRE 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.
Total land area, sq. ft.:
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)
❑ Notified for pickup - Date
Doc:.Building Permit Revised 2008
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
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/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 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 2008
Location � ��% s r
No. Date 2z
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # .5-r 7-
2 2
22
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Eastern Construction
"tfOMe 1wtpr0veKA ewt 5pec%aUsts
4 Hewlett St.
PO Box 1266 Phone/Fax: 781-233-5333
Saugus, MA 01906 www.easternconstruction.net
larvae /Address 3 I
Les Schnake
953 Johnson Street
North Andover, MA 01845
Proposal
Date: 1/21/2010
Proposal # 927
Rep Gary
`.y.CyMUSf f
7 iWilY) ^
Registration #: 130307
License #: CS 75948 MEMBER
Federal I. D. #: 01-0683412
*The following dates are approximate dates and maybe changed due to circumstances beyond the contractors contol such as but not limited to
weather or unforeseen issues
*Approx start date:
1/26/2010
"Approx completion date:
/9/2010
2/9/201:0:1
iSbDescriptian
dotal...
s ., s
1. Remove old siding from entire house.
10,900.00
2. Cover all outside walls with foam core fan -fold insulation.
3. Cover all trim around doors and windows with aluminum trim stock.
4. Install vinyl vented soffit panels.
5. Remove existing deck.
10,100.00
6. Dig holes for sona tubes.
7. Frame deck using 2 x 10 pressure treated wood.
8. Install new 5/4 x 6 pressure treated decking.
9. Install new 2 x 2 pressure treated rail systems.
All materials are guaranteed by the manufacturer. All work is to be completed in a professional
manner according to standard practices. Any alteration or deviation 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 $21,000.00
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
*Payment terms. 1/3 deposit due at time of signing contract, 1/3 due when job is haljcompleted, and balance due in full upon completion
* All home improvement contractors and subcontractors shall be registered, any inquiries about a contractor or subcontractor relating to a
registration should be directed to:
Registration Division, Program Coordinator
One Ashburtion Place. Room 1301
Boston, MA 02108
Tel: (617) 727-3200 ext 25239
• Balance due in FULL upon work completion.
• Eastern Construction is fully licensed and insured.
• MasterCard and Visa accepted, 3% added over $3000.
• Prices for stripping roofs are based on the removal of up to two (2) layers of
roofing. Additional costs apply for removing more than two layers.
AA&K Construction, Inc.
Date /—
Signature —
Signature
---------------
4_4
North Andover MIMAP
953 Johnson Street
January 21, 2010
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Interstates
— Interstate
HoriwntaI Datum: MA Stateplane Coordinate System, Datum NAD83,
— MaJor Roads
Roads
C* r Easements
NORTH
O«ao ,a ti
? �� as 00
3'
Meters Data Sources: The date for this map was produced by Merrimack
Valley Planning Commission (MVPC) using data provided by the Town of
North Andover. Additional data provided by the Executive Office of
Environmental Affairs/MassGIS. The information depicted on this map Is
for It be for legal boundary
- Trails
0 MVPC Boundary
L
O R
~ •: p
planning purposes only. may not ad uate
degnitlon or regulatory Interpretatlon. THE TOWN OF NORTH ANDOVER
MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING
0 Munlcipal Boundary
♦ - ♦
� s ' ;
THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY
OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT
O Parcels
• �o M
ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
Hydrographic Features
o+o"Arao
THIS INFORMATION
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Streams
Wetlands
'= Exempt lands 1" = 140 ft "�`
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Iloard of Building Regulations and Standards
i� 1
HOME IMPROVEMENT CONTRACTOR
Registration: 130307
Expiration: 2/16'2010 Tr# 262927
Type: DBA
EASTERN CONST. CO
STEVEN KALMAN
4 HEWLETT ST.,..+--��
SAUGUS, MA 01906 Administrator
License or registration valid for individul use (only
before the expiration date. If found return to:
Board of Building Regulations and Standards
One Ashburton Place Rm 1301
Boston, Ma. 02108
Not valid without signature
1Lt.�achu.ett� - Dep.irtment +A' Public 1,.tfets
Beard of Buildin;; Re�luulatiun. and 1,tandard,
Construction Supervisor License
License: CS 75946
Restricted to: 00
STEVEN R KALMAN
PO BOX 1266
SAUGUS, MA 01906
�—
� --:0- Expiration 3/6/2011
t .nnuu"l..Mr Trak 11543
NOTICE
TO
EMPLOYEES
NOTICE
TO
EMPLOYEES
The Commonwealth of Massachusetts
DEPARTMENT OF INDUSTRIAL ACCIDENTS
600 Washington Street, Boston, Massachusetts 02111
617-727-4900 — http://www.mass.gov/dia
As required by Mmisachuscm General Law, Chapter 152, Sections 21, 22 & 30, this will give you notice that
1 (we) have providcd for payment to our injured employees under the abovc mentioned chapter by
insuring with:
THE TRAVELERS INSURANCE COMPANIES
NAME OF INSURANCE COMPANY
P.O. BOX 1450
MIDDLEBOR_O_, MA 02344-1450
ADDRESS OF INSURANCE COMPANY
(7PJUS-0536N39-2-09) 05-22-09 TO 05-22-10
POLICY NUMBER EFFECTIVE DATES
JOSEPH 0 DANCA JR INS 182A HIGHLAND AVE
MALDEN MA 02148
NAME OF INSURANCE AGENT ADDRESS PHONE: #
a� A A & K CONSTRUCTION, INC DBA 4 HEWLETT STREET
EASTERN CONSTRUCTION CO
SAUGUS
MA 01 906
EMPLOYER ADDRESS
o
EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DA'L'E
MEDICAL TREATMENT
The above named insurer is required in cases of personal injuries arising out of and in the course of
employment to furnish adequate and reasonable hospital and medical services in accordance with the
'_— provisions of the Wtwkc:rs' Compensation Act. A copy of the First Report of Injury must be given to the
injured employee. 17w employee may select his or her own physician. The reasonable cast of the services
provided by the [heating physician will he paid by the insurer, if the treatment is necessary and reasonably
connected to the wmk related injury. In cases requiring hospital attention, employees are hereby notified
that the insurer has arranged for such attention at the
NAME OF HOSPfTAL ADDRESS
„oz W 2optGOz TO BE POSTED BY EMPLOYER
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Uf 600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Name (Business/Organization/Individual): F.4smero cc S ngi G Ai
Address:
W
City/State/Zip: � U S US AA d (9 d� Phone #: -2 k I� a 3 3-i� 3 3 3
Are employer? Check he appropriate box:
1. I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
2. ❑ I am a sole proprietor or partner-
listed on the attached sheet. I
ship and have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. ❑ We are a corporation and its
required.]
officers have exercised their
3. ❑ I am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
C. 152, § 1(4), and we have no
insurance required.] t
employees. [No workers'
COMP. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10. ❑ Electrical repairs or additions
11.❑ Plumbing repairs or additions
12.❑ Roof repairs
13.❑ Other
.,:f cf:y-L c::ac ;:u=t:.:; [)u7. 4: muss atso tilt out the section below show Wb then worl e:s' 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.
#Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
I am an employer that is providing workers' compensation insurance for my employee& Below is the policy and job site
information.
Insurance Company Name:
(_(�fs 1 ,c
Policy # or Self -ins. Lic. #:_ ( N UV _ 0S 3 GA3'7 - a '09 Expiration Date: S-
Job Site Address: % 3Tby1/) `�ili ( /J /U DO L)'-;7/-/� (� � 9 I /S
City/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
1 do hereby
under thl pain j�nd penalties of perjury that the information provided above is true and correct
A
7S 1- 233 - _'�3 33
Official use only. Do not write in this area, to be completed by city or town official
City or Town:
Permit/License #
- Z-1- 10
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town CIerk 4. Electrical Inspector 5. Plumbing Inspector
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 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-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 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.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 021.11
Tel. # 617-72.7-4900 ext 406 or 1-877-MASSAFE
Fax # 617-727-7749
Revised 5-26-05
www.mass.gov/dia
Eastern Construction Proposal
Date: 1/21/2010
^ +- O Me t vu p rove VV_ewt 5peOLG(Usts ° Proposal # 927
PO Box 1266 Phone/Fax: 781-233-5333 Rep
Saugus, MA 01906 www.easternconstruction.net
71
Narbe hAddress
22000055
Les Schnake Y �p
953 Johnson Street Ang0erm Hist t a BBB <
North Andover MA 01845
> SuPcr Srwice r�T-,�
AWARD MEMBER
Job Description 3,s Total
1. Remove old siding from entire house. 10,900.00
2. Cover all outside walls with foam core fan-fold insulation.
3. Cover all trim around doors and windows with aluminum trim stock.
4. Install vinyl vented soffit panels.
5. Remove existing deck.
6. Dig holes for sons tubes.
7. Frame deck using 2 x 10 pressure treated wood.
8. Install new pressure treated decking.
9. Install new pressure treated rail systems.
All materials are guaranteed by the manufacturer. All work is to be completed in a professional manner according to
standard practices. Any alteration or deviation 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.
An initial deposit of $200.00 is to be paid upon proposal acceptance.
• Balance due in FULL upon work completion.
• Eastern Construction is fully licensed and insured.
• MasterCard and Visa accepted, 3% added over $3000.
• Prices for stripping roofs are based on the removal of up to two (2) layers of
roofing. Additional costs apply for removing more than two layers.
AA&K Construction, Inc.
Total
Date
Signature D ��
10,100.00
$21,000.00
v
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