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Home My WebLink AboutBuilding Permit #399 - 97 PALOMINO DRIVE 11/20/2009 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: zep -O IMPORTANT:Applicant must complete all items on this page LOCATION t L !!f f.,kl Print w PROPERTY OWNER ' ,4-*t y t _Print MAP NO:� PARCEL, ZONING DISTRICT: Historic District yes o Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building nn -_ One family Two or more family Industrial Alteration h IJ No. of units: Commercial , replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer j DESCRIPTION OF-WORK TO BE PERFORMED: 0 U( Identification Please Type or Print Clearly) o2� 7 OWNER. Name. -�- A w�-�C�- Phone: Address: CONTRACTOR Name: ( ±� Phone: "7 J'1 V�y-fi d ry ,. Address: ./02 M � s I Supervisor's Construction°-License: 2 9 t Exp. _Date: Home Improvement license: All Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COS7q25.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt'No.: NOTE: Persons contracti!W with unregistered contractors do not have acc s to the guaranty fund Signature of Agent/Owner Signature of confractor 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) o 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 S Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL fid' Swimming Pools Public Sewer _ Tanning/Massage/Body Art ,. a! Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY r INTERDEPARTMENTAL SIGN OFF - U FdAM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS i HEALTH . Reviewed on Signature COMMENTS 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: Located 384 Osgood Street FIRE DEPARtMtNT---Temp Dumpster on site yes no ` j 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) f. ❑ Notified for pickup - Date Doc:.Building Permit Revised 2008 Or� Location No. _ Date A NORTIy TOWN OF NORTH ANDOVER f � F • AL , .. 9 + • Certificate of Occupancy $ CHUsE�� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # r 22644 v Building Inspector - Massachusetts - Department of Public Safety Board of Building Regulations and Standards ConstructioW Supervisor License License: CS 89566 Restricted to: 00 THEODORE B GRAB 1029 HUMPHREY ST SWAMPSCOTT, MA 01907 ..;- Expiration: 11/24/2011 ('uuuuisiuner Tr#: 10221 � �� w o�✓�aaaac�ivaelta Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registratioij 40838 Expirati(n==4A g- 011 Tr# 290650 Type:3�f?iav,'a#e Cs�rgration ADVANCED BASE ENT F1N1�SHt G, INC. THEODORE GR7�8 1029 HUMPHREY4�ST ,-; SWAMPSCOTT,MA 01907 `°` Undersecretary eF The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, M4-02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): �� 2,, Address: 2 NJ City/State/Zip: Co`VPhone#: 7fl-V�-�a� Are you an employer? Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ 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 10.El Electrical repairs or additions required.] officers have exercised their 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 workers13.❑ Other comp.insurance required.] *R.:y applicant that checks box#; must,;.Iso fill out the section below showing(heir workers'compensation policy information t 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 employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: 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. I do here c fy under the pains and penalties of perjury that the information provided above is true and correct Signafore: l�� 70 — 2d US' Phone#: �d 7 J 7�J �o D [[6. icial use only. Do not write in this area,to be.completed by city or town offwiaL or Town: Permit/License# Is Authority(circle one): oard of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector ther tact 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 )Focal 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 anddate 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,IIIA.02111 Tel.# 617-7274900 ext 4.06:. or 1-877--MAS:SAFE Revised 5-26-05 Fax# 617-72.7-7749 vmA,.mass.gov/dia ` NORTH 0 of 399 No. o. dover, Mass. - a COCHICMEWICK V ' AORATED PPS\ (I S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System ro".". / BUILDING INSPECTOR THIS CERTIFIES THAT................... C!1� .....!'l.r;.l."!ve, L-.......................................��4/ . • Foun ation has permission to erect............... buildings on 2 /.....,..•,�••.........�.C�..`.Q�!�'J,//✓..� Rough ........................... to be occupied as..... .. . ............. ................................................................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building-Regulations Voids this Permit. Rough a(� PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONS STARTS ELECTRICAL INSPECTOR. Rough ... - Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. SEE REVERSE SIDE Smoke Det. Ted Grab —Interior Renovations Advanced Basement Finishing 1029 Humphrey Street Swampscott, Massachusetts 01907 781-430-0415 781-454-5609 (cell) advancedbasementkyahoo.com. MA Home Improvement Contractors Registration# 140838—Exp 11/27/10 Construction Supervisor License#89566-Exp 11/24/10 i Proposal To Renovate Basement November 13,2009 HQ_NIE OWNER: Nicole& Glenn Cham■;el all ➢ Electrical Closet(unfinished interior) ➢ Sprinkler Closet(unfinished interior 2. Ceiling and Soffit Preparation ❑ 1" x 3" spruce strapping shall be installed (as needed) on ceiling joist 16" on center to support weight of new drywall ceiling. 3. Wall Structure ➢ Contractor shall- make wall alterations as indicated (approximately, as needed) on scale drawing. All wall structure shall be built according to state &local building requirements. S. Insulation ➢ All exterior walls shall be insulated so that all living areas and spaces are insulated according to code (as needed). The insulation value is R-13. 7. Finished Walls. Ceilings & Soffits ➢ All walls, ceiling and soffit of finished areas shall be enclosed with % inch "blue board". ➢ All blue board shall be veneer plastered to a smooth finish on walls and ceiling. 8. Doors I- k4aj- ➢ All hinged doors shall be"6 PANEL" ➢ All doors shall include standard hardware and doorknobs. All doors to be installed with finish casing. Finish casing shall be 2 % inch colonial style. 9. Baseboard ➢ Contractor will supply and install new baseboard. 11.Plumbin� ➢ Contractor will make every reasonable effort to re-direct drain pipe so that it is not an unsightly obstacle. 12.Materials Supplied by Contractor ➢ Contractor will supply and install all materials and fixtures. However the fixture listed below shall be supplied by homeowner and installed by contractor. ❑ Ceramic Tiles for Mudroom ❑ Grout for tiles. 13.Fire Sprinklers w 17.Scale Drawing ➢ Scale drawing attach shall be construed as an integral part of the proposal and agreement. 18.Provisions ➢ Homeowner acknowledges the following and hereby agrees to abide by these provisions: 1) Reasonable access must be made to the premises during working hours. 2) Working hours are from 7:30 AM through 5 PM on weekdays. Contractor may request the option of working on Saturday with homeowner's approval. Said approval shall not be unreasonably withheld. 3) The basement area is a construction site, therefore, children and pets should not be allowed in this area. 4) All personal property must be removed from construction site and contractor shall not be held responsible for this property. 5) Quite often, communications concerning the project and questions regarding the project will be done via "E-Mail". Homeowner agrees to reply i i Project Investment $ 22000.00 ➢ Payment Due with Agreement $ 1000.00 ➢ Payment Due when Project begins $ 7333.00 (33%) ➢ Payment Due when rough Electrical Work is completed $ 7333.00 (33%) I ➢ Balance upon completion Commencement Date Project shall begin on or about Jai uary 10,2010_and shall be completed on or about March 6,2010—. These dates are approximate. L 501 16' 34'1 4'4--1—13'4 10'6�5'11 � 42"bookcases r children play area furnace&storage area LLA �2 family room i �t-M`wall&pole enclosure r _ __________ O Move hot water heater � O U u 0( `T try pan UP Household Pantry w)shelves v -sliding doors \ \ it \ O yY1i` .+I uti ity closet — -- — —15'10 77 Jk 19' 7'8—� i 501 waste pipe enclosure w/clean-out access LIVING AREA 1148 sq ft