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Home My WebLink AboutBuilding Permit #1009-15 - 976 TURNPIKE STREET 6/4/2015 0 1CW L�- TOWN OF NORTH ANDOVER aoRT APPLICATION FOR PLAN EXAMINATION °', •° '°'" f 9 f Permit NO: l J "'*4 ` Date Received 9SS�cHuSEs Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION 976 Turnpike St North Andover MA Print PROPERTY OWNER Peg Graveline - JEM Property Group LLC � i Print MAP NO.:�_PARCEL:M'T1 ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building ❑One family ❑Addition ❑Two or more family ❑Industrial ❑Alteration No.of units: ❑Repair,replacement ❑Assessory Bldg ❑Commercial ❑Demolition ❑Moving relocation ❑Other ❑ Others: ❑Foundation only \ —___ DESCRIPTION OF WORK TOB FORMED New Kitchen, New Baths, Update E date Heating S ste r` change direction of stairs �� 0✓l, �, Identification Please Type or Print early) OWNER: Name: Peg Graveline Phone: 603-493-0992 Address: 14 Chatfield Dr Litchfield NH 03052 CONTRACTOR Name: Vinnie Desiderio Phone: 978-360-6952 Address: 138 River Rd Suite 107 Andover MA.--0�1L8�,1�0—a Supervisor's Construction License: C5 —g 'k " s Exp. Date: /, Home Improvement License: Exp. Date: b� ARCHITECT/ENGINEER Name:Phone: Address: Reg.No. FEE SCHEDULE:BULDING PE IT:$12.00 PER$1000 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost:$ x12.00=FEE:$ 7✓ Check No.: Receipt No.: Page W4 { } T , Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans Ib TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swiml T g fools ❑ Z Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS ZoningBoard of Appeals:Variance Petition No pp Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& iDate Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street I,�FaaI.RE DEI?ARTMEIVI" Ternp Durripster ori�site yesr # � ?ono `� ' 'y _ Located at 124 Main Street � ,. ' Fire ®e artment si n to/d to � `x COMMENTS . ....�.....f..r�.�f1'stix'� .. .. =T'.:f•+. .L. ... �`� :�c{:'�^-4�, l �:�rt,�L....fa °.....�..kks y+3.. ...-..i+s.S.....� 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-$1000 fine NOTES and DATA,— (For department use) it ® Notified for pickup Call Email Date Time Contact Name 2 Doc.Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses � Copy of Contract � Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application Certified Surveyed Plot Plan Workers Comp Affidavit i6 Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract 4. Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) 4. Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products INIOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) AL Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 46 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 Location !T�.�1 //��R—G► No. Date 40 . - TOWN OF NORTH ANDOVER ♦ Certificate of Occupancy ;$ Building/Frame Permit Fee A. �� Foundation Permit Fee Other Permit Fee FAe— $0� TOTAL Check# Building Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost j j 551,0100.00 m $ - $ 660.00 Plumbing Fee $ 82.50 Gas Fee 100 comm. $: 10;0.00. Electrical Fee $ 82.50 Total fees collected $ 925.00 976 Turnpike Street 1009-15 on 6/4/2015 Interior Remodel E r , NORTII c . : ve: r 0 h ver, Mass, COC.ic..... A04ATE D S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System r (s, BUILDING INSPECTOR THIS CERTIFIES THAT .......... ...... 4�..rZ,l�-:*�-.. .. ...4T,.Y .....1: ............................... has permission to erect buildin s o Foundation Rough to be occupied a&)...6444,...�..... r.1.L Frr.. I.� �1.!.�'!...� �o`�.....¢vl.� Chimney provided that the person accepting this permit shall in every 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 61 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO T S Rough i f Service j ................. .... ........ ..................................... Final BUILDING INSPECTOR GAS INSPECTOR 1 i Occupancy Permit Reguired to Occupy Building Rough j 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. i TYPE OF SEWERAGE DISPOSAL Swimming Pools ❑ 11Tanning/Massage/Body Art ❑ g Public Sewer Well ElTobacco Sales ElFood Packaging/Sales ❑ Permanent Dumpster on Site ❑ Private(septic tank,etc. V Electric Meter location to project NOTE: Persons contracts ith reregistered contractors do not have access to the guaranty fund I Signature of Agent/Owner gnature of contractor—V Ox� Plans Submitted ❑ lens Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING&DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ 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 Temp Dumpster on site yes no_ Fire Department signature/date The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: Location: City Phone 71 am a homeowner performing all work myself. �F am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Company name: �IJes . r e-.�` Address ` 6 City: IVU LL /2eszo�iry VVIA D lady Phone#: / 7� Insurance Co. Policv# Company name: Address City: Phone#: Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature ✓ Date 61Y11 Print name VIA C a of `r-I Phone Official use only do not write in this area to be completed by city or town official' ❑ Building Dept ❑Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone#: ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION The Commonwealth of Massachusetts Department of IndustrialAccidents .n. I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia iO�M SV�V Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/plumbers. TO BE FILED WITH THE pEgMITTING AUTHORITI'. Applicant Information Please Print Legibly Name (Business/Organization/Individual): )J e 5 t J-c,,ta Address: 5w s-F 0 I�qd, Wl A O l�G Y City/State/Zip: t 'd6 y Phone#: � 7 6- -mo 6 9 s z Are you an employer?Check the appropriate box: Type of project(required); 1.❑I am a employer with employees(full and/or part-time).* 7. [JNeiv'construction 2. am a sole proprietor or partnership and have no employees working for me in 8. El Remodeling Xany capacity.[No workers'comp.insurance required.] 9, El Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10[]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 120 Plumbing repairs or additions SQI am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 14.❑Other 6.FJ We are a corporation and its.officers have exercised their right of'exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workerscomp.policy number. ensation insurance for my employees. Below is the policy and job site I am an employer that is providing workers'comp information. Insurance Company Name: Policy#or Self-ins.Lie.#: 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 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. of perjury that the information provided above is true and correct. I do hereby certify under the pains and penalties [4y— 'dam Date: �� y /5 Signature Phone#: '1 -7� 3 6 o G y rcial use only. Do not write in this area,to be completed by city or town officialy or Town: Permit/License#ing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#: Contact Person: 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 certificates)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' compensatiori 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents ' 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-NIASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia y l Massachusetts - Soard Department of Public Safety of Si:ilding Regulations struction and S.ardards Con w Super�icor License: CS-054593 VMCENT DESIDAU0 t '` •,,�� `w 16 STEWART RIX r' North Reading ' !� s 01864 - Commissioner Expiration 07/2g/2016 Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991M )of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS licensing information visit: www:Mass.Gov/DPS 3ff