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Home My WebLink AboutBuilding Permit #335-14 - Exception 10/8/2014 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION q ` Permit N0: ' � j� Date Received ` u Date Issued: IW I IMPORTANT:Applicant must complete all items on this page LOCATION ^"2 1�G-�L44 /�.-1/E /fitU __ _ -- - Pn t PROPERTY OWNER &-A—uAcn-w- Print 100 Year Old Structure yesno MAP NO: PARCEL. ZONING DISTRICT: ..- Historic District yes no cZ7) /z, Machine Shop Village yesn_, OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement .,La-Assessory Bldg?t aw an ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well El Floodplain 0 Wetlands C7 Watershed District El Water/Sewer _ DESCRIPTION OF WORK TO BE PERFORMED: 1� 1rLc a v� nr n /�z 24 917 z� 2�Y S No S 7-90 c,lC Ty/,L 1 jo�s�-�c��-� 5 T Identification Please Type or Print Clearly) OWNER: Name: WA 14&K/La // zc e_ ,A,,z j�)/ Phone: Address: '7 7 M06-iI5 4,Ia-t4.1 tV 4A40ov,v,1z- 1,;-�4 CONTRACTOR Name: Phone: �l 2 -a Address: 2 ZG 1-6 w iJ& GC Supervisor's Construction License: 06 2- Exp. Date: Home Improvement License: -!Z _ Exp. Date: 2 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ONS 5.00 PER S.F. Total Project Cost: $ d _ FEE: $ 14 Check No.: /y Receipt No.: "Zt�"I .� NOTE: Persons contracting w' tregist ed cont actors do not have access to the guarantyfund Nignatiurel of Agent% �i Nature of contractor, Plans Submitted 0 ans Waived ❑ rtified Plot Plan ❑ Stamp ns 11 Ave f.t A._..Uti � Sz Locati�onj�/' No. ; � — Date . - TOWN OF NORTH ANDOVER . Certificate of Occupancy $ 60 �+,t, Building/Frame Permit Fee $ 'TT Foundation Permit Fee Other Permit Fee $ TOTAL $ 0 Check# i 26973 Buie Inspector Plans Submitted ❑ PlansWaived-11 Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF:SEWERAGE DiSP_OSAL 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 on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS 7oning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water 1% Sewer Connection/Signature& Date Driveway Permit DPW Tose o Engineer: Signature: Located 384 Osgood Street .FIRE DEPARTML-'NT - Temp Dumpster on site yes no (% Located at 124 Mair Street. - Fire-Dbpairfinerit signatu"re/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 Chapter166 Section 21A-F and G min.$100-$1000.fine NOTES and DATA— (For department use B Notified for pickup - Date Doe.Building Permit Revised 2010 Building Department The foh`owing is-.a list of the required forms to be filled out for the appropriate.permit to be obtained. Roofir,g, Siding, Interior Rehabilitation Permits u : Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work a Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Li Building Permit Application ❑ Certified Surveyed Plot Plan o Workers Comp Affidavit Li Photo Copy of H.I.C. And C.S.L. Licenses a 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 o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses Li Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract o 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 cans if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apw-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Bui?ding Permit Revised 2012 . Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost 200.00 m $ - $ 144.00 Plumbing Fee $ 18.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 18.00 Total fees collected $ 280.00 77 Edgelawn Avenue #12 335-14 on 10/8/13 Kitchen Remodel NOR Tit-/ Town of ? EAnd'over o No. Cj A C, LAN• h ," ver, Mass, A � 2o13 O 'Q COC NIC NaWICK V1, �d pOAgTED HP�,`'�5 S U BOARD OF HEALTH Food/Kitchen PERMIT �� LD Septic System THIS CERTIFIES THAT ......... . .e:`................................... ........ .............................................. BUILDING INSPECTOR 4i. Foundation has permission to erect ...... ................... buildings on .. . .. .. ..�, .�.+.!!!J...... .. .........�.. ` � r�VQ�0 Rough tobe occupied as ........ .... ..................... .. ........................................................................ 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service ................. .... o.rri5........................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinm 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. SEE REVERSE SIDE The Commonwealth of Massachusetts - Department oflndustriglAccidents Office of Invesfigations 600 Washington Street Boston,MA.02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lealb Name(Business/Orgaaization/Individual): All � // S/VY �/1 � / � c Address: l L�t�vdti�L s City/State/Zip: W( G . p, j- . 19, Phone#: 27 - L-- Are yo n employer?Check the appropriate box: Typo of project(required): 1. I am a employer with-- 4• ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ T am a soleproprietox orpartner- 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. [l We are a corporation and its 10.❑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.] employees.[No workers' comp.insurance required.] 13.❑Other 'Any applicant that checks box B1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they a're doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that checkthis 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,pollcy and job site information. Insurance Company Name: Policy#or S elf-ins.Lic.#: 17 2_0 6—0;L 2---0 Expiration Date: 3 -L �z- AV— Job Job Site Address: 2 6//< t. V N(_r0/City/State/Zip: /,z- &U z Atiach a copy of the workers'compensation policy$eclaration 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do Hereby ce ' d r the pains antWnaffles ofperjury that the information provided above is true and correct. Si ature: Date: 67 Phone#: 7 S Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - Phnnn 9f• 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 ofhire, express or implied,oral or.written." An employeY is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more ofthe 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 notmore 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 ofits,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 phonenumber(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 notrequired to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. $e 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. Anew 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 orpermit to burn 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 Co onwealth of A4a:.ssa.,rhusetts Depaz ent of InduOlal Accidents ()fRc,e of IAY08tigatzolns 600 Waftgtoa Street Boston,MA,02111 17-`Z27n4 00 e t 406 ox - ' � MA S Revised 5-26-05 Fax#617-727;7749 Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR egistration 162467 Type xpiration: 712/2`014 Private Corpeatiq wi ' BE ; NEW ENGLAND CU;1S,"�F!MI�E1�,N !`NC. ' Val Lanza5 P f I 226 LOWELL ST. � .. ,E WILMINGTON,MA 01887 r -' Undefsecretary ! : I Massachusetts -Department of Public Safety Board of Buitding Regulations and Standardg• ,s Construction Super`icor• License: CS-008828 VAL J LANZ � 34 BMY SV- REVERE MX 02 � T ` �� Expi.rat+ori .. Commissioner 04/20/2014 `;1 ' 1 03/15/2013 14; 12 .9785319442 93292 P. 001/001 ACORD CERTIFICATE OF LIABILITY INSURANCE PATE(MM,DOYYYYi THIS CERTIFICATE IS ISSUER AS A MATTER OF INFORMATION ONLY AND CONFER$ NO RIGHTS UPON THE CERTIFICATE HOLDER THIS i3 CERTIFICATE DOES NOT AFFIRMAT1vEl-Y OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZER REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: !f the Cerkifioate holder is alfa, TIONAL INSURED, the policy(ies) must be endorsed. If SUSRQQAT10N IS WAIVER, subject to the terms and conditions of the polity;Certain policios mQY require an endorsement,.A Statement ort this certificate does nat confer rights c tfio certificate holder in lieu of such endorsement(S). PRODUCER CONTACT Kilgore Insurance Agency PHONE 5 Centennial Drive 9781 531-655b aX.No: (9'Fe> 5�7-9442 Peabody, MA 01960 ADDRESS: INSURERIS)AFFORDING COVF,RA�iE INSURED ""- --••-- _. isuRER A I Western Wold xnaurance New England Custom Design INSURER 5- Safety Tnsur�nee Compar},y - _ _ Ron Weinberg INSURER c.:Trave3 ers Property E Casual t 226 Lowell Street / Unit B4-A ifasuR.FR.D; _ Wilmington, MA 01$$7 . INSURER E: I NSU REft F I "•"'��, COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDTIONS OFSUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDpoUCED BY PAJD CLAIMS, —�FIEFSUBR( — POUCY NUMBER MMlD N F *1501691 15016 EXP'NPEflPINSVRANCE MMJD YYYY — r . � LIMI75 GENERALLIABILITY INPP134�3227 3/14/131 3/14/14 EACHOCCURRENCE $ A - X COMMERCIAL GENE PAL LIASILITY DAMtTGET( ED CLAIMS-MADE }{I OCCUR REMl _50,000_ E-1 ME O EXP(ASH orw persm).__' $ 0 ` 0 �- I PERSONALE AOVINJt1RY _ $ 1 000 QQ0 CSENERALAGGREGATF. s 2 QQ0. COQ... 4GEN'LAGGRF.GATELIMITAPPCIESPER PROD PTS.COMP/OPAGG $ 2sOQ.Q.�QQ POLICY. PRO- r._.JFCTi LOC -- — AUTOMOBILE LIA51UTY $ X 5054921 4/5/13 4/5/14 WINEDSINGLELIMIT SEa ANYAUN 80DILYINJUKY Per AUTOS }� SCHEDULED I _ _ ( Fefson) E 2; 0.()_6 AUTOS BODILY INJURY(Por occimml) $ NUTOS IJED I PROPERTY 0 01! ""— Boo .00 HIR[OAVTOS „_AUTOS br accident) _.._._.. $ .�0 0-1.0.0 0 UMBRELLA LIAS OCCUR EACH OCCT URRENCE $ '(EXCESSLIAB CLAIMS-MADEI I — 1 AGGREGATE $ I DED RETENTION$ C+ V4RK✓:R$COMPENSATION $ AND EMPLOYERS'LIASILITY YIN i.7- pius-0239N23-2-13 3/x-4/13 3/14/14 X{ CSTAI.TS.c_. ,OFA _ /WY PR OPRIETOR/PARTNENE XECUTN'E OFFICFAMEMBER EXCLUDED? N NFA L. CH ACG CE Nr S _100,000 (Mandatory in NH) FL DISEASF�EA EMPLf)YEF,$, _10Q Q0.0 If y�L.0%xcrlb6 uAdef OESCRIPTIONOFOPERATIONSbelow E.I..DISEASE-POLICYLIM IT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONt/VEHICLES (Attach AOORD 101,Addidonal Reniirks Schedule,if more space isrequred) CERTIFICATE HOLDER CANCELLATION SHOUI-A ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE wit-1. BE DELIVERED "IN ACCORDANCE WM THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIV Cvrus A. F,:.ltror A,nn 4aoo MA AA w r,., .....,.,..... _ .„ . . I NEW ENGLAND CUSTOM DESIGN, INC. 226 LOWELL STREET WILMINGTON,MA 01887 #508-658-0881 Home Improvement Contract Registration No.402467 RESIDENTIAL HOME IMPROVEMENT AGREEMENT This is a legally binding contract. Make sure you read this Agreement and understand it before signing it. Do not sign this contract if there are any blank spaces. NOTICE: All home improvement contractors and subcontractors,unless specifically exempted by Massachusetts Law,must be registered with the Commonwealth of Massachusetts. All inquiries about registration should be directed to: DIRECTOR-HOME IMPROVEMENT CONTRACTOR REGISTRATION ONE ASHBURTON PLACE,ROOM 1301 BOSTON,MASSACHUSETTS 02108 TELEPHONE: (617)727-8598 This Agreement is made on 7 2' 1 3 by and between New England Custom Design,Inc.(hereinafter, "Contractor") and owner //4 0Jc', ilrIy (hereinafter,"Owner"), of City/Towne, &6�aaIlEor— Sta/te_ZDA..., Zip Phone Billing Address(if different): 77 1 z g l z-L-Awly A V w u E Job Address("ThePremises") New England Custom Design,Inc.Salespersons L L 41V M A A. DETAILED DESCRIPTION OF THE WORK TO BE PERFORMED. The Contractor agrees to perform in a good and workmanlike manner all work detailed below. Such work consists of the following. Total Contract Price $ .......................: �.a.��............................................................................. Payment Schedule $...... .. ..P..:..'................... ................... ........ :1.......................... ................... . r✓:..2........ 1�� ..r ............................................................. $........ ¢.: ................. �...... c > � $.::... , .. r.................. 1`1....11. 1.4/ n... .. .......�::...�...-�1.x0,dS.............. $............................................... ................................................................................................................................ $ ea 560 ,— BALANCE DUE UPON COMPLETION OF WORK .........;/.................................. ...................................................................................................................... . RIGHT TO CANCEL The Owner may cancel this agreement if it has been signed by the Owner at a place other than the address of the Contractor which may be his main office or branch thereof,provided that the Owner notifies the Contractor in writing at his main office or branch by ordinary mail posted,by telegram sent or by delivery,not later that midnight of the third business day following the signing of this agreement.See attached Notice of Cancellation.A cancellation fee representing 3070 of the contract price will be in effect if cancellation is requested after the legally allotted time has elapsed. ATTENTION H WNER• O NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Own 's Signature D to New ngland sto esign,Inc. Date