HomeMy WebLinkAboutMiscellaneous - 56 MONTEIRO WAY 4/30/2018 (2) pORTH a BUILDING PERMIT 0 .,%-ED 16s'�o TOWN OF NORTH ANDOVER c2 h 0m APPLICATION FOR PLAN EXAMINATION �. � 11L � e Permit No#: — ' Date Received �DR7ED IPp4`�* CIS �SSgL/ cHuss� i Date Issued: j} I O TANT:Applicant must complete all items on this page LOCATION` )_ _ 0/1 0 Q. Print PROPERTY OWNER Kett Ae I4Ztt1ann 0119 CAff5 Ng55h/er'a Print 100 Year Structure yes no MAP 0 PARCEL: I ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ;K One family ❑Addition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DE CRIPTION OF WORK O BE PERFORMED: ��► r5 dd� �u (b Iowa �eCK endgJJ 5101rr ID rwn1 Ject & A rPr'a o12, Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: 46- Co Phone: 70),- 65.04 Address: 1357 Mo,o4-ai n 6-Ji (J "IeiJ , MA o g a t Supervisor's Construction License: LS - �{�7 �3a Exp. Date: t 16 3 1 a©I'7 Home Improvement.License: Exp. Date: 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: $ 1s , �5 I FEE: $ 1 I Z� Check No.: © Receipt No.:� Z� NOTE: Persons contracting with unregistered contractors do not have access tote ua n f d 6ignature of Agent/Owner Signature of contractor i Plans Submitted ❑ Plans Waived 0 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 PLANNING & DEVELOPMENT Reviewed On 011911 Signature_ COMMENTS © `I b P(La Z"L�CONSERVATION Reviewed on Signature Y ` " -21 COMMENTS 7 �y 47 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 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.: I� 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) w _ 1 a p �I ❑ Notified for pickup Call Email Date Time Contact Name 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 o Building PP Permit Application u Workers Comp Affidavit Li Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work Li Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks u Building Permit Application !i u Certified Surveyed Plot Plan u Workers Comp Affidavit Li Photo Copy of H.I.C. And C.S.L. Licenses u Copy Of Contract Li Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o 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) u Building Permit Application j u Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit La Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) a Copy of Contract o Mass check Energy Compliance Report o 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 Doe:Building Permit Revised 2014 Location s O ' "' r-W w No. LT—"r` Date r . - TOWN OF NORTH ANDOV Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ 4i A TOTAL $ Check# `� `� Building Inspector � NORTIy � ... . Town of : _ ndover p �-+ ";. 0 h ver, Mass, ID COC NIC MI WICK �� i ORATED S V BOARD OFMEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT ..f-L.mdwt.�. .................................................. BUILDING INSPECTOR has permission to erect buildings on ..54 & �. Found^ 1 to be occupied as ..�,�G�J�(it .... ....... �..'.evt �Ii ...... ... a aA; � Chimney provided that the person accepting this permit shah in rYfes ect confor - . . on on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and C final r Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS'CONSTRUCTI S - Rough Service ................ ....................... ......_s.. ..................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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 Inspects.. Burner Street No. Smoke Det. r, 15 AL Massachusetts _ Board of Building RepartMent°f I'ubii Constructi., ns gulatio Safety License: CS 107 Aoranq Sta`res I i RICj�ARD 630 13S I40 IAETZ. Ashland TAIlITGAT 1` MA 01 7Z E ROADf Co �m,ssioner Expiration j 12/03/2017 i 1 i �,1pRTH Town of No. h ver, Mass O Ic 2 1_ �A COCNICNt W1CN`%, ��S RATED PPP��S U BOARD OF HEALTH Food/Kitchen PERMI-T T L D Septic System 4 f. THIS CERTIFIES THAT .......... �„e,,., BUILDING INSPECTOR Foundation , has permission to erect .......................... buildings on .. &.......�!!In.Q.h,.. ..C'rGo......uj .... Rough to be occupied as ..! �.r.... ryd........ ... .... atCw.►...... !t... .. ��IIYfs ......... Chimney provided that the person accepting this permit sha in everylFespect confor l' 'on 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final Y PERMIT EXPIRES IN 6 MONTHSELECTRICAL INSPECTOR UNLESS CONSTRUCTI S Rough Service I ................ ......................• •......... •.................... Fina BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. A.I.M. Mutual A.I.M. Mutual Insurance Company �/ Mutual 1 Massachusetts Employers Insurance Company New Hampshire Employers Insurance Company INSURANCE COMPANIES Associated Employers Insurance Company 07/23/2014 Richard Raetz 135 Mountain Gate Road Ashland, MA 01721 Re: Workers Compensation Insurance Policy Number: VWC-100-6019056-2014A Policy Period: 07/18/2014 to 07/18/2015 Dear: Richard Raetz Welcome to the A.I.M. Mutual Insurance Company. Your workers compensation policy with us is currently being processed, and your policy number is noted above. I am a member of the customer service team assigned to your policy. If you have any questions or requests, please feel free to call or email me. If you prefer, you may contact any of these areas directly. Certificates of Insurance Fax: 781-270-5690 Email: dcox@aimmutual.com Phone: 781-270-8740 or 781-270-8935 Credit Department Henry Green- (781)270-8780 John MacDougall, Manager: 781-270-8846 Claim Online: www.aimmutual.com Phone: 866-270-3354 Fax: 781-270-5599 We look forward to being of service to you. Sincerely, Carol Pace (781)270-8882 cpace@aimmutual.com cc: Desanctis Insurance Agency 100 Unicorn Park Drive Ste 2 Woburn, MA 01801 54 Third Avenue• P.O. Box 4070• Burlington, MA 01803-0970•Tel: 781.221.1600/800.876.2765 • Fax: 781.270.5599 BRIDGEWATER• BURLINGTON •CONCORD, NH • HOLYOKE• MARLBOROUGH sponsored by Associated Industries of Massachusetts ESTIMATE Raetz Company Ken Heitzman and Chris Nassivera 135 Mountain Gate rd 56 Monteiro Way Ashland, MA 01721 North Andover, MA Phone: 617-301-1802 Mobile: 978-387-2399 Email: rook345@yahoo.com Estimate # 000132 Date 07/19/2014 Description Total Labor $8,400.00 All labor for the demolition of the old existing stairs, and patching trim and lattice work to match. Fix all structural issues including new footings to outside perimeter, new posts and post anchors for"floating" posts. Level out entire surface and add stair on to new deck extension next to jacuzzi tub. Trim out stairs and railings, match existing decking. Disposal $550.00 20 yard dumpster Material $2,740.00 All material for specified labor. Lattice,Azek brand PVC trim boards, fasteners, concrete, anchor bolts, post bases, pressure treated framing stock and decking to match. Subtotal $11,690.00 permitting $557.00 Insurance $504.00 Total $12,751.00 Notes: 56 Montiero Way, North Andover, MA Page 1 of 2 By signing this document, the customer agrees to the services and conditions outlined in this document. Any and all work not outlined in this document will incur an additional fee. Signed on: 08/15/2014 Page 2 of 2 i The Commnonlveal'th of tl2'assachuseUs • . 0.flee o,fInves igafeons 660 Washington Street Boston,.A 02111 -ww wast'go-pldla Workewo'Compexwatlon InsuranceAffidavit:Bu der,-/Conti-actoxs/ElectAclansjTZ* Brig .ADIfficant nfoirima-tXon PXease `l�zn e itbXv 'Name,(Businessl()rganization/T>&iduaD: Ad&ass: 135 lnotjn4 h C-vth, CzV1 ,atcfz[p:_ A-S�Land Ara yore aim employer?C&ek the appropriate]lox: Type of project(required 1.6.T am a employer with `i• d T am a general contractor and T S. []Now cOnstmoffon employees( and/ax ar time)T havehiredthe sub-contractors listed o 2.[l T am a sole proprietor or partner n.the attached sheet:T 7. E]Remodeling ship and`haverta.eznployees These sub-Contxaetorshave 8. �Demolition worlting forma in auy capacity. workers'comp.insurance, g, ❑Buildumg addition [No workers'Comp.hl8bimance 5• ❑ale r a havcore e argils and its 10.]Electrical repairs ar additions xecluix'ed.] officers have exexcisecl.their 3.El Z am a homeowner Aing allwork right of exemption perMOL x1..[(Plumbing repairs or additions myself ENOworkers°comp. c•152,§1(4),and we have,no 12,QRoofrepais insuraneerecluired.] employees.[No workers' 13.[].OtTier comp.insurancerequired.] appiicanttbat checks nsialso�Ilouithesectionbel6wshowingtheirvrorkers'compensationpolicyinf Auyomnation. l Homeowners who submitibis affidavit indicatingthey bre doing allwork and then hire outside contractors mustsubmit anent affidavit indicating suoh. xContractors that cheAtbis bomustattached au additional shectshowk9thename ofthe sub-contractors andtheirworkers'comp.policy information. I tam to e�npl'oyeNtiicttzsp�ovicli�tg wopker��car Fellsation insuran foamy ernptoyees: Berow iSt�iepolicy ar2rijo�i site in•fox'matior2. , Insurance Company Name �e 5q►�G�l 5 h Su y q✓►CP /�q a cy Policy#ox el ins. ic.#� U�G '" 4 "�6 a 0 l q Expiralic.Date: -711% U lob Site,Address 5• Mog M f o r d o wr Attach acopy o tliieworkers'compensation-policy declaration page(showlug•thepoucynmherand expirationsdate). Failure to secure covexage as requiredunder Section 25A oflV GT,o.152 Cart lead to the imposition,of eriminalpenaTties of fine up to$1,500.00 andloxone-year imprisoumentx as well as civilpenalfies in the form ofa STOP W ORY,ORDS.and a fn.e ofup to$250.00 a day againstthe violator. Be advised that a copy ofthis statementmay be foxwarded to the Office of Investigations of the DTA.for insurance coverage vexif cation. X do Hereby ger " unci A ah, e a7ties of verjury that A informatiox��poVidec above is true and eorreet. Si atone• Date: Phone# "7g l-7 4 - D 5'o)l Offieial arse,wily, Do not write in this aYea,to be eowletod by city or toren official City or Town: Permit/License# lssuing.Authority(circle one): 1.Board of wealth.2.BuildingJDepartment 3.CRYNown Clerk 4.Electrical Inspector 5.PlumbingTinspector 6.Either - _ Information and ins tructions - Massachusetts General saws chapter 152 requires all employers toprovide workers'compensation for their employees. Pursuant to this statute,an employee is deflmcd as"..,every p erson iii.the service of another index any contract of hire; • e$pxess orimplied,oral oxwxitten" An.employeis defined as"an individual,partnership.,association,corporation o�ofhexlegal entity,ox anytwo oxxnore' o the dregoingengaged inajointenter pxise,and including the legal xepxesentatives ofa•deceasedemployex,.oxtbe xedeivex Ortxustee o.i an.individual pa�rtnersbip,association or other legal entity,employing empXoyees. Hovraver th6 owner of a dwellinghouse havingnatmoxe than three apartments and who resides therein,oxthe occupant ofthe dwelling liaise of another who employs persons to do maintenance,consf ninon ox repair work on such dwelling house or onthe grounds orbuilding appuxtenantthereto sMnotbecause of such employment be deemed to be an employe:" MGL chapter 152,§25C(6)also states that"every state or local lie-ensing agency shall withhold the issuance or renewal of a license or permit,to operate a business or to construct buildings iu th.e commonwealth for any applicant who has not produced.acceptable evidence of compliance with the insurance coverage xegafred:I Additionally,MIL chapter 152,§25C(7)states"Neith-erthe commonwealthnor aay ofits political subdiv�ions shall enter into any confract fox lite performance ofpublic workuntil acceptable evidence of compliance with,the insuxance, requirements ozthischapterhavebeenpresentedtothecgntracti gauthority," Applicants Please fill out:the workers'coanpensation affidavit completely,by checking the boxes that applyto you sitaa�on and,if A6cessaxyy,supply sub-confraotor(s)name(s),address(es)andphonenumber(s)along with their cerecate(s)of insurance. LimitedLiabilityCompanies(LLC)or Limited LiabilityPartuerships(W)withno employees otherthanthe, members oxpartners,arenotregakedto canyworkers'compensatloxzinsuxance, SfanLLC oxLLP doesbave employees,apolicyzs required. Be advisedthattbis affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be snxe to sign and date the aftzdavi� 'Ite affidavit should b e xetuxnedto the city or town that the application fox the permit or license is being xegao ted,not the DBp*artment of lnduskr al Acoidenfs. Should you have any questions regarding the law or if you are required to obtain,a wotkexs' eompensatioxzpolicy,pleasecalltheTiepartmentatthnumbexlisfedbelov,�: Selinsuredcompaniessh.ouldentertheir self"insurance license numbex on the appropriate line. Cady or Town Mcials Please beSUM that the affidavit iscomplete and Printed legibly. T$eDepaxtmenthaspxovidedaspaceattheboftom ofthe affidavitforyouto fll out in the event the Ofdce of)nvestigationshas to contactyouxegardingthe applicant. Please be-sure to Muthepelmit/Rcense numbex whirhwill be used as a xelrence number, ITh addition,an•applicmt thatznusf submitmultiple.permit/lic-ame applications iii any given.year,need only submit one aflldavit indicating current P olicy information(i-fnecessary)and under"Yob Site Address"the applicant should write ,all locatioW in (city or towh)"A copyotlieaificlaviGthat7�asbeezzofciallysurtpedormarkedbythe cit yoxtownmaybepxovidedtothe applicant as p6ofthat avalid aflxdavit•is on file fox futurepemmits orlieenses. .Anew affidavitmustbe filled ant each year.Where a Homo ovmer or citizen is obtaining a license ox p enait not related to auy business ox commercial venture (i.e.a dog license orpermitto burn leaves etc)said person is NOTxegairedto complete this affidavit. The Office ofXnvestigafions would like to thank you in advance fox your cooperation and sh.Quld you have any gt�esfions, Please do not hesifate to give us a call. TheDepartment's address,telephone ahAfaxnumber: Tha Goa mwcath 0rM—Qau,( a&P 1)(paelat QduxXccdot 6,904ft-..gtonfleet Ba.A04 St!A 02111 TOS, 6174-274900 0A406 Qx 1•-877- _ Revised 5-26-OS Fax 9 617-727-7749 • w�w.�.��,gQv�c1�� I v 'G ! ' Cl PROPOSED -% � FIL 7FRM/TT NOW OR FORMERLY (Typ.) JL T, & CAROL A. POWERS _ __ EASEMENT ED BOOK 4284, PAGE 155 J — PROPOSED 7 �SILT SAC,�a� �� IDE) PROPOSED --1 ` �SD� W GRASSED , y \ , ,- - �,n O A DEPRESSION-; - W 1r PROPOSED j��+ j f SILT SAC MoN v� JL 2�3 5t= G p PROPOSED 77NG TREES 1 EXISJ DOWNSP60 TO BE j cif MA_INT AINED 00 EASEMENT 00' WETLAND,,, - _ BUR= PSIS /� (SEE DETAIL)/ PA-�POSED- GAJE --- PROPOSED �0 1 CLEANOUT '} - = PROPOSED bOW/VSROUT FIL7ERMlTT Av. 50' N�-BUILD �5��� -• _f/. J�,- yr'•x`'• ONE .r /L!" \v.��o - — _ _-./ Wil./. 4, ' 'Y.•i �+ ,Y — r' `_— O� 1•' \- /e mil.. 4>, t''^� // y ' PROPOSED AREA OF ROOF r::•:.:::- = e°°° r - :: :.:: RUNOFF TO BE D/REC7E•D i o o - °° 0 00 - oe 0 0 0 TO PSIS. e o 0 0 - o 00 0 0 _ -!�� °o° 0000000°0° �; , • / - 0e oee°o°e0 � o 0 0 0 0 0 FY o > s. 0 0 0 0 : -, oe000°OOooO00000° t^ , PROPOSED i r Z71 CONS7RUC770N < ACCESS WFB7 � ,. PROPOSE - - - ',� ��% FENGEJ�, _` ���- --- � "_ • � .Iii, ��WFB3 +•- _ 5• =- ..� ami, WFB6 - WFB2 PROPOSEDi NOW OR FORMERLY IMPERVIOUS AREA CHART FX 7FRM/TTai - - CARS7FN D: BECH . All, DEED BOOK 12547, PAGE (�•) — DESCRIPTION E& _ � (TBR) ' All, , . IMPERVIOUS AREA WITHIN PORTION OF ali, 25' BUFFER ZONE FlL 7FRMI TT TO BE ''-'' WFB1 INSTALLED AF7FR IMPERVIOUS AREA WITHIN FENCE REMOVAL 50' BUFFER ZONE IMPERVIOUS AREA WITHIN 100' BUFFER ZONE IMPERVIOUS AREA TO BE ^ 'J INFIL TRA TEDWl THIN , GRAVEL AREA WITHIN 25' BUFFER ZONE 9000 NOW OR FORMERLY SHIRLEY KNOWLES HOWE GRAPHIC SCALE DEED BOQK 1448, PAGE 304 » SCALE.• 1 =20 FEET 20 0 10 20 40 80 METERS 0 5 10 20 30