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HomeMy WebLinkAboutBuilding Permit #621-12 - Suite 300 2/28/2012TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Z-- RTANT: Applicant must '�oibver < � 2Q�,_ Date Received all items on this � 6x. 3 OtD ` f \ Print PROPERTY OWNER t �^-� I� U V �I�' I Unit # Print MAP NO: `' PARCEL:* ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family enation No. of units:%ommercial ��stria) ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other CC p „43,.� ..¢ ,�iloodpl;, ®Wetlandsj:.,; ,.. 110 �� Wa er4 11 tnct'� .>�03Water/Sewer�.. 1 ESCRIP ! N U (Identification OWNER: Name: n� ���� L Address: q 51 A-Aoue_t WORK. TO BE P// ERFORMED: p .. i-- !7 N/� e4 r i . r L U 1/ J_ . l..t 6 t Please 1vpe or Print Clearly) • �R4_1 06 CONTRACTOR Name:C,k �(' Ldp Phone: Address Supervisor's Construction License: t �!►�`�%�� Exp. Date: p Home Improvement License: Exp. Date: '1 ARCH ITECT/ENGINEER _ ��'3 `t= Phone: Address: Reg. No._ FEE SCHEDULE: BOLDING PERMIT. $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $_�� Cj� FEE ^$ T 3e) Check No.: 0 y5 ,G NOTE: Persons contracting with unregistered fund Location No. DateAo45 f V' ko %-- ChE�ck # 4� �-o 6 -AP 25054 TOWN OF NORTH ANDOVER Certificate of Occupancy $- Building/Frame Permit Fee $ Foundation Permit Fee $- Other Permit Fee TOTAL �-building Inspector 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 on Signature COMMENTS 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 Dempster 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 DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section /-I/,% —F and G min.$100-$1000 fine Doc: -Building Permit Revised 2011 June/mi 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 Doe: Doc.Building Permit Revised 2008mi U) m X m x CO) v m _v, .0 C � CO2 Cl) CD � O n Z CO2CCD O 'v a' r C m C =' CO) at v CD D O cr CD CD 00 wCD �. C CD y CLO y O I CO CD B v CA O 1 Z CD �. o CD 0 CCD 0 A cn n 0 ,'OEE I r� c J 2 rn 0 cn O �• N O Q. N r dC, O m nCD c m • e� c. C m z NO• m NI C g moo- c T � o. O m y Er CD 0 y N s m CD 2 m-� '' a �OO.w C 7 42 y•p� CD aN �: n a O iw Ua o CD m y m mom. c O. N O y N N CL c ot S. = G n H ��co o m : CO) H NCD 1 m H 'O CD cos: ..�, "CD 0 �- IL � CO) o CD ...r =rt o CD W .� N CD CD dd: CL : Com: �C cm k. C/) rD rD C/) rn Poo0 Pi o , z E n z G o C rLd c)o n o tri ro 0 7d • op z H 0 0 c MDJ MDJ Engineering & Construction Marcos A. Devers, P.E. R.P.E.L.4:33848 C.S.L.#:47056 HIC.L.# 106698 16 Woodland St Lawrence Ma, 01841 T:978-804-7588 978-685-5691 E-mail: mdjincorporated@comcast.net comcast.net 2/23/2012 Building Repair Proposal Name: Mitchell J. Wachtel Job Site: 451 Andover St Suite 300 Address: 451 Andover St Suite 300 North Andover MA North Andover MA Use: Commercial Job Breakdown and Cost: 1. WALL a. Remove 4'x 78 " Wall b. Framing 40" x 40" c. Install Door 30"x78" 2. PAINT a. Paint wall (same existing) b. Finish Molding 3. CLEAN UP Materials Labor Subtotal $130.00 $150.00 $280.00 $280.00 $150.00 $430.00 a. Remove debris $210.00 $210.00 4. PERMIT a. Building Permit $30.00 $30.00 Totals $410.00 $540.00 $950.00 Total Amount to be paid for the work to be performed under the contract is $ 950.00 The Job will be completed within 7 business days. All home improvement contractors and subcontractors shall be registerd and any inquaries about a contractor or subcntractor relating to a registration should be directed to: Office of Consumer Affairs and Business Regulation Ten Park Plaza, Suite 5170 Boston, MA 012116 Phone: (617)973-8700 The homeowner is entitled to his(her) three-day cancellation period under MGL c 93 s48, MGL c1401) or 255D s14 as may be applicable. The owner has all warranties on the owner's rights under the provisions of and MGL c. 142A. The contractor will obtain all necessary construction permits. Owners who secure their own construction -related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES The contractor and the owner hereby mutually agree in advance that in the event that the contractor has a dispute concerning this contract, the contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided in MGL c. 1.42A Owners: Mitchell J. Wachtel Date: � r ; Contractor: Date:Z' 2 MDJ Incorporated repres nted by Marc Devers The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations / 1 Congress Street, Suite 100 Boston, MA 02114-2017 .�' www mass.gov/dla Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Apiplicant information Please Print Letjbh, Name(Businessr'Organizatitmlindividuatl): MDJ Incorporated Address: 16 Woodland Street Lawrence, MA 01841 Phone #: 978-804-7588 Are you an employer' Check tate appropriate box: 1. Q I am a employer with 3 4. Q I am a general contractor and I employees (full an&or part-time).; have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers - [No workers' comp. insurance comp. insurance.+ required-] 5. Q V4'e are a corporation and its 3. 111 am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, § 1(4). and we have no employees. [No workers' coma. insurance reouired.l Type of project (required): b. ❑ New constriction 7. Q Remodeling S. ❑ Demolition 9. © Building addition 10.Q Electrical repairs or additions I I. Plumbing repairs or additions 12.❑ Roof repairs 13.[X Other Repairs `Any appiimnt that checks box b 1 must also fill out the section below showinS their workers' compensates polio information. t Homeowners atso submit this affidavit indfoxiting the} are doing all work and then hire outside contractors must submit a new atf`idavir indimit" such. =Contracton that check this bm must attached an edditionai sheet showing the name of the sub -contractors and e -tate whether or not those entines have employees. If the sub-conttsetors ha -m employees, they must provide their workers' comp. polic4 number lam an employer that is providing workers' compensation insurance for my employem Below is the polict, and job site informadon. Insurance Company Name: Continental Casualty Insurance Co. Policy # or Self-ins.Lic. #:: 0417N57511 Expiration Date: 4124!2012 Job Site Address: " L/ 4�Oy-e-S*e &6 2Q6 Citystate/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 penaltie-q 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 5250.00 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 hereby certify, under the dhk provided above is true and carred Z- / `Z- 7 / / Z- 978-804-7588 Official use on4,. 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 b. Ether Contact Person: Phone #: 11assachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License License: CS 47056 MARCOS A DEVERS 16 WOODLAND ST r, LAWRENCE, MA 01841 �-- �- _.,0- Expiration: 10/25/2013 Commi Tr#: 5685 �/ j �.c1�a�nonocul!/a o�,s��aas�sduQefG� Office or Consumer Affairs & Business Regulation R �HOME IMPROVEMENT CONTRACTOR Registration: 106698 Type: �V ..., Expiration: 7/2412012 Private Corporatioi MD71NC. Marcos Devers — 61 WOOD LAND STREET WRENCE, MA 01841 L'ndersecretary IN ENGINEERING ' REGIPROF CIVIL ENGINEER z� J' � MARCOS A DEVERS a16 WOODLAND ST LAWRENCE MA 01841-2315 33848 06/30/12 741763