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Home My WebLink AboutBuilding Permit #135 - 1 FOREST STREET 8/17/2009 BUILDING PERMIT 00RT#1 q stye° 6 ti TOWN OF NORTH ANDOVER c? ' -° •6 0° APPLICATION FOR PLAN EXAMINATION '" « .. Permit NO: Date Received —L3(� �9 q°q-ro° Date Issued: a 1? D S- CHU`�� IMP�ORTANT:Applicant must complete all items on this page LOCATION e S Print PROPERTY OWNER A 1 1,P, Print MAP NC� ARCEL:_� ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building 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 DESCRIPTION OF WORK TO BE PREFORMED: 1 Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: N Qr-,56/-v Phone: Address: V Supervisor's Construction License: -7 cR 41 Exp. Date: Home Improvement License: 111q a Exp. Date: 0 / ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ `� FEE: $ 6 7. 00 Check No.: / ,-) /3 Receipt No.: X2-33 (.,; NOTE: Persons contracting with unregistered contractors do not have access the guarantyfund Signature of Agent/Own Signature of contract Location No. Date n d 1 NORTH TOWN OF NORTH ANDOVER 3 O Certificate of Occupancy $ Building/Frame Permit Fee $ .o. scMust a Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 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 - Ut. QRM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Boafd 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.: 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) ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 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 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 xAORTH '� � � AndoverTown of O ;•iry No. 12 9 - y C% __ y dover, Mass., �T • 1� ' T 0 LAKE co V 7�ADRATED `s BOARD OF HEALTH PERMIT TFood/Kitchen Septic System ` "C11 I I�� BUILDING INSPECTOR THIS CERTIFIES THAT... ....... .. ............_..).................................... Foundation has permission to erect...................................(2-4, buildings on ... ....... T.... ...1............................... Rough to be occupied as.......$........ a Chimney .. . . .. . . . . .. ........................................................................................... provided that the person acce ing this permit shall in every pact conform to the terms of the application on file in Final 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 b 1 i PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTR ST S Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. l 1 i:onsrnanweaft ofMassachusetts f l D�Partment of Industrial Accident lir L `•'JJ ,f IIIvSSfid atiolL4 . 600 ff,ashirrgton Street J �� Boston, MA 02111 Workers' Com usatiosn Insiu-aaeernas,�gov/die A iicant Information Aftciuvit~ Builders/contactors/Eie ctricians/Plumbers Please Print Lem-hi Name (flusinrss/OrpWiMLfionAndividual)' Address: > • Phone - Fmnploy= m °�� C7 pfoyea'i Cheek.the appropriate box: mpiayer with 4. Q 1 am a Type of Project r general contractor and I . ( egairm): (full and/gr par€-time.* havc ole.. ) lid the suh-c:ar�actors 6• ❑New construction . Proprietor or partner' listed on the attached sheet.S 7. ❑Remodeling S*and have no employees" These working for me in Su'cou�rs have �S'capacity. workers' comp.insurance. 8' Q Demoiitiott [No workers comp. ' p g, But�di required.] tasruance 5. Q We arc a corporation and its Q ng addition 3•❑ lain a homeowner o�� have dxercised their, 10•Q Electrical repairs or additions doing all work right of exei oon per MOL 1!.Q pleb myseI£[No war Icy' mg repairs or additions insurancere C0 G 1S2, §1(4)7 and,Wehave no 9u d'1 t eMployees:[No worm' 12.ff Roof repairs *Ally amlicent titer checks box'f#l mart also tutu out the rection 6ei�p• is BLMM=required.] I3.0.Qth� 1 ow Homeowadrs who sdhmit this afftdavh ind• ahvv✓ieg tlroiraarkerC'6ornpensetion policy information, 4caatractors that aheatt this bux rest } ��an demg An WOE'and than uric outside oonuactars rmist atJac>tr:d sa oasl elect showing.t In=,of the mh-coutreat� oulnnit a naw affidavit indialfq snch,• waut� I ar<. e►rrpuryer that cs:prro :worF r.�e<zsatinn dmv w°'ida'rx' p-u3•itfmrnetion. infarnurtior_ in<saraace or nrJ'mFht - Below r t ae Pow! an lob site Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration I3etc; Job Site Address Attsch a copy of the workere'com Crt3'�t�eJLrp. peesatwn Policy duxF$��Q page(showing the poky number and e Failure to secua•e coverage as required under Section 25A of xpiradoa date). fine up to$1,500 )o and/or one-year imprisonment, MOL c. 152 can lead to the imposition of aim' of up to$250.00 awe1I civil penalties in the form of a mal penahies of a Of up i dBY agairut the violator. Be advised that a copy of this STOP WORK ORDER anti a fine gations of the DIA for irusttrartce coverage venin""cation, trtenf may be forwarded to the Oft'rct of I do hereby c under the pouts wrd peRalti arPcgWY- rim`the infomawaR P vcro ' Si ded above is twe and carred Phone#: Data: offIciul use ontfp. do rio1 write uz this area,>a he completed by do or town a Iir4 Cky or Town: Issuing A P�It/LiCeuse# d uthority(circle one); 1. Board of Iieatth 2- Jau"diug Department 3.City/Town Clerk 4. EInspector 6 Otbe'r Iectricat 5. Plumbing Inspector Contact Person: Phone#; Information a. end Instructions Massachusetts General Laws chapter I S2 mqUiTM.all imp 3 Ayers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"..:avert' person in the service of another under any contract ofhire, express or implied,oral or writ=" An employer is defined as"an individual)partnership,ass�cisiion, corporation or other legal entity,or arry two ormort of tht'famgoing engaged in a joint enterprise,and includiar-1<g the legalreprc=ILZWU s of a deceased employer,fir flit receiver ortr=tee•of an individual,pminership,associatiain ar other legs]aTtity,employing employees.'Howewrthe owner•of a dwelling house having not more thea th=apa i-ments and who resides fi=m n, or the occupant of the dwelling house of another who employs persons to do ma:i77t=ance,construction or repair w&k on such dwellinghouse or on the grounds or building appurtenant thereto shall not b=wm of such employment be d---med to be an employer." MGL chapter 1 52,525C(6)also states that"every state us-local licensing agency sw withhold the issaaneeor renewal of a license or permit to operate a business or *o construct bulid'mgs in the commonwealth for any applicant who has not produced•auxeptable evideuce.&,e aompsanc a with the insnranec coverasQe re4aired." Additionally, MOL chapter 1 S2, 125C(7)states-Neither t$ic cotmnonwealfh nor any of its political subdivisions shall enter into any contract for the perfannex at of public work- untll•acceptable evidence of complizin=with the inmrsoc e roquirzmerds.of this chapter have bean presorted to-the carttractQng authority." Applicants Please fill out the workers'compensation•affidavit compl-m—tety,by checking the boxes that appiy to your situation and,if necessary, supply slab-coTrRctar(s)name(s4 addrrwns(es):and phone number(s)along with their=rtifucate(s)of insurance. Limited Liability Companies (ILC)or Limited Liability Partnerships(LLP)with no enployees otherthan the members or partners,are not requi ed,to-any workers'cci-rrupensi6on insosmncc Van LLC or UP does have empioyem,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confmnatian ofinsurence coverage. Ain be sure m sign and date the jif idavit ?ire Oidavit should be returned to the city or town brat the application for.the permit or license is being requested,notthe Department of Industrial Accidents Should you have any questions n gzn-ding the law or if you arc rquimd to obtain a workm, oanapensation policy,pleat-call the Department at the-nurm.ber.linked below. Self-insured companies should enter their self-insuraince'ficanst nurnoer an t£ae'appropiistz cies~. City or Town Officials Please be sure bast the affidavit is complete and printed hglbly. The Department his provided a space at the bottom of the affidavit for you to fill out in theevent the Officc of Ines pfions has to contact you regarding$fie applicant Please be sure to fill in the permit/license number which will be used as a referent number. In addition,an applicant that must submit multiple permit/hiwnst applications in any given year,need only submit one affidavit indicating current policy'information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town).'A Dopy 6t-the affidavit that has been officisily stamped or mariced by the city or taswn may be provided to the applicant as proof that a Valid affidavit is on file for futam permits or licensor A new affidavif must be fulled out each year.Where a home,owner or citizen is obtaining a Iic-nae or permit not related to any business or commercial vrnh= (i.e. a dog license,or permit to bum leaves adz.)said person is NOT.requimd to compietz this affidavit The O tf ice of investigations would Ifim to thank you in advance for your coopcca6on and should you have any questions, please do not hesitate to give us a coil Tl=Department's address,telephone and fax number. The Commonwmadth of Massachusetts Dcpartmant of lmdustrW Accidents Office Of.Lnve stiiQ�ons 600 Washington Ste=t Rnsfon, MA @2111 TeL#617-7274900 6ct 406 or 1-8.77-MASSAF$ Fax#61 7-727-7744 ILvised 5-2G-QS WWW-Mass.govid a NORTH ONNM Of Andover No. dover, Mass., 0 LAKE COCHICHE w ICK "q'A T E D C5 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT... .............. BUILDING INSPECTOR ......**........... Foundation has permission to erect........................................ buildings on .. .............................. Rough to be occupied as....... .......!tn......(2A, Chimney .............p ............................................................................ provided that the person accelfting this permit shall in eve:rk. Oct conform to the terms of the application on file in Final 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 J01--o- PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTR<.aST N Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In.accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: ► Fo,Q.I s is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL C 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: (Location of Facilitp ignature of Permit Applicant /0 9 l � Date BRAVIN Home Services 100 A Kent Farm Road P.O.Box 682 Hampstead,NH 03841 Sean P Parsons Owner 978 420 9996 HOMEOWNER INFORMATION 7S 0 Name Street Address(not PO Baas) City/Town State Zip Daytime Phone Evening Phone MailingAddress(lf different than above) WORK TO BE PERFORMED AND MATERIALS 70 BE USED Bravin Home Services agrees to do the following work for homeowner.. �.�! �•/, �1.J�'� C� ./`r�. � i.:il'HCl, C3'�7 '�'.JS r..J..��' �'�1 ' A : kn i, �i� r Matedals a ed to be used: Z-p a Y2 li SCHEDULE Me lbrfenfn9sabedrdeoff bead/revdtom7hwdxomsbmmb*vAdourconbvlarise. Hemwowneragreesand cuo�mpf9m.0 1p dN�neZMS�SU, 0("T4-Nrateves,BravinlSernliaescannot�DiwAra�S a�eraN7ca►alefiu '�'c-om 54<:,r 4— Work to begin: J_J Effected date of completion: TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE Bmvin Home Services agrees to perform the work,furnish the material and labor specified above for the Sum of s5 -393Q Payments will be made according to the following schedule $_�W 000 due upon signingcontract $ by_.J—___7—_—orupea_,comple1Ion of $ 5- 7�5due upon completion of contract TERMS AND CONDITIONS 1. Unless otherwise noted within this document,this contract shall not Imply that any lien or other security interest has been placed on the residence. 2. AMIcable Law:This Agreement shall be governed and construed in accordance with the laws of the Commonwealth of Massachusetts. 3. Entlregg►eement:These terms and conditions represent the entire and integrated Agreement behreenn Homeowner and Bravin Home Services and supersedes all prior negotiations,representations or agreements,either written or oral,and maybe amended only by wit Instruments signed by both Homeowner and Bravin Home Services. 4. LON1 AcW= Should it become necessary for Bravin Home Services to enforce any term of the previsions of this Agreement,or to collect any portion of the amount payable under this Agreement,then all litigation and collection expenses,including but not limited to witness fees,court costs,and attorneys fees shall be paid by the Homeowner. 5. Bindii gggmment Homeowner and Bravin Home Services respectively,bind themselves,their partners, successors,assigns and legal representatives to the other party to tins Agreement and to the partners,successors,assigns and legal representatives of such party with respect to all covenants of this Agreement. 6. Severabli ft If any provisions of this Agreement are held to be in violation of any law or ordinance,tiny shall be deemed stricken and all remaining provisions shall continue to be valid and binding upon the parties. I understand that this is a legally binding contract and have read and fully understand the terms and conditions contained therein. j Ho r Date n Home Services Date Homeowner Date 3-:1.. 1"lassachusetts- Department of Public SafetN .toll ELBoard of Buildin7 Rc��ulations and Standards Construction Supervisor License License: CS 87726 _ Restricted to: 00 SEAN P PARSONS PO BOX 682 HAMPSTEAD, NH 03841 c Expiration: 5/25/2011 ('onmiisiuner Tr#: 17054 ✓lee �orninzonuleal.Cl o�✓�aaaac�uc�ell Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR i Registration- 142446 Expiration: 4/5/2010 Tr# 266719 Type: DBA BRAVIN HOME SERVICES SEAN PARSONS 100 A KENT FARM ISD. HAMPSTEAD,NH 03841 Administrator