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HomeMy WebLinkAboutBuilding Permit #770-2011 - 10 ANDREW CIRCLE 1/7/2009 BUILDING PERMIT � - f CtiORTy � . TOWN OF NORTH ANDOVER 0.32 6. Fa • _ ° o APPLICATION FOR PLAN EXAMINATION Permit NO: _ (� Date Received Sys .,r.o sACHusE Date Issued: IMPORTANT:Applicant must complete all items on this page µ IL ,t ._. ........-..>_.,_a^d..-:..,.. :��a.. J. '.:-:r:;.f?: �T. ki' _ :J^-'.y•'., y...;.i:�' ..{�:•!' ....,':�... .5,.. .... .9-, ?... ,h „-,.. .. a. ..,,..r .�-:1��1p L': :J":: - :.T n+.✓i:i'.� - :��.> a .��.F-�.. - ry } - F.. U �f�� s ...: a .. ..,-. : .b.•:. ,a. r .1. t.>•!4, _�:..r71�1 n.: .f•,-_ :'-j 9L�af�` .'F.�r:v-.;-`.'t.'..,�1r;:e'.:jy.--��.G�_. ;`(.'i;f�':;•;. F .!- p� I'..:G,�IST �`PT.,. �.a }' �' ., .rL ::., a ::._.� ,fi;.:.. _ ,,� - I�llai�a�in: . . ..: �� .. r�_ .t .._ • ..�`:' + .:... Vii'". _ eA= p /.. `/ // TYPE OF IMPROVEMENT PROPOSED.L18E - 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 - C''' Le mads: -.. .-. Cdr5� 4: va. ... -,•' .°!. '..i. :'T•'- ��1 'Y:l 4.. r...n. `'�,.� - ':C�a - ua: 'z t';A'4 n,•-:::'.'.:i'?4'.:�' -•.Ea 3?l:r ti::..�T,'.:•:' ., ...... .1. .._. .Y fj}r T�•;.-_�..it• .nlA'•ap~ - YSr :.ya `..:+; .Y F � �tSeuver. :ti„t 'c• C _ DESCRIPTION OF WORK TO BE PREFORMED: A S f l40 41 wkU2 AD1,1 5 /=/?vim ✓�fZ/�/� �.�cs�' <1 n+G -f-fu� k4615 U iIYG- 7-c-/i- I-11i, rau--, U lfr� Z Yri�-� 1� //V6 i,�-L� t.4G:�i 1/ r�rl s� I=mo i 1!r�,yS Identification Please Type'or Print Clearly) OWNER: Name: (6w� I,Zov� S /3.-"'r Axt/ rte ci4GL Phone: G/7- 9V-? Address: 9'�� AdV DJ 1F,-W- 6 /a?01,� �• �-��i11,�r�,�" l�� � 3 Nd - r - f 0 : a .,,.,.- ,. , .,.ti ,:F......:j'd,._.. » ..:lrF. .^•l....:,.r,...�:.„1k;..�1; :':,;:; - >K"•; i.e•:_.. ''�:� ,:r ... .-.�. _.'...:...•...: ........ .n t_,. ... - .!. , ..... ....:. s.,, .:+ :°'� - - �+t 1.r. 'icy;; - :::j. •ti' �f4: '3 7 5. w... it. - Yt' a • R- 1. r rt.. , .:� :,*.:....-.,S-,.,♦. ,rt .,.. r1.:.i`-,::,.vN:.:�.-•,� ,.... 'v+ :''!�-..^ - z'�f!'i♦+%�:W:•.� ��"7 i. •'� _:•ti: .•k. :;1M .i:.:ii;J�a ;:b•.r.. -`�t�ck'-'� .:i"' •,,'tYay.,, .. ay.: �; ., , -.te..7_ r I-.� I.t-,!•S!�>.� .:: -.�,:,i�.�.yr?t�.:!.:^r „Y�. - i�':ti.•1,:.. :'f""K- .fi:�,.:;' ..� �a���et��s�rs:��o��r�c�r�;� 04tasg., L.. r. 1 tx�e•d . T-G317:�rra�rr��.� _..♦ _.. . .....- � . . cense. �i�- ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:x$`12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125,00 PER S.F. Total Project Cost: $_____ 7 6 / - — —FEE: Check No.: �3 Receipts` _ NOTE: Persons contract with unregistered contractors dory' `E=1Et17 fund '.: ignature.Qf - genal wrter i� - TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ,c Permit NO: Date Received Date Issued: _ IM11bR1TANT: Applicant must complete all items on this page LOCATION PROPERTY OWNER Print MAP NO: PARCEL: 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 Iteration No. of units: Commercial Repair, replacement Assessory Bldg A e-- Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: c„w" j �. lae � Identification Please Type or Print Clearly) OWNER: Name: VAT° Dt C-r, Phone: r Address: LO ✓-tN�� C- '9 CONTRACTOR Name: ° 14 Phone: Address: A4a r lv Vc) N�y-de Supervisor's Construction License: 6,-/62-o Exp. Date: /0+2S-2c)f d Home Improvement License: 1L 0,9FK Exp. Date: 1C" P d 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: $ FEE: $ X Z Check No.: Receipt No.: ac� NOTE: Persons contracting with unregistered contractors do not have access to a guaranty fund __ _-_ ____ - _s -___'_-__— __ .-___ _ _e signature of Agent/Owner Signature of contracto Plans Submitted Plans Waived Certified Plot Plan Stamped PI s Location No. Date `fig NORTH TOWN OF NORTH ANDOVER Of "s 0 '* 3? � . OC 1O p + i Certificate of Occupancy $ ��s'•^ E Building/Frame Permit Fee $ Mus Foundation Permit Fee $ r Other Permit Fee $ TOTAL $ Check # 22iY3 V Building Inspector 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 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: Doc.Building Permit Revised 2008 NORTH TO" of over 0 No. dover, Mass., 0 LAKE COCKICME WICK 0'1?4TS ? C2 BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........ .................. .......CA.40.4 6 Foundation has permission to erect................. .................. buildings on ..1.0.....AV\ 1116 0 ............................................ Rough A-- Chimney ............. fR77:�-.:7.7' W - to be occupied as ..... ............................vkdow.4....................................................... provided that the person accepting'this permit shall in every respect 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 Bilk % PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UN.LESS CONSTRW<MS 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. The Commonwealth of Massachusefts Department of Industrial Accidents _ ,. Office of Investigations iii:; 600 ff,ashinvton Street Boston, M4 02111 Workers' Cwww nzassgov/dia . ompensation Insurance Affidavit. Builders/Contractors/Eieatnr-ians/Pi Applicant Information. ambers Please Print LeQiibl Nalnne (Business/organira6on/Individual): j Address: City/5tate/Zig: /i) ,t j t) / } Phone #: Are you Sa employer?Check.the appropriate box: I.[] I am a employer with 4. ❑ I am a general contractor and I Typo of project(required): 24employees(fill]and/or part-time).* have hired the sub-contractors 6. E]'Now construction 4 I am..a-sole proprietor.or partner- listed on the attached sheet.? tgRemodeling ship and have no employees' These:su&contractocs have working for me in any opacity. workers' comp.insurance. g' Q Demolition [No workers comp.insurance 5. 9. []Building addition P ❑ We are a corporation and its 3.❑ required.] officers have exercised their 10•Q Electrical repairs or additions i am a homeowner doing all work right of exemption per MGL 11.�]PIumbing repairs or additions myself, [No-workers'comp. c, 152, §1(4),'and we have no insurance required.]t em la ees.[No worCes' 12.M Roof repairs COMP. insurance required.] 13•0Other 'Airy appiicatrt that cheeks bob a f must gist,fin out the section beiow showier theirworkam'oom t Homeowners who submit this affidavit indicatingthey am doin an B pensatiomi policy information 1Cmttraemts that check this boat must 6 wo*and then hie outside contractors moat submit a new affidavit indicafias such etfeoh an add.�tianal rhea showing the name of the sub-cormactors and their worktxs'cock, .mi , r F•••i nation. I am an enzpegyer twat is proviaurg:workers'compens�ri insurance or information. f ml'employe=, Be10w is the policy aced job site . Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address:-� A cc 4` City/stateMP—A ,4 q/" C� � Attach a copy of the workers' compensation'polficy deCiaratiloo page(showing Faihrre to the policy number and expiration date). . secure coverage as required under Section 25A of MGL c. 152 tin lead to the imposition of criminal penalties of a fine up to $1,500,00 and/or one-year imprisonment,as weii as civil penalties in the form of a STOP WOR of up to$250.00 a day against the violator. K ORDER and a fine Be advised that a copy of this staxement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c under the pains and peezaities a e ' / .1 fP rJuY that the information provided above is[rue and correct Phone#: �' -7 nl Of,j``ciat use only. Do not write in this area,to he completed by ett},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 Contact Person: Phone#: Information a • d r n Instruction Massachusetts General Laws chapter 152 requires all emp 3 oyers 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." l` An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the'foreguing 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 thiel 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 Shan withhold the issuance or renewal of a license or permit to operate a business or *e construct buildings in the commonwealth for any applicant who has not produced acceptable evidence-of compliance with the insurance coverage required." Additionally, MOL chapter 152,§25C(7)states`Neither the commonwealth nor any of its politiczl 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•afidavit complen-tely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractors)name(s),address(es);acid phone number(s)along with their certificate(s)of in nice. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not requuedtq ceay workers'ccbTnpensation insurance. If an LLC or UP does have employees,a policy is required. Be advised that this a.ffid;avit 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 retuned 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 requited to obtain a workers' oompau ation policy,please call the Department at the nur-nbar listed below. Self-insured coTnparri-should enter their self-insurance license number on the'appropTiate fine. City or Town Offaisis Please be sure that the affidavit is complete and printed legibly, The Department hes provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has tv 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 applicarri that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating-curr n policy;information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or twn)."A copy of-the affidavit that has be=officially stamped or marked by the city or town may be provided to the applicant as proof that a valid af€rdavrt is on file for future permits or licenses. A new affidavit must be filled out each year. When 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 bum 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 Depamnent's address,telephone and fax number. The Commonwealth of Massachusetts Department of L-ndustrial Accidents office of Invcstisations 600 Washington Street Bosfvn, MA 02111 TeL #617-7274900 est 406 or 1-8.77-MASSAFE Fax#617-727-7749f Revised 5-2b-115 www.mass_aov/dia U1 iS PROJECT ESTIMATE Date: April 13, 2009 To: Ms. Kate LaManna 11 Andrews Circle North Andover; MA 01845 978-984-5152 Garage Windows and floors Remove two windows from garage Replace windows using Anderson 200 series(similar in size) Remove entrance door 36 x80 Replace door with fiberglass door plus solid PVC jamb and casing Door handset and deadbolt are to be reused Trim windows using solid PVC to fit opening Remove and replace garage door trim using solid PVC trim boards to match Estimate does not include interior trim Total $2,575.00 REMITTANCE Please submit payments to: Deposit Amount �e: $8 Whipple Remodeling&Home Repair Signature: P.O. Box 823 Andover, MA 01810 978-686-7469 Thank you for the opportunity to bid on this project! OIOZ/£Z/06 :uoilendx3 �« �nf� 917860 VIN '83AO(INV N : 1S NIVVY 9917 31ddIHM -1 11383A3 00 :ol paloulsaa 0Z9l•S SO :8su031-1 asuaDI-1 aoslAJadnS uoi;onilsuoo sp.1upurl5 pur. suoiliqui)am 'Ouippris {o lmvo8 `l�.lr'•S �llynd.IIS iu�url.mdad - slaasngorssr.tl' .:�.. Boar o uil Ping #egula/ons n ar an as One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvemerit,C`©ntractor Registration Registration: 110988 Type: Partnership spr Expiration: 11/18/2010 Tr# 276663 WHIPPLE BROTHERS CONTRAC ING � ry j EVERETT WHIPPLE 455 MAIN STREET = ; F N. ANDOVER, MA 01845 - >; : 1 Update Address and return card.Mark reason for change. -• " µ Address Renewal _- Employment Lost Card DPS-CAI 0 50M-07/07-PC8490