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Home My WebLink AboutBuilding Permit #376-13 - 10 FURBER AVENUE 11/6/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: IX Date Received Date Issued: /Y 11,z IMPO TANT:Applicant must complete all items on this page LOCATION l D F u r be r Ave Print PROPERTY OWNER S Jeo In Gt/11 e HCA ryte Print 100 Year Old Structure yes no MAP NO:0�_PARCEL: ��LZONING 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 PERFORMED: II 5+�; o cAnc� r,O roo-� hn o_ Rel, 40 Pn�rs. Re Plage � I J. Identification Please Type or Print Clearly) OWNER: Name: ka.n;,e r'IattieI Phone: CIM L4'I A[17 Address: 14 u r b rye- CONTRACTOR Name: 3011ASI v WS k. Phone: q113 '33/ 3131 Address: iti'LUSPA Supervisor's Construction Licenser 0 01 Exp. Date: Home Improvement License: 1� �aq Exp. Date: 3 1 as 113 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: $ 0 0. 0 J FEE: $ oZP.AD Check No.: �.Z Receipt No.:,2:!C!E�L NOTE: Persons contracting with unregistered contractors do not have access to the uaranty and ;Signature of Agent/Owner Signature of contracto . Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Location �� r No. `� . Date 1;11K117 • TOWN OF NORTH ANDOVER ED • { Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ —' Check# 25916 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL r ` 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 Towi! Engineer: Signa#ure: Located 384 Osgood treet FIRE DEPARTMENT• Temp'Dumpster on site yes no Located at'124 Main Street Fire Departinerit 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 B Notified for pickup - Date Doe.Building Permit Revised 2010 Building Department The fohowing 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 2012 r 1 NORTH - _ . w: E ver 51 (o 1#3h ver, Mass, c o SLK■ �. 'P cow:cK .opR^T E O PPp`�,`5 S V BOARD OF HEALTH Food/Kitchen PERMIT TLD l Septic System THIS CERTIFIES THAT 57Af f4vV. f.E. ................................................... BUILDING INSPECTOR has permission to erect buildings on ........................................ Rough Foundation �O. :..fir. E�`.�Kf .......................... ......... ............... to be occupied as .401f1Zcce ... f, u�/ Q.�a!' a11.' r... 4!�1[.. ............................... Chimney provided that the person ting 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S RTS Rough ........ ... ...................................... Service ....... 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 Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE TT79 J.P.M. CONSTRUCTION COMPANY 31 Fredrickson Road • Billerica, MA 01821 Telephone • (978)831-3131 • (978)687-1391 License# CS 090601 H.I.C.# 0146039 PROPOSAL PROPOSAL SUBMITTED TO: PHONE: DATE: Stephanie Hamel 978-479-9617 11/2/12 STREET: JOB NAME: Hamel Job 10 Furber Ave CITY,STATE AND ZIP CODE: PAGE 1 OF 2 PAGES North Andover, MA. 01845 ARCHITECT: DATE OF PLANS: We hereby propose to furnish materials and labor necessary for the completion of: • Roof- Strip and reroof existing building(1700so including 6'-0" of ice and water shield at roof eaves and ridge venting. Remove existing crown molding and rebuild fascia trim to provide new solid sheathing for gutter work. Price includes up to 100 sf board replacement as necessary. • Window Dormers- Rebuild, reflash and reside (2)existing window dormers including 3'-0"x 4'-6" Harvey vinyl windows. • Doghouse- Remove existing basement entry and pour new concrete curb so as to receive a new metal bulkhead door unit including hydraulic crack sealing and gaskets as necessary. • Garage- Replace existing sill plates and rebuild lower wall framing of existing 14' x 20'detached garage using 4"x6" PT sill stock and PT studs as necessary. Resheath bottom T area of walls with PT pywood. Reframe existing garage door opening so as to receive(1) 9'-0"x7'-0" overhead door unit. Apply new double 4"vinyl siding(600sf)and trim coverage to existing walls and trim. (Door not included) 1 WE PROPOSE hereby to furnish materials and-complete in accordance with the above specifications,for the sum of: Eighteen thousand five hundred 18,500.00 dollars($ ) Payment to be made as follows: $6,200.00 down payment, $7,500.00 upon completion of roof,dormers and bulkhead,balance upon completion of job. All material is guaranteed to be as specified. All work is to be completed in a substantial workmanlike manner according to specifications submitted,per standard practices. Any deviation from the specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delay beyond our coptrol. Owner to carry fire,tomado and other necessary insurance. Our workers are fully covered by Workman' pensation I ce. Authorized Signature Note:This proposal may be withdrawn by us if not accepted within_ Days. ACCEPTANCE OF PROPOSAL The above prices,spec- ifications and conditions are satisfactory and hereby accepted.You are authorized to do the work as specified. Payment will be made as out- Signature lined above. AA 11/5/2012 Date of Acceptance: Signature ALL 2 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: 3 F(,p r*C L4 S 4 City/State/Zip:_ leC i'(XA MA Phone#: 6f7f- 131 3131 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6 ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.[ I am a sole proprietor or partner- listed on the attached sheet. t 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. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ 1 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.]t employees. [No workers' comp, insurance required.] 13.0 Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ?olicy#or Self-ins.Lic.#: Expiration Date: lob Site Address: City/State/Zip: I,ttach a copy of the workers'compensation policy,declaration page(showing the policy number and expiration date). ,ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine 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 if up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of nvestigations of the DIA for insurance coverage verification. do hereby cert' under the pa' and penalties of perjury that the information provide11 ,6 ove is true and correct. ,i nature: I Date: hone#: 31 3131 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 Contact Person: Phone#: 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 of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the 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 not more 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 of its 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-contractor(s)name(s),address(es)and phone number(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 not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit 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 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. A new 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 or permit 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 5-26-05 www,mass.gov/dia Officeof"Con6me'moiresA' iues/s gu a� 0 . License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 146039 Type: Office of Consumer Affairs and Business Regulation : Expiration: _3/22/2013 DBA 10 Park Plaza-Suite 5170 ,•' a==;=_ .; .;_ Boston,MA 02116 J ONST «:= JOHN MAS LOWS KI 31 FREDRICKSON BILLERICA,MA 01821 t Undersecretary Not valid without signature r' Massachusetts-Department of Public Safety Board of Building Regulations end Standards Construction Supervisor License:.CS-090601 JOHN P MASSIG 31 MDERIICI{SOWRD rt BILLERICA;MA,01(\8121 rI \` f Expiration * Commissioner 12/04/2012 i i j i