HomeMy WebLinkAboutBuilding Permit #879 - 10 LYMAN ROAD 6/21/2011 i
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit N0: Date Received
Date Issued:
ORTANT: Applicant must complete all items on this page
LOCATION or k A
Print
PROPERTY OWNER r% _Qcea�za
Print
MAP NO:_&2___PARCEL:a ZONING DISTRICT: Historic District yes ri
Machine Shop Village yes n
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building 5(One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
5'Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other _
����`'---,=W-� _ s•__I`®�F d`lan� ���Wetlandsa i���'�Watersfied�Distriet� _
Septic A Welll
i D WaerlSevvei - - -
DESCRIPTION OF WORK TO BE PERFORMED:
a
S+cep One Corsc- oS Ce_osr SQ,,51.s. �..�e✓e all
(Identification Please Type or Print Clearly)
OWNER: Name: RCIA C' -c. o Phone: 0I-7$-6g)-0610
Address: !O�7�w.4r R�• sc m%Jed O►spy c"
CONTRACTOR Name: \o I.�. �;V% lei %%I n I
Phone:
Address: 49 S<<-oo� S� Sa�a�s n4, 01Zo�
Supervisor's Construction License: C S S Y S Exp. Date: g 1 H/Zo 1.1
Home Improvement License: I p7 Exp.. Date: 7/31 /?01?-
ARCH ITECT/ENGI N EER
201zARCHITECT/ENGINEER Phone:
Address: Reg. No. ,
FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ 1 I ybo. oa FEE: $
Check No.: 1116-2- Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty d
x Signaturertof contradff
Sgnature,of _ .__
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 Permit Application
o Workers Comp Affidavit
o Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
❑ Floor Plan Or Proposed Interior Work
i
o Engineering Affidavits for Engineered products
� NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition. Or Decks
o Building Permit Application
o Certified Surveyed Plot Plan
o Workers Comp Affidavit
o 'Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
o Floor/Crossection/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)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
o Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o 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 2008mi
Plans Submitted ❑ Plans Waived ❑ Certified i"
eed Plot Plan ❑ Stamped Pians El
TYPE OF SEWERAGE DISPOSAL
i
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pool's ❑
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
S
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 2008mi
i
�ORTiy
Town of
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dtiwaa
o � over, Mass.,
COC MICM.W'CK
, �RATED P' �,��
S BOARD OF HEALTH
Food/Kitchen
PERMIT . .T Lj Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT.......... ..P.. f.. .....G.t'.rC'..de.a................................................................................................. Foundation
has permission to erect........................................ buildings on O.Z�* r.�o ....v ............................................. Rough
// Chimney
tobe occupied as.......................f..>`�/..,�../.......5� . ...�<� ..........................................................................................
provided that the person accepting this permit shall in eve espect conform to the terms of the application on file in Final
this office, and to the provisions of the Codes and By-La 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
PERMIT EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION TARTS Rough -
® Service
LDING 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.
c>
OM :STANS FAX NO. :17813349806 Jun. 21 2011 12:38PM P1
"20/2011 1140 PM FF:rM: __-.tar N. Fe Coe In .lY,n�ea `-c�icet- T% .7R1:34201� PAGE! 00i: 4F 002
ACORD� GATE v,IN101YYYY'1)
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THIS CERTIFICATE 19 I33UED As A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTTICATE HOLDER. THIS'
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BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(B), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the cert(fleate holder Is an ADDITIONAL IOURED, the poll"'/Iles)must be endorsed, If SUBROGATION IS WAIVED, subJecl to
the terms and conditions of the policy,eertaln policies may require an endorsement. A statornenl on tHs canifieate does not confer rights to the
cerlifioate holder In lieu of such endorsements,
PRODUCER NATE:___._-__..,: —__...,.,-- T.CI��.... --___�.•
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x.a- POSTER INSURANCE 9ERVICES ADa1p5GG: w� -
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NORTH ANDOVtS,R HA 01345-25013 INSURERLs?_AFFORDING COYc GE NAICa
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STAN'S ALUMM M HMO INeuNBR R 4111utD INSURANCE (4t0UF !�
IdPROVIDMINT CE*ZL INC INouaAR C -
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SAUGUS IIIA 01906-4862 ,IIAuaBe•F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER'
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED aLLOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PE=RIOD .
INDICATED. NOAMTHSTANDING ANY RECOIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH, RESPECT TO WHICH THis
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS$ROM MA' HAVE 899N REDUCED BY PAID"AIMS. _
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EVIDENCE OF INGURawcE CoVBRAG&
CERTIFICATE H04DER CANCELLATION
SHOULO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS,
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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/OrganizatiorOndividual): q��A!I-im, �VY,,�
--�
Address:
City/State/Zip: G,e,0S, A, O Yt ob Phone#: - Z11 - l YGa
Are you an employer?Check the appropriate box:
1. I am a employer with l 4. ElI am a general contractor and I Type of project(required):
employees(full and/or part-time).* have hired the sub-contractors 6• [1 New construction
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, E]Building addition
[No workers'comp.insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL I L❑Plumbing repairs or additions
myself. [No workers'comp. c. 152, §1(4),and we have no 12.❑Roof repairs
insurance required.]f employees. [No workers'
comp.insurance required.] 13.�Other��^ ►a ��
Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: m dv n c tnG
Policy#or Self-ins.Lic. ST G 91 '11 73 O ct Expiration Date:J, °1
Job Site Address: ! 12d City/State/Zip: Lr AJooac� A pl g yg-
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 penalties 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$250.00 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 t ain nd penalties of perjury that the information provided above is true and correct.
Signature:
Phone#: °179c- 319,-R87g
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):
L 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 personsIto 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 maybe 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 lndustrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
Tel. 617-727-4900 ext 406 or 1-877-MASSAFE
Revised 5-26-05 Fax#617-727-7749
www.mass.gov/dia
VORBACH ARCHITECTURE
Robert J.Vorbach—Architect
58 Manchester Street
Nashua,New Hampshire 03064-2114
Telephone/Fax:603-886-1738
Date: April 26,2011
Department of Conservation
North Andover,Massachusetts 08145
RE: Maplewood Reserve—Phase 3 Townhouses
2357 Turnpike Street
North Andover,Massachusetts 01845
Dear Sirs,
We are submitting this formal request to the North Andover Conservation Department for
the purpose of requesting modifications to the existing foundations of Buildings 24, 25
and 28. These requested modifications include Buildings 24 and 28 that are detached
garages. We are requesting to have the garage bays added on the right end,in order to
provide the correct number of garages as they relate to the units in Buildings 23 and 27.
This will add an additional 288 square feet per garage bay. A total of(4)units are
impacted by these modifications(Buildings 23,25 and 27)as noted on the Plan—Revised
4/21/11. Regarding Building 25,the garage is attached to the unit on the left side adding
the extra space required.
In the area of Building 21 near the fire hydrant and electrical transformer,we will need to
add a 9 X 9 area to accommodate the community mailboxes.
In addition,we have been asked by the North Andover Building Inspector to add a chain
link fence for protection from land drop-off in the back of Buildings 17, 18,20, 22,and
23, as well as behind Buildings 25 and 26.
Sincerely,
Robert J. Vorbach—Architect
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�` 'flee >e9>so�ace of.�aQeadu«aeflei
�. License or registration valid for individui use only :(
Office of Consumer A>Tairs& siaees Regulation before the expiration date. If found return to:
HOME IMPROVEMENT CONTRACTOR Wice of Consumer Affairs and Business Regulation
ZZ Registration:t� 07352 TY 10 Park Plaza-Suite 5170
x Expiration: IM0112 Private Corporation Boston,MA 02116
Cr
U- S 'SALUMIN _ CTR INC
Stanley 5 �- �•`�'
Thom$s Y tti,. C_- ,�-s}
18$,I qE ST I.
LYNNFlEtO,?JIA ply. Undersecretary Not valid without sign
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Location
No. Z f_ Z/ Date a12
MOR,h TOWN OF NORTH ANDOVER
3 • oL
Certificate of Occupancy $
Building/Frame Permit Fee $
4CMU5
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
, 7
Check #
24L9 2 ji
Building Inspector
Stan's
General Contractor& Home Improvement, Inc. CARPENTRY-ROOFING
COMBINATION WINDOWS&DOORS 89 School Street,Saugus, MA 01906 SIDINGS-GUTTERS
VINYL REPLACEMENT WINDOWS CUSTOM TRIM COVERAGE
(781)233-1868
Federal ID No. Contractor Registration No. 107352
Homeowner Information'.
goh } Resp—!'lacy U'r eo
to Lyr.,aJ 'ea
0%4\% AdDue-cj 11c, o k%6 <
The Contractor agrees to do the following work for the Homeowner: S�;P CecRr Sk.�SI�S, 's�►S�c�l *y)6 �d
4,0+6 QCA vf,%� � �i(�+ i-'s. zeooVa 0 v Sow ,S,
Materials expected to be used: 3/0 �ogM7 1�i nye Sid 1%3 Du1r•j� �r4•�C f_ , Glc
The following building permits are required and will be secured by the contractor as the homeowner's agent(owners who secure their own
construction-related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund):
1.
Proposed Start and Completion Schedule-The following schedule will be adhered to unless circumstances beyond the.contractor's control arise.
�s/21/f Date when contractor will begin contracted work.
71�y' (► Date when contracted work will be substantially completed.
Total Contract Price and Payment Schedule
The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of:
Payments will be made according to the following schedule:
$ 1,000. 00 upon signing the contract. -- rr
#VALUE! upon completion of the contract. fly ��t��cc Q,S ! S�Je t3 C°i`^ )I,,
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
Two identical copies of the contract must be completed and signed.One copy should go to the homeowner.The other copy should be kept by the co tractor.
�Zo
Ho owner's Signa Contract ' signatur
6A.1 J
Date Date
You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing at
his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing
of this agreement.
Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on this
residence.
The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor
Registration.Any inquiries relating to registration should be directed to:
Office of Consumer Affairs and Business Regulation
Ten Park Plaza,Suite 5170
Boston,MA 02116
Phone:(617)973-8700
Arbitration
The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the
contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer
Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided In Massachusetts General Laws,
ch 142A.
Homeo ner's Signat re Contr lol s Sign ure
NOTIC :The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor.
The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties.
Execution of Contract
The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached.
Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable.One
original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor.Any modification to the
original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed
copy of the contract,and the three day recission period has expired.
Accelerated Payments
A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems
him/herself to be financially insecure.However, in instances where a contractor deems him/herself to be financially insecure,the contractor may
require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work.Withdrawal
of funds from said account would require the signatures of both parties.