HomeMy WebLinkAboutBuilding Permit #698 - 102 MILLPOND 4/3/2012 pORTH
BUILDING PERMIT
TOWN OF NORTH ANDOVER F
APPLICATION FOR PLAN EXAMINATION
Date Received
Permit NO: 3 q°BATE°SPP`��
�SSACHus��
Date Issued:
IMPORTANT Applicant mustcompleteall items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Residential
Non- Residential
❑ New Building ❑ One family
❑ Aridition ❑ Two or more family , ❑ Industrial
Iteration No. of units: Q Commercial
El Repair, replacement ElAssessory Bldg 11 Others:
❑ Demolition ❑ Other
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(� / /DESCRIPTIOROF WORK TO BE P
d► R FORME
C 01yiC�l
Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address 1 Q L`^ C�
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Supervisor's Construction Licen e _ �c k:` Efixp�
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ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125. PER S.F.
Total Project Cost: $ FEE: $ ��—
Check No.: li v 2— Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaran fund
-
Signature of Agent/Owner
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
o Copy Of Contract _ '
ith Sprinkler Plan And
❑ Floor/Crossection/Elevation Plan Of Proposed Work W
Hydraulic Calculations (If Applicable)
❑ 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
❑ 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 2.2007
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
DATE REJECTED DATE APPROVED
CONSERVATION ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH ❑ ❑
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 Drivewav Permit
Located at 384 Osgood Street
�FI -31tExDEPARTMENT Tern' Duni star oii slfe yes �` �"
t; ''�.r£ 1 p p ,„ ,t? ,:xw ' 'moi sa«;n 0,e.t .`` .: z -F•'.rt -
Located+at x124 Main Street= x n x> z'-s
`C",
pFrre Departmen#s�gr�ature�da#e �'�` <w` i 6x 4s ` r
JT.
CC)MMENTS
°p'�
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
f1"WVLr-d
❑ Notified for pickup - Date
Doc.Building Permit Revised 2007
NORTH
® of over ,
No. X.
big
�, 0 , dover, Mass., � • 3 . �
Q - LAKE
COCHICHEWICK V
RArEo
BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT....` ......... ... .................a V .. o.^..................4..... .............................. Foundation
f8
has permission to erect......................................... buildings o ..... . ... ..........lrul((................................................... Rough
to be occupied as.......... �A� ......... .. . .. ' /!...................................................................................
Chimney
provided that the person accepting this permit shat 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
�•} PERMIT EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
)t Z UNLESS CONSTRUCTtgXSkTS Rough
................................................... Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Ocatpy 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.
(YA �-
25--
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46UEASANT STREET•MEDFORD,MA 02155
(781) 603-2110
ADDITIONAL COSH'S
From: For: Judith Judson
Doherty Construction
45 Pleasant St
Medford, MA 02155
Phone (978)314-3776
Job Description:
Supply and install two electrical heating units for newly constructed living space
Per this proposal,labor and material will be provided in accordance with the above specifications,
For the sum of:
$ 750.00
Payment schedule as follows:
$750.00 upon completion of job
All material is guaranteed to be as specified and will be Authorized signature:Derek Vasques
completed per standard practices.Any alteration or deviation
from above specifications involving additional costs will be r
executed only upon written orders,and will represent an extra
charge in addition to the estimate given.All agreements are
contingent upon strikes,accidents or delays beyond our control. W£reserve tlW light to
withdraw this proposal
if not accepted within
thirty 30 days.
Acceptance of additional work: Judith Judson
The above prices,specifications and conditions
Are satisfactory and are accepted. Signature of
This'proposal authorizes work to be completed
As specified.Payment will be made as stated _
above. Signature: 6 a"r rig
46 PLEASANT STREET MEDFORD,MA{12155
(78-1) €03-2110
ADDITIONAL COST
From: For:Judith Judson
Doherty Construction
46 Pleasant St
Medford,MA 02155
Phone(370314-3776
Job Description:
Construct new floor over existing concrete garage floor consisting of pressure
treated lumber 16"on center to be insulated with rigid foam insulation and then sheathed
with tongue and groove 3/4 plywood
Per this proposal,labor and material will be provided in accordance with the above specifications,
For the sum of:
$ 1000.00
Payment schedule as follows:
$1000.00 upon completion of job
All material is guaranteed to be as specified and will be Authorized signature: Derek Vas
completed per standard practices.Any alteration or deviation gna ues q
from above specifications involving additional costs will be
executed only upon written orders,and will represent.an extra
charge in addition to the estimate given.All agreements are
contingent upon strikes,accidents or delays beyond our control. We reserve the right t6'
withdraw this proposal
if not accepted within
thirty 30 days.
Acceptance of additional work: Judith Judson
The above prices,specifications and conditions
Are satisfactory and are accepted.Signature of
This proposal authorizes work to be completed
As specified.Payment will be made as stated
above. Signature: 41A;I-i.. IL
i
46 PLEASANT STREET WMFfl,RD.ASIA 02155
From: For:Judith Judson
Doherty Construction
46 Pleasant St
Medford,MA 02155
Phone (978)314-3776
Job.Description:
-frame garage space including office room,utility closet,mudroom and closet
-install new electical wiring for newly constructed space per code,
-heat new space with two electric wall mount heaters
-insulate all exterior walls
-hang sheetrock joint compound sand and paint all new construction including one
coat of primer and two coats of finish paint
-all finish trim to be 2 i/a inch colonial casing and 5 '/z inc colonial speedbase
-carpet office and stairwell
-tile mudroom
Per this proposal,labor and material will be provided in accordance with the above specifications,
For the sum of:
� $ 25.500
Payment schedule as follows:
$5000 deposit
$5000 after framing and sheetrock
$5500 after completion of job
All material is guaranteed to be as specified and will be Authorized signature: Derek Vasques
completed per standard practices.Any alteration or deviation r
from above specifications involving additional costs will be
executed only upon written orders,and will represent an extra
charge in addition to the estimate given.All agreements are t
contingent upon strilmes,accidents or delays beyond our control. We-reserve the right to
Owner is responsible for all necessary insurance. withdraw this proposal
if not accepted within
thirty 30 days.
Ameptance of additional work: Judith Judson
The above prices,specifications and conditions
Are satisfactory and are accepted.Signature of
This proposal authorizes work to be completed
As specified.Payment will be made as stated
above. Signature:Qv,r_%c� _
Office of Consumer Affairs and Efusiness Regulation
10 park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Coffin-tractor Registration
-' = Registration: 170897
i Type: DBA
Expiration: 1/11/2014 Tr# 220638
DOHERTY CONSTRUCTION
DAVID DOHERTY "
2 PLEASANT ST CT
MEDFORD, MA 02155
Update Address and return card.Mark reason for change.
Address ❑ Renewal F� Employment ❑ Lost Card
DPS-CAI Co 50M-04/04-G101216
°O"""' '�W if nes 1�"ala on License or registration valid for individul use only
� Office of c.`onsumer Amt airs B sines egulatton g y
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: �17pg97 Type: Office of Consumer Affairs and Business Regulation
>171:1%2014 DBA 10 Park Plaza-Suite 5170
Expiration:
Boston,MA 02116
- —,
DOHERTY CONSTROQT:f,O;N
C 14 J�
DAVID DOHERTY���fE
�,�
2 PLEASANT ST
MEDFORD, MA 02155", Undersecretary Not valid without signature
$ Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Supcn icor
License: CS-096823 .
DAVID W DOBFRTY--- �•r.
46 PLEASANT S1REE�
MEDFORD$LA 021551 r
l
Expiration
Commissioner 10/25/2012
NORTH
own of Andover ..
0 .X M "n
No.
o o , dover, Mass., � ' 3 • L�
COC
HICKEWICK
yet
7,p ORATED
.S V ` BOARD OF HEALTH
Food/Kitchen
PERMI I T D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THATV� icb--K.................
4 ....................
Foundation
s o .. !has permission to erect......................................... building .40...................................................
Rough
tobe occupied as.........e..Gt .........�.. ���P..................................................-..�......................... Chimney
provided that the person accepting this permit shat ' every respect conform to the terms of the application on file in Final 1
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
PERMIT EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
X Z UNLESS CON STRUC S, TS RoughService
.............. ...............................................................................
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 Massachusetts
Department oflndustriglAccidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.massgov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organi2ation/Individual):
Address: ��� \eck S"V,, +
City/State/Zip: VV-,JSP-honeS #:
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ 1 am a employer with 4. ❑ I am a general contractor and i 6. FJ Now construction
employees(full and/or part-time).* have Hired the sub-contractors
2$ lam a sole proprietor or partner- listed on the attached sheet. 7• ❑Remodeling
ship and'have no employees These sub-contractors have 8. ❑Demolition
workingfor me in an capacity. workers'comp.insurance. 9
y p ty. 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 LE]Plumbing repairs or additions
myself.[No workers'comp. c. 152,§1(4),and we have no 12.0 Roof repairs
insurance required.]t employees.[No workers' 13.❑Other
comp.insurance required.]
*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 anew 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.
I amnemoethat ispYovdnwokers'compensation insurance for my employees Below is the policy and job site
information.
Insurance Company Name:.
Policy#or S elf-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as requiredunder 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 c under he pa' s pe al' s ofperjury that the information provided above is true anti correct. -
Si afore: � �
Date:
Phone#: 00 6�-3
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.CitylTown Clerk 4.Electrical inspector 5.Plumbing inspector
6.Other - -
Contact Person: Phone#:
Information and Instruction's
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 j oint 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.aceeptable 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-contractors)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, lir an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. AIso 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(ifnecessary)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 fature 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 o£Massaehusetts
De-partment of Industrial Accidents
Office of Investigations
600 Washington.Street
Boston,MA 02111
TA.#6.17-727-4900 ext 406 or 1-877rMASSAFB
Revised 5-26-05 Fax#617727;7749
www,mass,govfd is
M
• Cl
err
E.
RESIDENTIAL-COMMERCIAL
FULLY INSURED
103 Summer Ave. MA Lic.#38148
Reading,MA 01867 (781)758-4949
powerlinechief@aol.com VISA/MC Accepted
Key Notes
ORemove existing central vacuum.
OFuture window - Andersen 400 series,
casement window CW135. RO 2'-5"W x
3'-5 1/2" H. -No G144 Lto&S .
2"
0 16" deep adjustable shelves on heavy
- duty brackets and standards.
N
p O Heavy duty closet rod. For extra
support, hang center bracket from
Utili /Stora a ceiling.
C Office
12 O Rod & shelf.
7009 15 O O Relocate existing wall switches as
P).. required for new wall.
New gypsum board ceiling.
O - g0 Remove existing wall at bottom of stair
as shown. Wall should stop at existing
�o
� door jamb. New edge shall be drywall
n with corner beads.
ea ea S'� Mudroom Og New carpet and pad.
07 10 15 O10
_ New ceramic the floor.
(2)2668 , i f - - 11 New carpet on existing stairs.
---- 4 ------ -- 8 12 Existing concrete slab floor.
5
O
�101 - 13 Replace existing ceiling (up to indicated
03 " I dashed line) with new gypsum wall board
1 hour fire rated ceiling.
a14 Verify existing garage ceiling to remain
CC[ ea meets 1 hour fire rating. If not, please
g bring up to code.
Provide new heat and a/c for new space
„ ?„ by connecting into existing forced air
system. Verify existing system can
handle the additional loads.
13
Electrical Notes
Provide new surface mounted ceiling light
fixture with switching as shown.
Provide new duplex outlet as shown.
— — — —— — — —— — — — — — ——
o�
N
• �� Existing
Garage
Partition Type Key
14
Existing partition to remain.
�rrrrm New partition, see types below.
A 2 x 4 wall construction w/1/2"GWB.
B 1 hour fire rated 2 x 4 wall
construction.
C Furred wall - 2 x 4 on flat w/1/2"
GWB.
I
MARY FLETCHER FERRILL
ARCHITECTURAL DESIGN
6 Edgemere Road, Rockport,MA 01966
Revision 07-18-11 Construction 978.578.4309 marycayfletcher@hotmail.com
Project Judson Residence Date 07-0s-11 Drawing Sheet
02 Mill Pond Scale 1i4°=1'-o"
North Andover, MA Drawn MFF Basement Plan
Project No. A-Q