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Home My WebLink AboutBuilding Permit #843-11 - 1027 GREAT POND ROAD 6/13/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO -9�. Date Received Date Issued: � t IMPORTANT:Applicant must complete all items on this age LOCATION l a4,77 S4 ctl t J l). Print PROPERTY OWNER 4f 16 r//✓E �k ec:S ?E�' Print r MAP NO-1 PARCEL: ZONING DISTRICT: Historic District yes ri0 li Machine Shop Village e Y es no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial ❑ Iteration No. of units: 11 Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other n ®'Septics' ®Weh ®Floodpla ®Wetland �® Wa ersh'e D strrct DESCRIPTION OF WORK TO BE PERFORMED: �L&ILI,r, JVIA)POWS ?Fe S,Y/0 dL 4-5 A 46,ieA41D ?N 411, P ' ,,S 04/y p Z rRe,,< 545e-7/G11.19 Identification Please pe or Print Clearly) OWNER: Name: 7,4 A, Phone: �� IIS 104 "� D Address: � t rhe pto CONTRACTOR Name: 55'rAow6,,ff11 e,4,sow Phone: t,,,25% ' 77 Address: 13t<i oCs 57° 6146414Scsi�ta Supervisor's Construction License: C S Exp. Date: Home Improvement License: l�'�,��'j r Exp. Date: F / ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ T,00o. y FEE: I� Check No.: Receipt No.: NOTE: Persons contraciink with unregistered contractors do not have access to th aranty fund Signatu`re„of�Agent/Owner .rte x. ,;,� �_ :' Signatu�e_of contrac �F0. ,` 41,0,le�t� Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan .0 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 I CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on-- Signature COMMENTS m 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 I U Notified for pickup - Date Doc:.Building Permit Revised 2008 i J lII f 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 Iltation 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 Com Affidavit avlt ❑ 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 o 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 Doe: Doc.Buildin Permit Revised g vised 2008iru {, I "I 4 Location �a , a��' �'`• No. Date�9.0 NORTH TOWN OF NORTH ANDOVER A i • }�e Certificate of Occupancy $ � S CHUSE<�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check it1 2 L 4 2 Building Inspector V)S 7� Emerson Remodeling 22B Bridge St . , Chelmsford, MA 01824 978-256-4177 May 10, 2011 Tina Sylvester 1027 Great Pond Road N. Andover, MA Here are separate estimates on work you would like to be done on the house. I. This estimate is to install 4 Anderson double-hung windows on the 2nd floor. (2 on the front and 2 on the back). All windows will be in terratone, pine interior, Low-E glass and full screen. Replace interior casing (Colonial casing) insolate around the windows and shingle where needed around the windows. Material and Labor $3,780.00 Adjustment from below - 850.00 o $2,930.00 II. This estimate is to install a 24"x24"Anderson octagon window in Terratone& pine interior. (Anderson does not make an open able octagon window) Material and Labor +$830.00 Total - $3,760.00 III. Here is a separate estimate to re-side the front and the back on the 2"d floor. /" 1. Remove the existing cedar shingles of the 2nd level of both front& % k� 2. Install house wrap over the plywood sheathing. -; .f', f• 3. Install red cedar shingles from corner to corner on the front and thWbIck. 4. Will remove the front and back gutters and downspouts, but not the trim boards. 5. Will install a roof diverter above the front steps. Material and Labor $4,950.00 1 - If you decide to re side the front& back sections of the house, deduct$850 from therice on the 4 windows. p 2. The estimate does not include painting. �� ,r 19 The cost for disposal would be + $426.00 Total - $5,375.00 . Payment schedule can be Y discussed. Tina Sylve Date Stephen Emerson Date Note:This proposal maybe Withdrawn by us if not accepted within 90 days. All material is guaranteed to be as specified.All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above specifications involving extra cost 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 control.Owner to carry fire,tornado and necessary insurance.Our --___ workers are fully covered by Workman's Compensation Insurance. NORTH To' VM of Andove LAKE o dover, Mass., LUZ It COCMIC MEYVICK ®S RATED 7 V BOARD OF HEALTH Food/Kitchen PER # Septic System MIT T BUILDING INSPECTOR THIS CERTIFIES THAT................�.`a./'�.1.�.�.��!lr✓`....... 1�......v .7` --''........... Foundation has permission to erect........................................ buildings on .Z.4) "..... � � �".. Gi'.... ....'.. �... Rough tobe occupied as............ ........ . C 1# ..... .6J( of cld.......... .............................................. Chimney 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 /w PERMIT' EXPIRES IN 6 ONTHS ELECTRICAL INSPECTOR (lJ UNLESS CONSTRUC 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. �amerrr airs i inessF ega atron s. Office of onst CTOR CONTRA Type: ! HOME IMPROV'mr,. Registration: ,,142551 DBA Y iration: %418_12012 ° Exp '. EN"EMERSON: "' 3�{ti !t ,S-CEPH 2213BRIDGIE STRE T �'a �ndersecretar I 1 t I jELMSFORD,MA 01824 M�tss:tchusetts- --� B0.1rd of Depart of P Building Ref u6lic Cortstructi0 •ulations; SafEr�" License: CS n SUPervi tnd Stand;tr'ds Restrict 19489 sor license ed-to:.00 STEPHEN _ I 228 GRID E3..- 228 E ST CHELMSFORD MA 01824 t `' — �� "unrmLcsfuruy 1' Expiration: 1211012011 f Tr#: 12463 ` a The Commonwealth of Massachusetts Department oflndustrialAccidents A Office of Investigations 600 Wash' ington Street ` Boston,MA 02111 www.massgov/dia Workers". I CoxrApensation insurance Afridavit:Buildelrs/Cont>ractors/JElectricians/Plumbers Applicant Information . Please Prilnf L,eali.blY Name(Business/Organization/Individual): 6M,5.oS,al,) Address: I City/State/Zip: mac.M s x'O i�b Phone##: 7p'..��r -.t��7? F re you an empioyer?Check the appropriate box: Type o f project(required}: ❑ I ama employer with 4. ❑ I am a general contractor and Iemployees(full and/or part-time) have hired the sub-contractors6. ❑New construction I aim a sole proprietor or partner listed on the attached sheet. 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.El Electrical repairs or additions 3.❑ T ain a homeowner doing all work right ofexemption per MGL - 11.❑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 sectioi;below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they aie doing all work and thea 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 acid their workers'comp.policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is t/ie policy andJ'ob site information. Insurance Company Name: „ , Policy#or Self-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 required under Section 25A of MGI;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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u r the pains and pena ies ofpesjury that the information provided above is true and coir ect.' Signature: Date: 4 / Phone#: Official me 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 Per 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 ore ofthe foregoing engaged in a joint enterprise,and including the legal representatives ofa 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 aparbnents 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 ofpublic work until acceptable evidence of compliance with the insurance requirements of this*chapter have been presented to the contracting authority." Applicants PIease fill out the workers'compensation•affidavit completely,by checking the boxes that apply to yoursituation and,if necessary,supply sub-contractors)narne(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 cavy workers'compensation insurance. If 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. Also be sure to signand 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 ifyou 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 S PIease 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 eventthe Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the Pen-nit/license-number which will be used as a reference number. Irl addition,an applicant that must submit in ultiple�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 pen-nit 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 Department's address,telephone and fax number: The COrnMonwe4h Qf Massachusets Dq,partment Of Induwial.A widearls Office of TnvestIlptions 600 Washington Street Boston,MA 0.2111 Tel.#617-7274900 ext 406 or 1-877 MASSAFE Revised 5-26-05 Fax#617-727;7749 mass.govldia