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HomeMy WebLinkAboutBuilding Permit #792 - 103 FULLER ROAD 6/7/2010 BUILDING PERMITo "ORT" q 6ttuE0 h6' �IO ;TOWN OF NORTH ANDOVER 02 O� APPLICATION FOR PLAN EXAMINATION 70 Permit NO: Date Received gDRA7ED q`� ��SSACHUS�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 2 69 3 6Qu G L Z,9•4-4 Print / PROPERTY OWNER Z; >e.6:�J /\J <- ' e �✓ Print MAP 210PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Shop Village yes o 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 PREFORMED: el''-- eA-0 G 17-7/S fZ''72 -t_G Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name:,. Z ,4�a„I s,ar - Phone: Address: Z y. Ata-e J jcj-; A �*'/A'L D 116,5C- 2- Supervisor's Construction License: Exp, Date: Home Improvement License: Exp. Date: 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: $,2 -5- /�J _ FEE: $ Check No.: �' a"f' Receipt No.: ;I a y NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner _ Signature 6f contractor Location/6�3 )5w, 7 No. Date - ;? - l� Mo�Th TOWN OF NORTH ANDOVER O? •• ••Oow � a Certificate of Occupancy $ • �. ..�-.:.. - r � Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 232 << Building Inspector 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 Packaging7Sales' ' 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 i 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 i 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 Q PP 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 i Doc.Building Permit Revised 2010 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:Building Permit Revised 2008 The Commonwealth of Massachusetts Department of Industrial_9ccidents Office of Tn vestig¢tions 600 Washington Street Boston, MA 0 111 WorkersCompensation Insurance Affidavit: Builders/Contrac Aupbcant Information tors/Electricians/Plumbers Please Print Lea.bly Name (Business/Organization/Individual): / 2��c c� Address: City/State/Zip: AJ, Phone Fship you an employer?Check the appropriate boa: I am a employer with 4. ❑ I am a Type of project(required);tPneralcontractor and Iemployees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction I am asole proprietor or partner_ listed on the attached sheet x ❑Remodeling and have no employees These subcontractors have working for me in any capacity. workers' comp.insurance. 8 ❑Demolition [No workers' comp. insuranCe 5. ❑ We are a corporation and its 9. ❑Building addition 3•( required.] officers have exercised their 10 E3 Electrical 1 am a homeowner doing all work rte t of ex repairs or additions myself. [No workers' comp. gh emPtion per MGL 11.0 Plumbing repairs or additions p c. 152,§1(4),and we have no 17,❑Roof repairs insurance required.] t 4 ] employees. [No workers' comp.insurance required.] 13.0 Other :,=BY a."^2iC:mt that Chi--nl c bo),.:U7 IDI:SS:SU 1212 L`L't the 3eC.'Q C:SQR'e—"o'A"-a'h--ir-orke'S'coII2r .....r••:•••� .0:..:8'1C� $omeowners who submit this affidavit indicating the;,are doing aL'work and hien hireoutside contractors 47iV submit a new affidavit indicatin such. !Contractors that check this box must attached an additional sheet showing the name of the sub-contactors and their workers'co S I am an employer that is providing workers'compensation insurance for information my employees Below,is thee polio¢d,infsitormation. Insurance Company Name: Policy#or Self-ins.Lie.#. Expiration Date: Job Site Address: Attach a copy of the workers'compensation policy declaration pa sho City/State/Zip: Failure to se^ure coverage as required under Section 25A of MGL cp 152can(sho lead to the imposition of tthe policy number and expiration date). fine up to$1,500.00 and/or one-yeas imprisonment,as well as civil penalties in the form of a STOP WORK criminal Band apenalesffine 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 hereb cerfi 5. nder the pains and penalties o er u fP .! ry th Signat the information provided ove is true and correct a :1 Date:_ 12-Mo Phone#: Of•fecial 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 6. Other a Inspector Contac Person: Phone#: Information ant d 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 o`an individual,partnership, association ox-other legal entity,employing employees. However the owner of a dwelling house having not more than three apartalents 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 c onstruct 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 i mltil 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' comp enation 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 stare to sign and date the affidavit. The affidavit should be returned to the City or town that the application fbr the perrimtor license is being"equesfed,not the Department of Industrial Accidents. Should you have any auestioris regarding the law or ffyou 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 bum leaves etc.) said person is NOT required to complete this affidavit The Office of Investigations would like to than you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call- The allThe Department's address,telephone and.fax number... The Commonwealth of Massachusetts. Department of Industrial Accidents Office of luvestibat ons 500 Washmgton Street Boston, MA 02111. Tel. -lut, 617-72.7-4900 ext 4-06 or 1-977-MASSAFE Revised 5-26-05 Fax#617-72.7-7749 �'v�'u'.mass._aov/dia 0*1 µORTH TOWN OF NORTH ANDOVER , b. �_ °� 09 °}2 OFFICE OF BUILDING DEPARTMENT o , 1600 Osgood Street Building 20, Suite 2-36 North Andover,Massachusetts 01845 sacHuse Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978) 688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please print DATE: - /lJ JOB LOCATION: /o 3 rn r L Number Street Address Map/Lot HOMEOWNER Z/4wa. n1 e- �;zt G J S' S- - Get Name Home Phone Work Phone PRESENT MAILING ADDRESS /6 3 L City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Jim Swal en Plumbing & Heating ESTIMATE g g g 20 Fanwood Dr Hooksett, NH 03106 7-27-05 978-815-3359-603-645-1117 MA License#26892 - NH License#4193 Customer/Billino Location Lawrence Nelson Same 103 Fuller Rd North Andover, MA 01845 Job Description Replacement of fixtures in 2 n floor Bath and Master Bath. This estimate is an accurate price for work and materials as Disconnect old plumbing fixtures. described in the job description. It is also an estimate and may vary I will work with the contractor to install the new tub and shower units. due to condition described s de c bed in the terms and conditions. Once floor, walls and vanity cabinets are installed and finished, I will install the new toilets, shower trim, fixture stops and vanity plumbing. TOTAL: $2,300.00 " Note—we may have to open some of the first floor ceiling for access to plumbing if all attempts fail to make proper connections from the floor we are working on. Start Date N/A Finish Date N/A Approximate time of completion 3-5 days Terms and Conditions 1- All work described in above job description will be completed. 2- Estimate is based on visible conditions;price may vary due to non-visible plumbing conditions. 3- Not responsible for existing plumbing conditions and additional work may be required to complete project/repair. 4- Additional cost may occur if it is necessary to upgrade to current plumbing/heating code for a safe and proper working plumbing/heating system.Or if required by local Plumbing/Gas Inspector. 5- An change in this estimate will cause rice to v Y g p m'Y• 6- Final payments are due upon completion of work. 7- Estimate must be signed and returned with deposit prior to start of work. 8- Estimate is good for 30 days.Prices subject to change due to material cost,availability and special order items. 9- Work dates are subject to change due to unforeseen circumstances and will be rescheduled in a timely manor. 10- Additional cost for removal of old plumbing/heating material. 11- Permit fee are not included and will be at additional cost which vary by location. ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Signature Date Schlothan& Sons Construction Invoice 822 Main Street Haverhill,MA 01830 Date Invoice# 8/31/2007 6 Bill To Larry Nelson 103 Fuller Road Norht Andover Mass. P.O. No. Terms Project Quantity Description Rate Amount I Strip House,Tyvek,And Install 5 1/4"Hardiplank Cement Board app.600 linear Feet 24,500.00 24,500.00 Strip Casing off all window,Garage Doors,Apply Vinyl Trim(Koma Trim) 4 Extra Material and labor 1 For Front Trim on Windows.Vinyl Trim And Molding 80.00 320.00 1 Repair Plywood area(rot,water damage) 135.00 135.00 1 Repar,Replace,Reflash rear deck,board Pressure treated 165.00 165.00 1 Install short comer board above sunroom Materials only 53.00 53.00 1 Extra trim on garage doors N/C 0.00 0.00 2 Install Two Frost free spickets N/C 0.00 0.00 Debris In Contract 0.00 0.00 Deposit$12,500 Second Payment$ 10,000 Balance Due$2,673.00 Thank you for your business. Total $25,173.00 NORTH Town of _ Andover dover, Mass., (o • - l 0 LAKE COCMICMEWICK V ADRATED `S U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System I BUILDING INSPECTOR THIS CERTIFIES THAT........... �ir...... ,.L.,, ..Q...h...............................................:.......... Foundation 113 has permission to erect.................:...................... buildings on "—%.................................... Rough to be occupied as 1 )..i9c .. �l C..S.... �Q.,S.....-.....�1!..�...V 4^.. .L... �- .1.. chimney provided that the person accepting this permit shall in every respect conform to the termsbf the application Oil 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 PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCS TS 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. NORTH 0 0Andover 0 VO No. Z = C o dower, Mass., (o - l a T QL KE 1. GOC MI CME WICK A0RATEO PP� S `s U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR 10 THIS CERTIFIES THAT........... �i r..... ,.�.j..Q.... .................................................................................. Foundation has permission to erect.................:..:................... buildings on .....�..... ..... �.i74nV?r.....�. ...........I................... Rough 'I_ n 1 / to be occupied as-010j..19�rt,`�'�...!I.G�Q•ft. o.�/11C..1..5..../ �C�. .....'.....�.!�...v�n.�./.� ... . . Chimney provided that the person accepting this permit shall in every respect conform to the termsbf the application Oil 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 3� PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCT S TS 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.