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Home My WebLink AboutBuilding Permit #196-13 - 109 NUTMEG LANE 9/10/2012 NORT1f BUILDING PERMIT ?oa TOWN OF NORTH ANDOVER - APPLICATION FOR PLAN EXAMINATION Permit NO: lab, Date Received �9SSACHU5 Date Issued: a, UVII)PORTANT:Applicant must complete all items on this page LOCATION__J 09 �t. �V . AilabytK. WA nn Pnnt PROPERTY OWNER 1`.bLN2T' C7-Z7rr;�ti Print MAP NO: ` PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ew Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other C Septic E Well a Floodplain E Wetlands ❑ Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: 13UI L-0 A CAA&A 6fp In, /,75) C;;L) L I I/ 17__:��7 n Identification Please Type or Print Clearly) l OWNER: Name: 1�2N3 2T (7� -�l Phone:G I 7-6 9_0<3q l Address: - , CONTRACTOR Name: AL IPhone: 61:2-:7) -0660 Address: I-1mr-13g X)e- Y n aw A Supervisor's Construction License: X1-70 Exp. Date: I q-ly Home Improvement License: G sZ6a Exp. Date: 9— ; 13 ARCHITECT/ENGINEER CL- -I 65 645)L_ Phone: 73) --/;z9 Address:20 D 51WAM�J 5T. Ly 11,1GNE5Tk-J�& Reg. No. �?S 9 6 4 FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project ost: $ � FEE. $1z, Check No.: LIP Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the gu ranty fund K, Signature of Agent/Owner Signature of contractor TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Old Structure yes no MAP NO: PARCEL: ZONING 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 0 Repair, replacement ❑Assessory Bldg 0 Others: 0 Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date:- ARCH ITECT/ENGINEER ate:ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: t NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ 6 � 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 ❑ ❑ /p dot Y-F COMMENTS CONSERVATION Reviewed on P L 2 Si nature r1�r COMMENTS EALTH Reviewed on Signature C MENTS 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 Os ood street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Deparfinedt.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 Doe.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 (Singe 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 Location /d 7 �5 Z, No. 1 Date--/ZZ-- • - TOWN OF NORTH ANDOVER • �. Certificate of Occupancy $ Building/Frame Permit Fee $ �. Foundation Permit Fee $ i - Other Permit Fee $ TOTAL $A-0. Check#� 25693 Building Inspec or NORTH Town of E ., ndover No. , LAKIh ver, Mass, • 3..., cocHIcnew C" '1 •Q o `y 'kV Cl - S U BOARD OF HEALTH LD Food/Kitchen PER Septic System THIS CERTIFIES THAT Q. O BUILDING INSPECTOR ................... ..... ...... ...... ............................................. .. Foundation has permission to erect .......................... buildings on .101.... �.... .. ..L.A.*............... Rough to be occupied as .......bu.;)..d.......lak......... ... ... ..........................s............. Chimney provided that the person accepting 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES I TH ELECTRICAL INSPECTOR UNLESS CONSTRU I AR Rough Service ............ ................................................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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 CONTRACT IL. SPARTAN MANAGEMENT CORP. 364 LINEBROOK ROAD DESIGN - BUILD - MAINTAIN IPSWICH, MA. 01938 Contract#: 0600-01 Phone: 978-356-9941 Contract Date: 30 August, 2012 Fax: 978-356-9942 Payment Terms: To be determined E-mail: Avell@Spartanmanagement.com CONTRACTED TO: LOCATION: Robert Gorman Gorman Residence 109 Nutmeg Street 109 Nutmeg Street North Andover, MA. 'North Andover, MA. CABANA CONSTRUCTION - GENERAL CONTRACTING SCOPE OF WORK Provide and perform all services required to: General contract, organize, coordinate, and supervise the construction of one cabana at the above address, as detailed in the attached plans, specs and artist's drawings, in compliance with all state and local codes and ordinances. TERMS Contract cost as follows: The cost of the labor& materials plus a 10%fee. Includes permit work& inspections. Additional work or changes in the scope of work, upon approval, will be invoiced as the cost of the labor& materials plus a 15%fee. Spartan Management Corp.,as required by this agreement,certifies with the authorized signature below that: All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices.Any deviation from the above specifications or unforeseen site or regulatory conditions involving extra costs will be executed upon authorized approval by Mr. Robert Gorman,&will become an extra charge. By: Date: 30 August,2012 AI ellante,Owner,Spartn Management Corp. I agree with all the terms an nditions of this contract and authorize All Vellante and Spartan Management Corp.to proceed with this scope of work as ai above. By: Date: obe GPanperty Owner TOWN OF NORTH ANDOVER AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142 A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal,demolition,or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units...or to structures which are adjacent to such residence or building" be done by registered contractors, with certain exception, along with other requirements. Type of Work: <i nv-AV A Cd�5 ��1� Est. Cost /5K Address of Work )a9 �ZQT 115(x- bM1 - Owner Name: w � rnw Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): For office Use Only Work excluded by law Permit No. Job under$1,000 Date Building not owner-occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FIND LINER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: q-la- la /C�Atuj� 6 L12,A 0 Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street lj�U ,.� _ Boston, MA 02111 c www.mass govhfta Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): Address: -36q Ll AUE—BuzV, City/State/Zip: �� H,MA• 0)93 0 Phone #: 07- 71a-o66D Are ou an employer?Check the appropriate box: Type of project(required): l l am a employer with 4 1 am a general contractor and I 6XNew 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 ? E]Remodeling ship and have no employees These sub-contractors have 8. Q Demolition working for me in any capacity. workers' comp. insurance. 9. Q 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 11.❑ Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.Q Roof repairs insurance required.]f employees. [No workers' comp. insurance required.] 13.❑Other 'Any applicant that checks boz f€l 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. $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 air employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. `�- Insurance Company Name:_ /a�N U 04 X6�Y • {iti. Policy#or Self-ins. Lic..#: JVC— &29 1 S -71 Expiration Date: Job Site Address: ��'"I �� 7�^ Cs/�ll�/1 City/State/Zip:_ Nf•AL*-)oV�ig�� 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 underj1he pains and penaltiesof perjury that the information provided above is true and correct Signature: A LL= Date: — b Phone#: 617'710-1%60 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#: ACORD� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) Y)08 16 2012 PRODUCER (978) 356-2116 :ALTE:R ERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Gregory Insurance Agency AND CONFERS NO RIGHTS UPON THE CERTIFICATE R. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 61 Market Street THE.COVERAGE AFFORDED BY THE POLICIES BELOW, . P.O. Box 625 Ipswich MA 01938-0625 INSURERS AFFORDING COVERAGE NAIC 2 INSURED � INSURER A-ARBELLA PROTECTION Spartan Management INSURERe Technology Insurance Co. 364 Linebrook Rd INSURER C. INSURER D: Ipswich MA 01938- INUR E:S COVERAGES ER THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'L POLICY EFFECTNE POLICY EXPIRATION japi TYPE OF INSURANCE POLICY NUMBER DATE M DATE(MM1DDjYYj LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Me ocounence $ CLAIMS MADE OCCUR / / / / MED EXP one S EERSONALBADV INJURY S GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT-APPLIES PER: PRODUCTS-COMPIOPAGG S POLICY JRT LOC A AUTOMOBILE LIABILITY 17073400000 12/17/2011 12/17/2012 COMBINED SINGLE LIMIT ANY AUTO (Ea accxW) $ 1,000,000 ALL OWNED AUTOS / / / / BODILY INJURY X SCHEDULED AUTOS (Per person) $ HIRED AUTOS / / / / BODILY INJURY NON-OWNED AUTOS (Per accident) S PROPERTYDAMAGE (Perac=Wd) S GARAGE UA8HM AUTO ONLY-EA ACCIDENT $ ANYAUTO / / OTHER THAN EAACC $ AUTO ONLY: AGG S EXCESSIUMBRELLA LIABILITY / / / / EACH OCC RRENCE $ OCCUR CLANS MADE AGGREGATE $ S DEDUCTIBLE / / / $ RETENTION S B WORKERS COMPENSATION AND TWC3291871 09/21/2011 09/21/2012 X T R uMrrsI 10ETR11- EMPLOYERS!LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S 100,000 O /MEMBER EXCLUDED yes,describe under / !I yes,deEl DISEASE-EA EMPLOYEE$ 500,000 SPECIAL PROVISION below E.L.DISEASE-POLICY LIMIT E 100,000 OTHER DESCRIPTION OF OPERATIONSADCATIONS/VEHICLES1EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Job: CERTIFICATE HOLDER CANCELLATION } } — SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER.ITS AGENTS OR REPRESENTATIVES. AUTHORED REPRESENTATIVE Woburn MA - (6A <ft::� ACORD 25(2001108) ®ACORD CORPORATION 1988 ft,,:INS025(0108).05 ELECTRONIC LASER FORMS,INC.-(806),327-0545 Pagel cf2 1.a Massachusetts -Department of Public Safety �! Board of Building Regulations and Standards Construction Supen icor License: CS-0.22170 ALBERT V VEAANTE.- 364 LINEBROOK ROAD IPSWICH MA 01938 Expiration — Commissioner 01/04/2014 0/ae {oJoorvino�iusea/ o�� Z�aaaac�u�aelta Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration: -x-1.64260 Type: Expiration: V-25f2013 <' _- _ _ Individual ALBERT J.VELLA!I.y ( ALBERT VELLA1,4TE;;_ . 364 LINEBROOK IPSWICH, MA Undersecretary