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HomeMy WebLinkAboutBuilding Permit #782 - 110 QUAIL RUN LANE 4/30/2012 NORTy BUILDING PERMIT oF�iLec qy TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION vJ � O Permit N0: Date Received '44 ��SSgctiusE��S o Ara. Date Issued: IMPORTANT:Applicant must complete all items on this page �; �� '�' �„�,,.fy t,,i11'��aC}�� ;rnz':�act � i3 ; Y•-. �- ct �• ,..--,' �'.. t1'+t c."..' - -: Yk .cry ���. tii'�' it` jt sk '�' c��ac n�S� �p Yy ,, �+3 '. i' c a i•''itie ; ( r i+4 r r ., ` (�. LtOC4T®N.1 _ - U�+ J . ,- PROPERTjI'OINIVER -6 '_� z. MAFaNOPARCF fZ®NING'�®ISTRICf� Histo�icDrstnc't? eyes; n F Machine Shop Village? TYPE OF IMPROVEMENT PROPOSED USE Reside Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other "'- i } .`'"'_x"' y Septic; t❑#Welly ,,, µ s Floodplain ,,❑WetlandsS? r ' p�Watershetl District t � *�®Water/Sewert:_.'�.._y.'.. ...a.t l E.:. --j' f y 'rt �.*. f , _ ' DESCRIPTION OF WORK TO BE PREFORMED: 2v2oae . vc);c- �y.xIGLzS o,4�5 (VC, Z1, 4 C L�/73;�2 2�,grL Q 2 2v3t3F/2 ;2A�,F 1�.�;4_4 = iG c� © �/,2 �!�- -T�ra �,�F s�� GAS -� Identification Please Hype or Print Clearly) OWNER: Name: / 1y S�.c;� /��✓��' i Phone: Address: L)JI-1L QLJ hl � -8 jf r ,S� a - 10 f . > r l s r�U� v-�C'. `CJ a t'�`�'f� '� s`� 'i( f• �. ,� r+ ttf rzt 4 cf t ak . S �• s. �� ..s �SJ �V� t COIVTRACT,©R�'Name" one a - .1 v. � ...Al �.-' ;. f1. .�.}�'!� ..•s/ 4 y... t?- - ^- �ay.rjr;-f'_.-.:4,-.y � . 7 A�ddressa � `Su ervisor='s Corstructon7License=.��3�. t 7- rExp?t1-7 �D^ate.� ,.t 1 ,r�a t. �� ( t it A !�w.., Cyt�4 , +i.. '. ✓- HomeImprov�ement License ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMMIIT�$9 OO PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �, / °d ' FEE: $_ /0 �— e__ Check No.: a Receipt No.: 5 NOTE: Persons contr cting with unregistered contractors do not have ecess to e uaran fund - ---.- Si natureSignature-of contractor. `~ t; 9 w —- — - 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 CONSERVATION Reviewed on Signature COMMENTS HE*LTH 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 DPW Town Engineer: Signature: Located 384 Osgood Street FIREDEPARTMENTrxTempDumpsteron sltelyes _ f Locatetl;at12�4MaStreet r a ✓ 1 0 Fire?Department��griature/ciate � s - — f"` �aY.'�fi4 '♦y '� .Zs," ;±• ; � �' `� r� K t - s,� -..i• �., }, . .�: Y _ COMMENTSa 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.$10041000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 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 40TE: 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 V40TE: 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 o Engineering Affidavits for Engineered products N OTE: 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 DEPARTMENTMFORM07 Revised 2.2008 Location /&- No. /- Date IV • TOWN OF NORTH ANDOVER . g Certificate of Occupancy $� p" J Building/Frame Permit Fee $ r-- Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Checky� 25246 Building Inspector i - IN1assachusetts- Department of Public Safeth Board of'Buildin- Re-ulations and Stundardb Construction Supervisor License One-and Two-Family Dwellings License: CS 46636 RAYMOND E DAMPHOUSSE J -„ 75 BUTTERNUT LANE METHUEN, MA 01844 Expiration: 6/2/2013 t'ummixsiuncr Tr#: 16791 ✓lze�ar�vnwnu a�./v(,czda�cct Ofticebt•6murnert'<fiairs,&�T3zsi6cae = HOME;IMPR.bVEMI PdT'CQNTRACiQR }, _ Etegist'rakion: 70862 �i E>a+��tiin X6/28/ 012 Pri a'2 P opt, �tA '.FiO SSFSONS. t z rtz:ymend Damni,&ssE,J �, 75 Butternut Lase c i p-,,Yuen,MA 01'344 _�: r REG. #101862 ROOFING — SIDING — INSULATION I Date �r ` From �5 2 ..4 ll� {NtunH {t1ddl•iq TO. IATUD L WMMV , n:All S If*=43.,2'BOX`431 LAWRENCE P.0,LAWRIENCE IYtASSACHUSETTS (11842 I (we) hereby authorize the -Contractor to .furnish all materials and 'tabor necessary to inataii< 'construct and place the Improvements described below in-on building located at No. West. City Slate 1n accordanea with the 1o11owinp speclQcattons. We will remove all roof shjpgks off toid roof area,up to two la ey rs Replace any boards or sheathin at t ad- - ditional-cost.—A new 8"-clear or-white-aluminum drip edge-applied on all edges. Approx.-Eft-af-ice-and-water_ membrane applied on eaves, 3ft in valleys, strips around skylights, along chimney flashing-and sidewall junc- tions. A new base sheet applied.A lko 30yr Cambridge architechual or standard roof shingle installed. Install new vent pipe boot flashings. Waterproof existing chimney flashing and remove debris: ©c Optional Products Roof Over Shingle Ridge Vent Existing Roof Soffit Vents All of the above work to be done in a Good and workman-tike manner. All men and equipment Insured. Prsmis"to be left clean upon completion of work. For the total sum of ti dollars. Entire Sum to be paid Immediately upon completion In accordance with plan as shown below. TOTAL CASH SELLING PRICE ..........i f� DOWN PAYMENT IN CASH . .. ....... �z4zc DEFERRED BALANCE v UPON COMPLETION ..... The undersigned agrees 16 keep property mentioned in this agreement properly Insured against 'loss by fire Including the Contractor's Interest therein. This agreement shall become binding only upon the written acceptance hersof by sold Contractor,and upon such acceptance this shag constitute the entire contract and be binding upon the parties hereto, there being no covenants,promises or agreements, -- written or oral except as herein set forth.it Is the intention of the parties hereto(hat this contract efiall be binding upon their respective heirs, executors, administrators,successors and assigns. Customer agrees to pay a reasonable sum as attorney's fees and Court Costs If placed in hands of attorney for collection. The owner further agrees that In event Of cancellation of this contract after acceptance by the contractor end before the work Is commenced the OWNER agrees to pay 20% of the total consideration herein named as liquidated damages for breach of contract. Said contractor shall not be responsible for damage or delay due to alrlk°s, fires, accidents, or other causes beyond his reasonable control. We, the undersigned, certify that we are the sole owners of the property heroin described on which said work or repairs are to be performed. IN WITNESS WHEREOF, the undersigned has]have) hereunto set his(their]hand(*)and seal(@) the day and year written above.. Accepted By Husband � l ?RAYMOE.DA USS , R.AND SONS 1° NO ING CO..IN^. r Mall Address Of different Imm•bovq n• • T11U of OII NORTH 0 Of 0 E No. Nai w.w-.� y�!.•y.. oL , dover, Mass., '3y • I e� T LAKE COCMIC MEWICK �� E s RATED 7 BOARD OF HEALTH Food/Kitchen . . PERMIT T D Septic System i ' BUILDING INSPECTOR THISCERTIFIES THAT...................................... .......... .......... .....11..L.a. /!! ... ...1........................................ Foundation has permission to erect............... .................... buildings on .1to....... � ............. ......... Rough to be occupied as �..... ...p� ... chimney J .. .��..... ..... .. .. . . �T ........................................ provided that the person accepting th permit shall in every respect con to the terms of the application on fil in Final- this inalthis 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 UNLESS CONSTRUCTIS TS Rough Service BUILDING INSPECTOR Final I 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 FIREDEPARTMENT Until Inspected and Approved by the Building Inspector. Burner - Street No. SEE REVERSE SIDE Smoke Det. AORTH Tovm of 0 X 10 , dover, Mass., '�y • � O� COC MIC EWICK �� 7� ORATED p'P�,��� `S BOARD OF HEALTH Food/Kitchen , - . . PERMIT Septic System BUILDING INSPECTOR ....... S � � ..... �.THIS CERTIFIES THAT � . 1 . 1........................................ Foundation has permission to erect............... .................... buildings on .1�('........ �, L �M .................. Rough !. to be occupied as ,cam."? :. ............:...... I... Chimney provided that the person accepting th permit shall in !vL ery respect conf to the terms of the application on fil 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 UNLESS CONSTRUCTT S TS -- Rough -' Service BUILDING INSPECTOR Final Occupancy Permit Required to OcLupy 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 J1 Smoke Det. y The Commonwealth ofMassachusetts - Department oflndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov1d1a Worker' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Avylicant Information PleasePrint Legibly Name(Business/Organization4ndividual): y Deq,,r?,h 4, r1 G c/a. Address: 2E_ lJyV J eL . City/State/Zip:_/ r'tlL) 1piel Phone Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with c,2_ 4. ❑ I am a general contractor and I 6. ❑New construction employees @Lanoz4dtime have Hired the sub-contractors 2.ElI am a sole proprietor or partner- listed on the attached sheet.x 7• El Remodeling ship and'have no employees These sub-contractors have 8. E]Demolition working forme in any capacity. workers'comp.insurance. . g• (]Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ 1 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.EKoof repairs insurance required.]t employees.[No workers' .13.[jOther Ate' comp.insurance required.] 'Any applicant that checks box#1 must also fill outthe section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they Ere doing all work and then hire outside contractors must submit a new 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 am an employer that is providing workers'compensation insurance for my employees Below is the policy anti job site information. Insurance Company Name% ,�fly 62 Z Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: u+`} L- K City/State/Zip: r 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 o.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. Ido hereb cer c er thepains an penalties ofper. ry that the information provided above is true and correct. - Signature: Date: Phone#: 3S 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.PIumbing 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 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 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 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. Han 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 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 In 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 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 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 Com4lonwealth of mossachwetts Depadmit ofladustrzat Accidents Office of Investigations 600 Washington.Street Boston,X14,02111 Tel,#617-72.7,4900 ext 406 or 1-877:MA.SSAFB Revised 5-26-05 Baz,#617;,727-7749 '��v.zxxass,govfdia. TRAVELERSJ� WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (6KUB-663X466-A-11 ) RENEWAL OF (6KUB-663X466-A-10) INSURER: THE TRAVELERS INDEMNITY COMPANY 1. NCCI CO CODE: 11347 INSURED: PRODUCER: RAYMOND DAMPHOUSSE & SONS PERRY INSURANCE AGENCY ROOFING CO INC 522 CHICKERING RD 75 BUTTERNUT LANE NORTH ANDOVER MA 01845 ME THUE N MA 01 844-1 91 2 Insured is A CORPORATION. Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy period is from 08-22-11 to 08-22-12 12:01 A.M. at the insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s) listed here: MA B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: 0= _ Bodily Injury by Accident: $ 100000 Each Accident Bodily Injury by Disease: $ 500000 0— Policy Limit Bodily Injury by Disease: 100000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A 0= m-. D. This policy includes these endorsements and schedules: 0� SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE 0� 4. The premium for this policy.will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All required information.is subject to verification and change by audit to be made ANNUALLY. DATE OF ISSUE: 09-21 -11 TL ST ASSIGN: MA OFFICE: ORLANDO INDUS AFF 161 PRODUCER: PERRY INSURANCE AGENCY 753XF 000123