HomeMy WebLinkAboutBuilding Permit #629 - 111 GLENNCREST DRIVE 4/28/2008 BUILDING 1'tKMI I / V6
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TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
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Permit N0: Date Received �R,T.o•� �5
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Date Issued:
IMPORTANT Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building A'One family
0 Addition 0 Two or more family ❑ Industrial
❑ Alteration No. of units: Q Commercial
❑ Repair, replacement ❑ Assessory Bldg 0 Others:
❑ Demolition ❑ Other
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DESCRIPTION OF WORK TO BE PREFORMED:
denti ication Please Type or Print Clearly)
OWNER: Name: d6l LC- Phone:
Address:
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ARCHITECT/ENGINEER Phone:
. No.
Address: Reg.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ � a o O FEE: $
Check No.: Oo2 Receipt No.:
NOTE: Persons ontracting with unregistered contractors do not have access to the guar ty fund
Location///
No. Date 6
NOR•., TOWN OF NORTH ANDOVER
F 9
• ; , Certificate of Occupancy $
CMUSE<� Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # a�
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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 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/ Driveway Permit
Located at 384 Osgood Street
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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
Doc-Building Permit Revised 2007
J
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 -
,u 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)
o 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
o 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
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978-794-38M
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Proposal Submitted To: Date:
Mr & Mrs Phil Doyle 3/25/2008
Street: City, State & Zip:
11# Glencrest Drive North Andover, MA 01 845
978.687.2989 Window and Door Proposal
1. Install 14 double hung Paradigm Tapestry White vinyl 12. On the interior of breezy way cut ceramic tiles best as
replacement windows with Low-E glass and argon gas. possible to allow for new wall (customer trying to find
Included 6 over 6 GBG(grids)also comes with half match).Finish off with new ceramic the of new a000d
screen. threshold.
2. Install I new replacement casement Paradigm Tapestry 7.Install new pre-pruned pine on interior between door and
in kitchen over sink with/without grids/ windows,ready for customer to paint.
3. Install l new Paradigm Tapestry 30degree bay window 8. On Breezy way entry door to main house install l new
vinyl frame(head and seat of window are wood)Note customer supplied door and lockset.Install new casing to
The center window is a picture window with two side match standard clam ftif casing on the interior of door.
casement windows. Only the casement windows will
have grids. This is a new construction replacement the Building Permit Included
rough opening will not change.Includes all 2 1/2" RemovdofallVc&,related debris
clam shell casing on the interior Note On exterior will Paradigm's warrantee is limited lifetime by mfg
construct new roof line over window and shingle. Therma Tru door mfg warrantee is 20yrs
4. Front breezy way tear out and re-frame front entry way Workmanship warrantee is I Oyrs.
to accept new windows and doors. Install I new
Therma Tru smoothstar single swing 6' by 6'8" 15 lite
(flat GBGs)Door with 1 screen and hardware. Total Amount:$19 500.00
5. Install Paradigm Tapestry windows with tempered
glass(mass code)one on each side of the new door.
These picture window units will also include 15 liter Payment Schedule
with GBGs flat.Between the new door and the win- 1/3 at Start
dows new composite trim will be installed.Also on 1/3 at half way
bottom of entire exterior. Final upon Completion
AeccP111nee of Proposal - Tile abovc prices,,specifications
mid corrdi4ion1 al ,-,satisfHclitry and ara fimby accepled.
You are authoriize� to do til,e woT�As specified, P8,Y11101 Signa tim? y
will he mado as outlincd a .+eye.
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Town of Andover
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C% dover, Mass.,
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7v E BOARD OF HEALTH
Food/,Kitchen
PERMIT T D Septic System
1BUILDING INSPECTOR
THIS CERTIFIES THAT............ekel..........0.0.1- �...................................................................................... Foundation
has permission to erect ....................................... buildings It I.........cwttvvwortar�.....0.6vas...... Rough
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Final
provided that the person accepting this permit shall in every respect form to the terms*"*o*f*'the*"a**p*"p'li'c"a"ti*o"n*...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
'�3 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION S Rough
Service
BUILDING INSPECTO %ki
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Rough
Display in a Conspicuous Plac6 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.
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
a
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information l _ Please Print Legibly
Name(Business/Organization/Individual): Tb�NAd V�ZrA O-j C A a 0!
Address: a ��-"�/�(.-< VA
City/State/Zip: /4t'l4W—v1 Phone.#:
Are u an employer?Check the appropriate box: Type of project(required):.
1am a employer with ' 4. ❑ I am a general contractor and I
employees(full an part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ I am 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. employees and have workers'
[No workers' comp, insurance comp. insurance.$ 9. ❑Building addition
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3. I am a homeowner doing all work officers have exercised their 11-[1 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs
insurance required.] t C. 152, §1(4), and we have no
employees. [No workers' 13.0Other
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 a new affidavit indicating such,
xContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: fl- h U 7d-4
Policy#or Self-ins. Lic.#: Arr C.. `7 6° 9 '�G 4V 1 2-4 + `'1 Expiration Date:
Job Site Address: r j Cr•l C/7, T /JA City/State/Zip: N/��y �4
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 and the pains and penalties ofperjury that the information provided above is true and correct.
Si attire: '� Date: LY�d
Phonek �'� ' 17 S_
-AtJ-1
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#:
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 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,opera'te.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-contiactor(s)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. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may 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
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.
i
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 permittlicense 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 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 of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
Tel. #617-727-4400 ext.406 or 1-877-MASSAFE
Revised 11-22-06
Fax# 617-727-7749
www.mass.gov/dia