Loading...
HomeMy WebLinkAboutBuilding Permit #742 - 111 GLENNCREST DRIVE 6/30/2009 ' L BUILDING PERMIT NORrN p tt�ao TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION * _ Y / ^ u Permit NO: Date Received �,q"�R,Tlp•.�'`:�.c� SSAGHUSE Date Issued: (� " IMPORTANT: Applicant must complete all items on this page LOCATION _ Print PROPERTY OWNER [6q Print MAP NO: /1,11 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 Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: 2Y/L Identification Please Type or Print Clearly) OWNER: Name: 014,'L- 0a-41L Phone: Address: t� Cbz r �/1 Ute N CONTRACTOR Name: SaPhone: Address: .,M��-� f-( (:F77idcl� r►-► A �S License:— ��12 —.Exp. Date: ~ Z,- t k Supervisor's Construction Lice © P Home Improvement License: 3 S 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: $ c� �o °° FEE: $ Check No.: ('00 Receipt No.: � NOTE: Persons contracting wit nre eyed contractors do not have access to the guaranty fund !Signature of Agent/Owner,'r� Signature of contractor, Location No. Date �' 10 ' U &ORTN TOWN OF NORTH ANDOVER IC, 9 i, + i • ; Certificate of Occupancy $ cMusE` Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTALo $ Check # 2& Y` 22"i 64 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 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 Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street :FIREDEPARTMENT - Temp 'Dumpster on yes no Located at 124'Main:Street Fire{.De_partment'signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ' I 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 4 I ❑ Notified for pickup - Date i Doc.Building Permit Revised 2008 Building Department I� The following is a list of the required forms to be filled out for the appropriate permit to be obtained. I 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 i I Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 %AORTH Town of 4Andover . No. OF LA E dower, Mass., COCMICMEMCK y�. ADRATED `S BOARD OF HEALTH PERM . IT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT........... .. 1... .. .................................................................................................................. Foundation has permission to erect ........ ........................:.... buildings on r /� ................... Rough .... to be occupied as... .. .`.. or�..�.... ........� . ....0........ ..... .08... 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 �i 4V PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU ST 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. The Commonwealth of Massachusetts ^ ! Department of Industrial Accidents # 1 Office of Investigations 600 TTr � ;r ashington Street Boston, MA 02111 www_mass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lemibly N8II1e(Business/Organizadon/individual)'_ e\Z/,�/�,,?•G�1 (I Uh 4-0 g.t c /Co.U,4'— Address: D/� City/state/Zip: K M/I'D Phone#: j'3/ Are y an employer?Cheek.the appropriate box: Type of Project(required): 1. I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.El am a:sole proprietor or partner. listed on the attached sheet i ?• ❑Remodeling ship and have no employees These sub-contractors have 8. [�Demoiition working for mein any capacity, workers' comp.insurance. [No workers'comp. insurance 5. 13We are a corporation and its 9. Building addition required.] l0. Electrical red-) officers have exercised their ❑ repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I L❑ Plumbing repairs or additions myself. [No•workers'comp. c. 152, §1(4),and we have no 12. Roof insurance required.]t 'employees. ❑ ice [No workers' 13.❑.Odder comp. insurance required.] *Any applicant that checks bol#l must also fill out the section below showing their workers'compensation policy information, ?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-canttactnrs and their workers' m „ r ,•o^^Ei^,mfamution. t am an employer that is provWwg:workers'compensation insurance for m1'employees: Below is-the informapolicy and job site tion. Insurance Company Name: �L f't h a;i 44 Policy#or Self-ins.Lic.#: ALJ C/)o T4 L(4 u 2Qo I Expiration Date: Job Site Address:__ l Cnti r /Jl-? City/State/Zip: o 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 5250.00 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 under the pains and penalties of perjury that the information provided above is true and correct Si Lure: Date: \29 Phone 3� O fficialonly, Do not write in this area, be completed by city or town official Town: Permit/License# ority(circle one):ealth 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspectoron: 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 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)acid 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 may be submitted to the Deportment 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 heir self-insurance Iicense number on the appropriate tine. 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 perrnit/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 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 #617-727-4900 ext 406 or 1-8.77-MASSAFE Revised 5-26-05 Fax#617-727-7741 www.mass.gov/dia OIli� � � One Ashburton Plae - Room 1301 8©stvn_ Msss4chusetts 02108 1 ionic lmrffoveumffl Contractor Rcaiswdttvl l ReQui ratttm 137057 Type, DOA k> On 1O02O10 Al. t. UMiUi=K Ute r.. t��;1Ur JOHN LANZAFAME 166 A MERRIMACK ST. METHEUN. MA (}1 a44 L,pdttfe.*,ddrr s and return[wrd. !�lwrA ,ru>un tu, ;r„„, Address Renewal Etnptuymenl ! :.s! 1 ;n.., bwt►rd atsmAdima skagelim"Oft bed 9ftodart. r'K3� iacetsao w6 ardlraDW or r M tttatre tie est deet*. of a ,I.sae:al b: R091111IINVAINIP”. s]%)!), ttlsae dot Me Steads :(swwta ire 17satt1 0— t!'Outaft 13O! �x'•�iDkACK S T �... ,5 1 i 1k UA,,IIA" i��r l �I.t,,.tihua:il� i)c{t.trtntrur .ti i'ut+Ar. �.ticit Ktau'tl of Kuiitlirt_ iic�ututittrt. ,ttttt �4atttlarti, Construction sur)erv!sr,r License Liceit CS 0920 Restymcle S to. 00 30 TEMPLE DR -✓T""" tAt)17 Al1U ii 4rV4yIT r ...mut.....n.•r T,u, 13449 �t.t,,.,t tu/,rtt� i)cit.trttttt'rtt :,f i't,frit� �.ttcl, �t/NE`i! .,t i3,utttitrtti Kt•;;stk;tlttEn. and '.t:tttti:trci� onStruCtlOR Suvers lsor t..,cr+rtstr 89120 Krstrtcted to: 00 _.....� �, "_RTif;#i^TF— CW UASWITY l RAt4Ct-- Ha .._ nrs w rrr��w r reo w __ -...... �r go lli m U"m tME Cj�IR'F1f K:x+Ta 6XIMWD DN NAY+All - _ - $.�,a:rc.t. •`1 a�+�a:tl Y AL�Y� �7�lFt�OiK:F'6�itC.Lar. SRA t11,14 i w/R I ",CUV&***A t - + iMDllFfll.iC i OEC o+Si�Mt'K'+G! .�>ttK"'t�" Jlilii k�A ALL ,Cr 13�NlYt � Vit'^ MmsilR� _ _ - �t T t�L1E N Ai+k 5•• �"" — ,►f.x.U@&EtI ►MANE w�.O11�E SWSVWA/O�YEtYI��TSE!SEKa!'ElIXiDMRwGMTEt f MtiY•iC Avg 6?F yi5tl6t/1A�GE " V* TM Clti'K.ATF aA►Y 9t(S-SUE a4 yE}F qn c7�1 "W IS S ' ,Wk tW'C!�tvrx CLSNCNTtt NS y iff a[i^'v 5 wGl!'3AEGA�R"Awm,ugpww q A'I�_W�IE - .. ._ _ +Mta r+r!`tis �Gulitlt£wGk i -. �:. I . •. 1 ...,....,c..., - , a@O t,IR'sA. ani Y�Rxe._... > .. ♦F}rSl.1M.i 4 ALYVI Wl:.1N P �T .••. ( 1f4SYRxiW Y tl�it `, .,_____�.,`..^ _. (•K(fd1►� 'Sx •�}� ... ,i.ritlf 1,a. I [( 5 V WLI.�N. , ...inn... � Rist .. � RC><3+l�lr.• - »ApY�•,pT r,,.wru ' _ taxi Fe_o4a�, •yTf:'1(Mlt`'+ {4 nL.l.1E)!i,l I S f L ��i�►.wcw.asap ANINRr jflp�gl�Qi37' � t�� ____ E1FA1 s .s_; _ µa KF •Elt+l.,i 1101 t'�'• I 4 }�` � t1ryYJ.1t i P l+faT.M F - f - wit rsO ,"t oa um aagArABl tit tft%"Ia>i.m«.,t, NE?�fC!c4 twr rmrYar}ts .4ukm r#ili4D m TLi{ ,r , it•• .. Ckw Ashbmon Piwe - Room 1301 ALL UNDER ONE R40OF Chimneys Residential & Commercial Roofing All Types Of Siding CHIMNEYS POINTED-REBUILT-CAPPED Expert Masonry Work Mass Toll Free I* Roof Leaks Experts * Licensed & Insured 1-800-WAIT-4-USLoca//y Owned&Operated Since J976 License#034200 ® (924-8487) Ixo Tee ? acm 02'qOhn ! We Work Year Round 978-794-3883 _ • _ • • • • 11845&4!�AeaV, 1Temple1 1 1844 Proposal To: Phil and Marilyn Doyle Date 6/22/09 Street: 111 Glencrest 978-687-2989 N. Andover, MA 978-948-7383 Shed proposal Custom 8'x16' shed In our opinion the shed from Eastern shed company with plain pine exterior is just not great of a product. The basic package has a 2x4 floor system with no ramp or stairs. The upgraded 2x6 system costs$$2,650.00. We can build a custom shed with a 2x6 floor system and"LP Smartside" exterior sheathing, with a ramp or stairs by our carpenter(Tim) on site for a very com- parable price. Shed: $2,650.00 Labor upcharge: $ 400.00 Demo and trash 350.00 Total cost: $ 3,400.00 *Note* New 8'x16' shed is same exact size as exist- ing, and also new shed is being*constructed in same exact location of where existing shed is now. Acceptance of Proposal—The above prices, specifications and conditions are satisfactory and are herby ac- cepted. You are authorized to do the work as specified. Payment will be made as QUtlined above. Date of Acceptance: `/014 Signature: Signature: tZ=:_. r