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HomeMy WebLinkAboutBuilding Permit #426-15 - 12 HERRICK ROAD 11/3/2014 BUILDING PERMIT �.10RTli 0 -(1 ,b;�tio TOWN OF NORTH ANDOVER O . APPLICATION FOR PLAN EXAMINATION 4ZJJ,-I61 Permit No#: Date Received I L,� 'll A°R�reo�PaygS Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION I � 1' S CG tC cl Print PROPERTY OWNER Print 100 Year Structure yes no 0-1�—MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 'KOne 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 PERFORMED: a Identification- Please Type or Print Clearly _ OWNER: Name: o bar i bAe-,v r�sr�:� Phone: 9� 3� 1163 Address: r"1(- K Contractor Name:14ae ,;SeA L)Phone: 27 k Yf 3 Address:_, '1 (., At t-J Supervisor's Construction License: (15,SL - 09 Exp. Date: r Home Improvement License: /D /5Z3Y Exp. Date: 6 ARCHITECT/ENGINEER k0-A-6 Rev61'4QAU Sc>>J Phone: 915' VS 3k0(, Address: 3 ((-, PL AtN S-r L -0 LNC, i I .4 A . Reg. No. 3 FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. FEE: $ Total Project Cost: $ J� � ' �''� 1t+ owl o Check No.: �(Q � Receipt No.: NOTE: Persons contracting With unregistered contractors do not have access to the guaranty fund Signature of Agent/OwneSignature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE'OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swunming 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on _ Signature COMMENTS a P 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 FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department 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 Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 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 o 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/Cross Section/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 2014 Location `` No. 2�"`1� Date . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 11 Lk Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ti I Check# f/ 3 r ' . s , `"' j Building Inspector �► �. �� � � �f ��� ��� -.� { j i � - PROPOSAL "HERB" ROUSSEAU & SON, INC. Vinyl&Aluminum Products 316 Plain Street---Lowell, MA 01852 Free Estimates Tel. (978) 453-8626 or (603) 321-4733 Vinyl& Aluminum Siding - Combination& Replacement Windows& Doors Propos�l Submitted To: Job Site: Date: Robert Henderson 12 Herrick Road October 8,2014 41 Herrick Drive North Andover,MA Methuen,MA 01844 We hereby submit specifications and estimates for: Certainteed or Mastic vinyl siding to be installed on house. Color and size to be chosen by homeowner. Install 3/8" Styrofoam on entire home. Cover all window and door trim with aluminum. All soffit and fascia trim to be covered with aluminum and vinyl materials. Vinyl light blocks,and dryer vent to be installed where needed. Yard to be left clean of all debris..................................$9,500.00 Optional: Install vinyl shutters....................................$65.00 per pair All items on interior walls to be removed or secured. Lifetime warranty on labor and materials. ---------------------------------------------------------------------------------------------------------- We Propose hereby to furnish material and labor-complete in accordance with above specifications,for the sum Of: NINE THOUSAND FIVE HUNDRED DOLLARS AND 00/XX— $9,500.00 Payment to be as follows: One half down when job is started and remainder upon completion. All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements conti ent upon strikes,accidents or delays beyond our control. Owner to carry fire,tornado and other necessary insurance.PH lsgopd or i ty d4ysunless otherwise agr ed upon. Authorized Signature: A. ACCEPTANCE OF PROPOSAL - The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do oecifi d. .Payment wil made as outlined above. Signature: /r Si ature: Date of Accep ce: YOUR RIGHT TO CANCEL-You are entering into a transaction that will result in a security interest on your home. You have a legal right under federal law to cancel this transaction,without cost,within three business days from whichever of the following events occurs last: 1. the date of the transaction,which is the date customer signs retail sales agreement. 2. the date you received your Truth-in-Lending disclosures;or 3. the date you received this notice of your right to cancel. If you cancel the transaction,the security interest is also canceled. Within 20 calendar days after we receive your notice,we must take the steps necessary to reflect the fact that the security interest on your home has been canceled,and we must return to you any money:or property you have given to us or to anyone else in connection with this transaction.You may keep any money or property we have given you until we have done the things mentioned above,but you must then offer to return the money or property. If it is impractical or unfair for you to return the property,you must offer its reasonable value. You may offer to return the property at your home or at the location of the property. Money must be returned to the address below. If we do not take possession of the money or property within 20 calendar days of your offer,you may keep it without further obligation. HOW TO CANCEL-If you decide to cancel this transaction,you may do so by notifying us in writing at: 316 Plain street,Lowell,MA 01852 You may use any written statement that is signed and dated by you and states your intention to cancel,and/or you may use this notice by dating and signing below. Keep one copy of this notice because it contains important information about your rights. If you cancel by mail or telegram,you must send the notice no later than midnight of the third business day(must be dated)after you sign the RSA,(or midnight of the third business day following the latest of the three events listed in the section"Your Right to Cancel"). If you send or deliver your written notice to cancel some other way,it must be delivered to the above address no later than that time. I WISH TO CANCEL Consumer's Signature: Date: y The Commonwealth of Massachusetts - Department of IndustruclAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance davit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): ,�-6 C 1�, fj Cjy,�'S`E'A Q Address: �L,r,R r r✓ S� City/State/Zip: /,a tl/T�2j,cl Phone#: �� Are you an.employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. El am a general contractor and 1 6. E]Now construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ lama sole proprietor or partner- listed on the attached sheet.t '/• E]Remodeling ship and'have no employees ese sub-contractors have 8. ❑Demolition working for me in any capacity. orkers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. M We are a corporation and its required.] officers have exercised their ME]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.❑Roof repairs insurance required.]i employees.[No workers' 13.[i Other ►v S I� I comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 7-Homeowners who submit this affidavit indicating they Lie 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. lam an employer that is providing workers'compensation insurance for•my employees. Below is the policy andjob site information. Insurance Company Name% Policy##or Self-ins.Lic:#: Expiration Date: Job Site Address: 42 AC e�2 t J<oL City/State/Zip: N /4 rev r_�o tj 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 c.152 can lead to the imposition of criminal penalties of a fine w:p 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 certo under the pains and penalties of perjury that the information provided above is true and correct. signature• .,,.����-✓ Date: Il EZI Phone#: -2— Official ZOfficial 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 9.Building Department 3.City/Town Clerk 4.EIectrical 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 Iegal 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 producedacceptable 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. If an 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 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 Eno. 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. Anew 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: Tho Commonwealth of Massachusetts Depadmmt of f ndusWal.Aocxdents (?face o�Tnt�estigalri,ous 600 wawngtoa Street Boston,MA.421.11 Tel,#617-727=4900 at.406 ox 1-877-MASSAFB Revised 5-26-05 Fax#617-727-7749 www—ma.agov/dia, � NORTt�•r own of �. Andover p No. = � ' h ver, Mass, 42j* S U BOARD OF HEALTH LD Food/Kitchen TSeptic System PERBUILDING INSPECTOR THIS CERTIFIES THAT .... .............. ....... ........ ..... !1►.r� !........................... 1 •• �. �A.. Foundation has permission to ere „,........................buildings on .... . ..... • Rough eshall .. ................................ Chimney to be occupied as .... . .......... . .......... , . ... ........ ...provided that the person accepting this per in every respect con m 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 PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES 1N 6 NTH ELECTRICAL INSPECTOR ' UNLESS CONSTRUCT T S 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. t �z Office of Consumer-Affairs,&Business Regulation ME IMPROVEMENT CbNTRACTOR Type: egstration 101294 piivate Corpora5if . piration: 612512016_} HRE ROUSSEAU&'SON"INC 1 Michael Rousseau 316 PLAIN ST '; - ------ Undersecretary Lowell,MA 01852 A f R` Massachusetts-Department of Public Safety ,t Soard of,Suilding Regulations and Standard s Construction Super�-isor,Specialty +!" ' =License: CSSL-099724 - - MICHAEL P ROU�S`SE.. P.O.BOX#1262 Lowell MA 01852T Yy 21 }� /j!S_.)j"ISAJ Expiration Commissioner 02/21/.2016 1.