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HomeMy WebLinkAboutBuilding Permit #900 - 124 SAW MILL ROAD 6/14/2012 BUILDING PERMITof pORTH TOWN OF NORTH ANDOVER O APPLICATION FOR PLAN EXAMINATION U® � 's e« •w Permit NO: Date Received �SSACHUS�� Date Issued: Cv / 2 IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER �f2/ Print. 'MAP NO:Z/Q Y PARCEL:4� ZONING DISTRICT: Historic District yesno !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: Identification Please Type or Print Clearly) OWNER: Name: / Phone: Address:_ i CONTRACTOR Name: / Uva (�j//i/ Phone: �A3 Address: ��/ Supervisor's Construction License:: 3 5 3 Exp: Date: J9 Home Improvement License: Exp. Date: C� 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: $_ lor,y,�a 66 FEE: $ �SO4 Check No.: 9U7 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature 6f Agent/Owner Signature of contractor 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 I 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 z 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 - 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 Li 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 o 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 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Location No. Date / ? • TOWN OF NORTH ANDOVER e ® Certificate of Occupancy $ Building/Frame Permit Fee $7SrD(� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ r t I Check# -.i �1 f 25414 Building Inspector NORTH Town of s EAndover No. 90D * - h ver, Mass, r16 L cocHic"IWICK p0R'�TED S u BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .......rLe.1W..o./.,,....AA!'zy.......................................................................... BUILDING INSPECTOR �a Gf SaW � Foundation has permission to erect .......................... buildings on ......../.................... �......P�Q ..... ............................ ,,QQ .. Rough to be occupied as ........Y..1. ..x:1.4'? ......�......5.... ::'�:"�G!YC�!f'fir„ C .�t:................................. 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 IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI TARTS Rough Service .......... .... ..s e........................................ 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 Ax -6 Office of Consumer Affairs and usiness Regulation 10 Park Plaza - Suite 5170 Boston, Massac.4usetts 02116 Home Im rovement o nraetor Re istration P � g Registration: 121604 Type: Individual Expiration: 5/24/2012 Tr# 293905 QUINN'S CONSTRUCTION THOMAS QUINN 868 MAMMOTH RD. DRACUT, MA 01826 Update Address and return card.Mark reason for change. -� Address F-1Renewal F-1Employment Lost Card DPS-CA1 0 50M-04/04-G701216 �� rpamrraanusea i o� M.'k,aeGt t License or registration valid for individul use only Office of Consumer Affairs&Busi6ess Regulation ME IMPROVEMENT CONTRACTOR i before the expiration date. If found return to: Iregistrati R 121604Type: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 piration: 5/24/2014 DBA Boston,MA 02116 QUINN'S CONSTRUCTION THOMAS QUINN 868 MAMMOTH RD. DRACUT,MA 01826 Undersecretary Not valid without signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards Unrestr'lcted-Buildings of any use group which Construction Regulations Supen-isor contain less than 35,000 cubic feet(991m3)of License: CS-039732 enclosed space. -us a THOMAS J QifITN - 4, 868 MAMMO'T'H RD�77 DRACUT MA, 01826 '`•; 4; -• I Failure to possess a current edition of the Massachusetts. I r4t z* State Building Code is cause for revocation of this license. ` Expiration Commissioner 03/25/2014 For DPS licensing information visit: www.Mass.Gov/DPS QP ID: JP CERTIFICATE OF LIABILITY INSURANCEDATE(MMIODmrYY) 03(12112 THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHOR(ZED REPRESENTATIVE OR PRODUCE;,AND THE CERTIFICATE HOLDER. IMPORTANT; If the certtfioate holder is an ADDITIONAL INSURED, the policy{ies)must be endorsed. If SUBROGATION IS WAIVED,suhject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the Certificate holder in lieu Of Such entlorseman S. PRODUCER 978-9755-1300 oNTAGT Se reve&Half Insur,Assoc.lne NAME: 305 North Main St. 97$-9757596 PHONE FAX Andover,MA 01810 EG �� }: A1C Np: Edward Ramirez ADDRESS: PRODUOER cu OAER ID fi:THOMA-3 INSURER 5 AFFORDINp COVERAGE NAIC# INSURED Thomas Quinn INSURER A:Distel Group � dba Quinn's Construcl,ion w8uRERg:Hartford Ins Co. 868 Mammoth Road Dracut,MA 01826 INSURER C: INSURER D: INSURER E: J .NSURER F COVERAGES CERTIFICATE NUMBER; REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOIWTHSTANDING 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 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUt fl POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR TYPE OF INSURANCE ! Y POLICYNUMBER MlDD MMroo LIMITS GENERAL LIABILITY EACH OCCURRENCE g 1,000,00 COMMERCIAL GENERA(,LIABILITY M021000227 01115112 01/15/13 PREMI (Ea acouna,ca) $ 100,00 CLA1M"AOE I A I OCCUR MED EXP(Any pne person) $ 5,00 — PERSONAL A ACV INJURY S 11000,00 GENERAL AGGREGATE S 2,00D,00 GF.N'LAGG.REGATELIMIT APPLIFSPER:PRODUCTS-COMPIOPAGG $ 2,000,00 POLICY PRO- Loc � AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S ANY AUTO (Ea Reeldent) ALL OWNED AUTOS BODILY INJURY(Per person) S SCHEDULED AUTOS BODILY INJURY(Per accident) S HIRED AUTOS PROPERTY DAMAGE � (Per aCGltlnnt) NON-OWNED AUTOS $ UMBRELLA LIAR $ OCCUR EACH OCCURRENCF. S EXCESS LIAO H-CLAIMS-MAD= AGGREGATE S DFOIJCTIeLE 3 RETENTION F WORKERS COMPENSATION x WC STATU- OTN• S AND EMPLOYERS'LIABILITY YIN I IMI,L OFFICERIMEM3LREXCLUDANY Fp?cv^UTNE r NfA 41161P704 01/15112 0I/15/13 E.L.EACH ACCIDENT g ID0,00 (Mentlaorywr In and F,L.DISEASE-EA EMPLOYEE $ 100,00 IfT?o-deecripeunCar D- G4'?PTION OF OPERATIONS Mlow F-,L.DISEASE-POLICY LIMIT 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 131,Addilfonal ROMOCV Sehodula,If more apace It mqulred) Sale Proprietor Thomas Quinn iS Excluded under Workers Comp CERTIFICATE HOLDER CANCELLATION LOWELLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED.BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AuTHO�RI,ZrD RR�E,PRRES/EN�TAVVE 1988-2009 ACORD CORPORATION. All rights reserved. kOORD 25(2009109) The ACORD name and logo are registered marks of ACORD OLIN The Commonwealth ofMassachusetts Department of industrial Accidents Office ofInvestigations 600 Washington Street Boston, AM 02111 www mass go Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers ARP licant Information Please Print Legibly Name(Business/organization/Individual) ��/ ��y S C'��5/���•C����� • - - - -- — -7— City/State/Zip:.. Phone#: A re an employer?Check ropriate boa: I am a em to er with 4. Type of project(required):'P y ❑ I am a general contractor and Iemployees(full and/or part-time). have hired the sub-contractors6 ❑New construction. I am a sole proprietor or partner- listed on the attached sheet.# 7• ❑Remodeling ship and have no employees These sub:contractors have working forme in any capacity. workers' comp,insurance. g' •❑Demolition [No workers'comp.insurance 5. ❑ We are a corporation and its 9. ❑Building addition 3.❑ required.] officers have exercised their 10.❑Electrical repairs or additions 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 insurance ] emrequired.]t 12-ElRoofrepairs q employees. [No tivorkers' �,/ comp,insurance required.] 13.Ly'Other . y E_,:icant that chess box#1 must also fill eut the section below sho;=,••. �W� T Homeowners who submit this affidavit indicating they are doihire m� don policy information. #Contractors that check this box must attached an additional ng all work and then hir outsi a contractors must submit a new affidavit indicating such. 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 and job site information. Insurance Company Name: ,% /Vj'�f2 6 Policy#or Self-ins.Lie. Expiration Date: Job Site Address: cf Sj« ,Q� City/State/Zip- KY4--.//��� /�a6 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 ofMGL 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 under the pains and penalties of perjury that the information provided above is true and correct. Sienature: Date.: Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Pertnit/I.,icense# - Issuing Authority(circle one): L 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 6r 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 6r 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 co " PP p p mphance 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, checking the boxes that apply to your situation and,if necessary, 1y sub=contractor(s)n ame(s),address(es) and phone number(s)along with their certificates)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 be 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 rvtsL'ned to the pity iSr vm th=t the i4±y 12cE for far the or license is being rega'est-P not the o-p ern f • pmt —3 a "" s �-- �i-`�–T4'�'�-'• C1_ 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. 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. A new affidavit must be filled out each year.Where a homeowner 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 f6r 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 Baston,MA.02111 Tel. #617-72.7-4900 ext 406 or 1-8.77 MASSAEE Revised 5-26-05 Fax#6.17-727-71749 STTTTT.STI T1 n Rln�s �... Tomuinn Contract Q Employer ID # (978) 265.2390 QUINN'S CONSTRUCTION 868 Mammoth Road • Dracut, Massachusetts 01826 Page 2 of 3 E WORK TO BE PERFORMED AND MATERIALS TO BE USED Contractor Agrees To Do The Following Work For Owner: __ ,, , f-, ~ '. ; _,• 3, -,/�,., "-'. ,, S - - - `J c/ 1' ✓ .J t/" sit / /✓� ��d,�/C/s'/ / r� �( } ! t�/ /,C'�1`.. �!-.�,�,�-a ��r/is -"� ,� � x .a .r � 7. � w f��c ,•-.��, �. � ) - 1. J rf, ;d-C"r�/.�.rr'-; ���.R/ r-" .,/_ ��� /�7 r-- e � a �1 i� CC�i '. ✓,,'�Iv2 r/r� a;a�,. % /'""r.•, ,/ r �-'/ � .r"`r �-I r . �i..H e ��Jr'a"� l L'�.— �t r 7t r �rA— r ✓ ! �J r^ .Ia' .1C.,.—/ / ! I f / ./�!( � ' `~� �.K,r<'' lL ` .,=�. -') 3 • J r r' i lC.: ✓" — /�/.f "'�/ ' �r� 1 "x/C ,r J - 1 i._.I ). r 1t .. ✓,_ j / .i l J 1� )c The following schedule will be adhered to unless circumstances beyond the contractor's control arise: Work Scheduled To Begin: / // - Expected Date Of Completion: (Date Contractor will begin contracted work) Date when contracted work will be substantially completed) TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE The Contractor agrees to perform the work, furnish the material and labor specified above for the SUM of: $ C7,;D5,) J J (*Include all finance charges in this amount*) Payments will be made according to the following SCHEDULE: $ '�)­ ,: j p-1—upon signing contract(*Not to exceed 1/3 of the total contract price OR the cost of special order items, ' whichever is greater*). $ �.',' 1 by / / or upon completion of $ , by / / r or upon completion of r J $ ,_,. upon completion of the contract(*Law forbids demanding full payment until contract is completed to both parties'satisfaction*) In order to meet the completion schedule, the following material/equipment must be special ordered before the contracted work begins (*Law requires that any deposit or down payment required by the contractor before work begins may not exceed the greater of(a) one-third of the total contract price or(b) the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule*): $ r to be paid for DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Identical copies of the contract should go to the homeowner and the contractor. Homeowotr's Signature Contractor's Signature 1 Date Date You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller,which may be his main office or branch thereof,provided you notify the seller in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery,not later than midnight of the third business day following the signing of the agreement. See attached notice of cancellation for an explanation of this right.