HomeMy WebLinkAboutBuilding Permit #016-17 - 133 GREENE STREET 7/6/2016 e I BUILDING PERMIT NORTH q
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
6-17 Date Received
Permit No#: � A°RAreo PPP '(5
--17
Date Issued:0-' -o .SSACHU5�4
IMPORTANT:Applicant must complete all items on this page
LOCATION e e e N t (L G 7—
P I t Print
PROPERTY OWNER I r S440 L-C.
Print 100 Year Structure yes no
MAP PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building 4?6ne family
V<ddition ❑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:
Ike x 3o igDo1Tta �'l�
Identification- PI ase Type or Print Clearly
OWNER: Name: �� � aV LL Phone:
Address:
Contractor Name: ��4 �-�^ i K J Phone: 7
Email: h v cl 9'-7 S:!� hS,U < C-v
Address: S c No& TV ^'
Supervisor's Construction License: 030 5-9 (0 S Exp. Date: i9p
Home Improvement License: 0 q L( �' 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. t a
Total Project Cost: $ 3a� o FEE: $ Irg?
Check No.: Receipt No.:
NOTE: Persons contracting with un r stered contractors do not have access to the guaranty fund
1
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. ❑ Pennanent Dempster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF e U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Signature ��
COMMENTS
HEALTH Reviewed on Siqnature
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
f
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTiMENT - Temp+Dumpster on-site eyes_ __ w no#
Located;at 1.2,4,Mbin4Stmet
Fiee Depactmentsignature/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)
i
Ll
Notified for pickup Call Email
Date Time Contact Name
Doc.Bnilding Permit Revised 2014
i
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
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
Building Permit Application
,rF 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
OTE: 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
4, Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Copy of Contract
2012 IECC Energy code
Engineering Affidavits for Engineered products
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
Doe:Building Permit Revised 2014
. =J
Location / �7 e r F f
No., Date -
i i
• - TOWN OF NORTH ANDOVER
k Certificate of Occupancy $
Building/Frame Permit Fee $ =r"
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ >
Check#f
,Building I ector
Enter construction cost for fee cal- North Andover Fee Calculation
Construction Cost
32,000.00 m
$ - $ 384.00
Plumbing Fee $ 48.00
Gas Fee 100 comm. $ 100.00
Electrical Fee $ 48.00
Total fees collected $ 580.00
133 Greene Street
016-2017 on 7/6/2016
16x30 addition
BUILDING PERMIT OF NORTy q
32 h6ygL.E D..;6 t6+�
TOWN OF NORTH ANDOVER -
APPLICATION FOR PLAN EXAMINATION
* Z : rye
Permit No#: / *
6-/ 7 Date Received �°o a`
�gSSgcHus�c 5
Date Issued:99-0
-090
IMPORTANT:Applicant must complete all items on this page
LOCATION I `3� G� N t � G
Print
PROPERTY OWNER L t4
Print 100 Year Structure yes no
MAP PARCEL: ZONING DISTRICT: Historic District yes_ no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building 4?<5-ne family
f<ddition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑Well p Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
( 4 X 0 /V
Identification- Plppase Type or Print Clearly
OWNER: Name: �'� ✓ 1`I-c�LC, dU' Phone: (Q 6 - 179
Address:
Contractor Name: PA v / Phone: 7 3-5-3
r�
Email: h v Cu 2 t/Jkc'Q CCr
Address: 6 C-ti D11, NO"k nom` aY
Supervisor's Construction License: (250 59 (0 Exp. Date: � Ago t(?
Home Improvement License: I O q L{9 Exp. Date: s—, (
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: $ o CAS FEE: $
Check No.: 626 Receipt No.:
NOTE: Persons contracting with un r stered contractors do not have access to the guaranty fund
Aqof_ - _
I
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OE SEWERS GE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swim ring Pools ❑
Well ❑ Tobacco Sales ❑
Food Packaging/Sales ❑
Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF e U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Signature �h
COMMENTS
HEALTH Reviewed ori 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
,t
DPW Town Engineer: Signature:
�_� . O
FIREi-DEPAR�TMENT m Located F+
ted 384 Osgood Street
�,% =,T_empIE)u Aster on site, ,yes;,, , .zw ,u` ��riod
Located' Sty. ._ a. =w_ - T__ _
_,at�124�Main eet - r
,. _
rFire4Department signature/date
COMMENTS
r 1 . - NORTF{ A
_ . w: .. . 2 1 : :. .� . . ve: +
No.
h , ver, Mass, 7 le-
coc"Ic"twics.
A0RATED PPp��S
S U BOARD OF HEALTH
PERMIT T LD Food/Kitchen
Septic System
THIS CERTIFIES THAT .........1.. ` :::`. ...1�.`:� �: .......................................................................... BUILDING INSPECTOR
�' Foundation
has permission to erect .......................... buildings on ./ti C.�.: «mil ....5. ............................
.............. . ......... .
Rough
tobe occupied as ............1 ,.., ...:l�b.....r ............................................................ 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 JN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONST N Rough
Service
.. .... ..... .. ..... .... ........... . . .......... ... Final
BUILDING I SPEC R
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. _
Massachusetts Home Improvement Sample Contract
This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard
language to protect homeowners. Seek legal advice if necessary. Any person planning home improvements should first obtain a copy of"A
Massachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the
Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website.
Homeowner Information Contractor Information
Name r Company Name
1r rtr 14 C.L W N� t ./Le.L
Street Address(do not use a Post Office Box address) Contractor/Salesperson/Owner Name
Q-r eco ^v r S 1 A v 1 4.11 k �•t o
City/Town State Zip Code Business Address(must include a street address)
Daytime Phone Evening Phone Cityrrown State Zip Code
q ) ? 3(eo - 1771 No - orA Im 4 01TY 5-
Mailing Address(It different from above) Business Phone I Federal Employer ID or S.S.Number
Home Imporement Contractor Reg.Nuud a Expiation dole
raw requires that most home
..tracts r ' 7/17
a vaareght
d ratba aumhr O, I/
The Contractor agrees to do the following work for the Homeowner.
(Describe in detail the work to completed,specifying the type,brand,and grade of materials to be used,use additional sheets if necessary.)
/ 4 X 30 10 Di !-io •v
Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will
and will be secured by the contractor as the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise
(Owners who secure their own permits will be �d�G
excluded from the Guaranty Fund provisions of Date when contractor will begin contracted work.
MGL chapter 142A.) 0
/ ate 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 total sum of. 3).1800 M
Payments will be made according to the following schedule:
$ 10 0010 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 /'r/jL
or u�pion completion of
$ , by / / 1�a6r upon completion of
$ 7. 0 Q upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction)
The following material/equipment must be special $ to be paid for
ordered before the contracted work begins in order
to meet the completion schedule.(**) $ to be paid for
NOTES:(a)Including all finance charges(**)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.
Express Warran -Is an express warranty inProvided
the contractor? MoNo D Yes(all terms of the warranty u attached to thecontract)
Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third
party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for
materials and labor under this aereement
Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the
contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices
carefully before signing this contract.
• Don't be pressured into signing the contract.Take time to read and fully understand it. Ask questions if something is unclear.
• Make sure the contractor has a valid Home Improvement Contractor Re isle tration. The law requires most home improvement contractors and
subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor
registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757.
• Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to
see a copy of a"proof of insurance"document.
• Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer
Guide to the Home Improvement Contractor Law.
You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the
contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the
third business day following the signing of this agreement. Seethe attached notice of cancellation form for an explanation of this right.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!!
coptes of the contrNtgurst be completed and signed.One copy should go to the hon,emvne other copy shoul kept by the corrector.
mcowner's Signature o a or's ignatur
Date Date
The Commonwealth of Massachusetts
n Department of IndustrialAccidents
I Congress Street,Suite 100
`= `< Boston,MA 02114-2017
www mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information {� Please Print .L/e 'bl
/In
Name (Business/Organizationdividual): U C k-'K S M 6 i10C,4 c.I/Z r r
Address: 15 C�_
J 2
Ul S
City/State/Zip: Na✓L N �)-w.�o M(}Phone#: 9 7
Are you an employer?Check the appropriate box: Type of project(required):
1.❑I am.a.employer with employees(full and/or part-time).* 7. ❑New construction
2fiKam a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling
any capacity.[No workers'comp.insurance required.]
3.❑I am a homeowner doing all work myself[No workers'comp..insurance required.]t 9. F1 Demolition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 wilding addition
ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees.
• 12.❑Plumbing repairs or additions
S. I am a general contractor and I have hired the sub-contractors listed on the attached sheet.
❑ 13.F1 Roof repairs
These sub-contractors have employees and have workers'comp.insurance.#
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.F1 Other
152,§1(4),and we have no.employees.[No workers'comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
i 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-contractors and state whether or not those entities have
employees. If the sub-contraci6i s 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:
Policy#or Self-ins.Lie.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certifyW#er thee pains qddpenalties of perjury that the information provided above is true and correct
Si nature: Date: 0
Phone# 7 �D CI _3 ?37
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 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-contractor(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 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 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.
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 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 Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston,MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 02-23-15 www.mass.gov/dia
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CS-069105
Construction Supervisor
PAUL G.HUTCHINS
16 STACY DRIVE +
NORTH ANDOVER MA 01846
CA,_ Expiration:
Commissioner 06/06/2018
~ (9/4 4�0?NniBdILIIICQ�{IL Oy
Office of Consumer Affairs&Bnsi ess Regulation
ME IMPROVEMENT CONTRACTOR Type•
egistration: :1-`9313 DBA
xpiration:;_7/171,26,16
HUTCHINS HOME If+1T
PAUL HUTCHINS
121 FARNUM STREET
g �
NORTH ANDOVER,MA 01`845'' Undersecretary
' f