HomeMy WebLinkAboutBuilding Permit #768-11 - 14 PERRY STREET 5/13/2011 L
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit N0: 76 Date Received
Date Issued: /✓? //
I ORTANT:Applicant must complete all items on this page
LOCATION N &L-PU 5(
7 Print
PROPERTY OWNER ie- 5
Print
MAP NO: PARCEL: 02�, ZONING DISTRICT: Historic Districtes n
y o
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
i ❑ New Building ❑ One family
EE4
i ❑Add' ' n ❑Two or more family ❑ Industrial
❑ eration No, of units: ❑ Commercial
i epair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
® S ptic ®Well _ Flo dpla 0 Ude lands W ater�hed Dish
DESCRIPTION OF WORK TO BE P'iR ORMED;
(Identification Please Type or Print Clearly)
OWNER: Name: w c ��
Phone: ��
Address: l
CONTRACTOR Name: �;,vw,nt �c v,�„� Cc�,�t� ,��-�� �L-'kphone: o 732
Address: I S(�.-v{rzv- l_,2 �-{ �, ,) �'� 03
Supervisor's Construction License: /04 2g Exp. Date:
Home Improvement License: 1i;(6 i l Exp. Date: ��f zl�2=
ARCHITECT/ENGINEER Phone: `
s
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: FEE: $_ 7�
Check No.: 7 Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to uaranty fund
Si nature"' AA ent/O`wner` xS - -
g = AStgnature oftcontractor Mss
�? F_
Building Department
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 Camp 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
l
❑ 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)
o 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
Doo: Doc.Building Permit Revised 2008mi
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 ' El Food Packaging/Sales ElPrivate(septic tank,etc. El 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 S eet
FIRE DEPARTMENT -Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS�,w� �'-r�-
t
I
Dimension
Number of Stories: Totals square feet of floor area based on Exterior xterior dimensions.
i
Total land areas . ft.:
q _
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
I
® Notified for pickup - Date
Doc:.Building Permit Revised 2008mi
Location/
No. " // Date
NORTH TOWN OF NORTH ANDOVER
0
F s
9
Certificate of Occupancy $
�•�a',,,°''<�'
Building/Frame/Frame Permit Fee $
s+cHust 9
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
24153
,uilding Inspector
ORTH
ONM Of 6 over
No.
7T.
68'- Zo�� _
C%0
tL- LAK -O , dover, Mass.,
COCMICME W ICK
ADRATED
S U ` BOARD OF HEALTH
PERMIT TFood/Kitchen
I Septic System
S��,f �G,li BUILDING INSPECTOR
J1THIS CERTIFIES THAT...... . .�.. �..�. ....................... ................. .......................................................................................
Foundation
has permission to erect...............:.:...................... buildings on ./..9Z??: ' ' .........S
............................................ Rough
to be occupied as.................................. �!/. .. ....... ...... �' �.. ................................ Chimney
e
............... C y
provided that the person,accepting this permit hall i every respectconform o 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
PERMIT EXPIRES IN 6 MONTHS Final
ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION STARTS
Rough
.................................... ............... ........................................................ Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove Rough
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.
Fully Licensed and Insured • Member of MA Better Business Bureau 111 Member of NH Better Business Bureau
GAF Cert.ME#20212 �07��"� � HIC.Reg#1,66661
' EIN#26-1081508 MA CSL#014728
'BBB` �..•,..wo..a.�.
General Contracting, ill
AME o0
_ � M�C�iElitue
51 S. Broadway#2214 Salem, NH 03079 (603) 890-0084 10 Stevens Street#141 Andover, MA 01810 (978)475-0095
PROPOSAL SUBMITTED TO PHONE DATE
{
STREET E-MAIL
CITY,STATE,AN ZIP CODE" �/( Q JOB LOCATION
Completely protect the home with tarps to catch falling debris. Respect and protect shrubbery and flower beds.
Strip off I layers of,ro.ofing.material down to the bare roof deck. Inspect the roof deck for structural defects.
Determine the condition of the underlying plywood or boards, and repair and replace as necessary*.
Inspect roof ridge for proper 11/2" spacing on either side of ridge for maximum exhaust ventilation. Cut in if necessary.
Install new heavy gauge 1,i1,r t (color) A11-1,,-' drip edge at roof eaves.
Install �11 ice and water shield to meet manufacturer's specifications (i.e. 6 feet from roof edge, 3 feet centered in
valleys, around all skylights, chimney bases, roof penetrations and at all sidewall transitions).
Install Z-',2 r- e, AI'm.Anl breathable roof deck protection to remainder of the roof deck.
Install new heavy gauge Gij✓1r'4- (color) f,��(J� drip edge at roof rakes.
Install tI starter strip at roof eaves and rakes.
Install(-'k Tc.ir, desired color.'-,,Io,�r (color) � 1.v,
Install new flashings to meet manufacturer's specifications. (i.e. sidewalls, chimneys, skylights and roof penetrations).
Install '?Q —(feet) of </. Cc.�, �tv,/ ridge vent at roof ridge to allow maximum ventilation.
Hand nail to ensure proper fastening.
Install /00 (feet) of <_;ic distinctive hip and ridge cap. Hand nail to ensure proper fastening.
Thoroughly clean up and dispose of all roofing debris on property. Magnetically sweep property for nails.
Notes: - S' �1 - tz-"fx�'---� ••f— �:r P X l c-..o tJ YyCC fi C �A-r't A:, r/I
ay. �',Ic. r k��C3;I�l �:� lr fi P_' �,1.. fe N ) ( P x r- f f,� �lL.T I/•fX7t<'
1_ r
Edmunds(3eneral'Contractin wjl,l
9 s..-_-� �
• Obtain all necessary construction-related perm�it)8o atopl thi.,-.ss project.
• Perform work as efficiently as possible without sacrificing quality.
+Furnish and install all necessary material's to complete the project. f r��t1 l-last' ^5
• Provide a thorough clean-up and disposal of all debris generated during project.
Edmunds General Contracting LLC agrees to commence work on/or about
and described work will be completed in about r days.
Product Upgrade 1:''# � � �1h�*� r ?a'.cv c z % c'•rv;N�rJr t�
Product Upgrade 2: 4 ---t - ---�� v�r-fini S�c_t`
J ')F~ �C>
Contractor's employees are fully covered by workmen's compensation and liability It is further agreed that this contract may be assigned by the contractor,and also
insurance. that the obligations hereof shall bind and apply to their heirs,successors or estates
of the parties.
Upon completion of the above work,all undersigned agree to execute and deliver to
the contractor,their joint note in accordance with his(their)above obligations as Edmunds General Contracting LLC guarantees all workmanship performed for
requested by contractor.Upon refusal to do so,contractor may at its option declare S�years.
the entire contract price or so much as then remains unpaid,immediately due and
payable.It is agreed that,if permitted by law,contractor shall be paid by the We will register 1 factory enhanced warranty
owner(s)all reasonable costs,attorney fees,and expenses,in addition to the providing '2 years of material defect coverage and X years of
amount due and unpaid,that shall be incurred in enforcing the terms and conditions workmanship defe t�coverage through GAF Materials Corporation for:
of the contract and/or any lien in connection herewith. no charge. _'r the additional cost of 7I X
'Edmunds General contracting LLC will provide the materials,labor and disposal to replace up to 64 sq.ft.off,roof decking and 20 ft of fascia at no additional cost.
Any additional materials including labor and disposal will be replaced at C per sheet or linear toot.
x
Edmunds General Contracting, LLC agrees to furnish the material and All material is guaranteed as specified.All work to be completed in a workmanlike manner according to standard
practice.Any alteration or deviation from above specifications Involving extra costs will be executed only upon written
labor complete in accordance with the above specifications, for the sum orders,and will become an extra charge over and above the stated contract price.Contractor is not responsible for
1 ,� damage due to high winds,tornadoes,hurricanes,fire or other hazards.Owner(s)agree to carry fire tornado and other
of ,1•. f d ;�c.c.-., .1) +1..,l t ;;I,,r c r dollars(s G Lt'p ) necessary insurance.Contractor is considerate of owner's landscaping and but due to the nature of the roofing
installation some damage may occur.We attempt to minimize any damage,and will not be held responsible If any
Payment Terms: _ _ damage occurs. Contractor is not responsible for any damage to the'nteiior�bI property,including pre-existing
• `� - - - conditions(i.e.water stalns,-crumbling plaster,exposed nails).,or•conditlons-resulting-from application-of.materlals:as-
AdeOSit Of •. :.
p (not to exceed 1/3 of the total contract)is due upon specified above.Items in the attic may need toxbe covered 6ythe'dw er.Contract r Is not responsible for damage
start of work.The balance ofP(;r-C,O is due when work is completed to the caused by ice dam build-up.All agreements arp contingenty n strikes',accidents, delays beyond our control.
satisfaction of all parties.
.+'d Signature:nature:
thorze .
• For your convenience we offer financing and accept all major credit cards. Aug r' ��
If you elect one of these options we will add an additional 5%to the contract ! ( 5drr ds General/Contracting LLC
rice stated above to cover dealer/merchant fees.(��o - � ) {I``t ` - �In" /
P %�kJr i,�� �,I c� i; ;U�
• A finance charge of 1.5%per month(18%per year)will be charged on past due J Note: This proposal may be wlfh raven by•u if not accepted within
7
accounts over 30 days I_..�y t days. `
01LCC�11tance Of Propo!5al The above prices,specifications,and DO NOT SIGN THIS CONTRACT I�TFERE R)E ANY LANK SPACES.
conditions are satisfactory and are hereby accepted.You are authorized to do
the work as specified.Payment will bemadeas outlined above. Authorized Signat5re: -
Date of acceptance: ()�� Q Authorized Signature:
x
All home Improvement contractors shall be registered.Any inquiries about a contractor or subcontractor relating to a registration should be directed to:Office of Consumer Affairs and Business Regulation,10 Park Plaza,Suite 5170,Boston,MA 02116(Phone:617-973-8700).
Owners who secure their own construction—related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund provisions of MGL.c.142A
The owner will receive a signed copy of this contract before work will commence.The owner has three(3)business days to cancel this contract and incur no penalty.Correspondence should be directed to Edmunds General Contracting LLC at the above address.
Rev.04/11
The Commonwealth of Massachusetts
6 ;, Department oflndustrialAccidents
Office of Investigations ,
4� �'v r
600 Washington Street
Boston,MA 02111
www.massgov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information . Please PrinfLegibl�
Name(Business/Organization/Individual): (�c� /�yi Lc'S�C17 .Lr11iIc LCL
Address:
City/State/Zip: C:5-6 l Phone#: (0
Are aln employer?Check the appropriate box: 'Type of project(required):
1. I am a employer with 5 4. ❑ I am a general contractor and I 6 El New construction
employees(full and/or part-time).* have hired the sub-contractors
Remodeling
2.F1 am sole proprietor or partner- listed on the attached sheet. 1 7. ❑ g
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers'comp.insurance. 9. ❑Building addition
[No workers' comp.insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL - 11.0 Plumbing repairs or additions
inyself.[No workers'comp, c. 152, §1(4),and we have no 12.❑Roof repairs
insurance required.]t employees.[No workers'
13.❑Other
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.
Contractors that check this box must attached an additional sheet showing the name of the sub-contractors acid their workers'comp.policy olic information.
X am an employer that is providing workers'compensation insurancefor my employees. Below is the policy and job site
information.
Insurance Company Name: 1-1 '{y
Policy#or Self-ins.Lie.#: wc..? ?,/S 3r., 7:5 z�2o Expiration Date: //zr / Zo/z
Job Site Address: 114 Nwn/�, -3 City/State/Zip: ItJ r���c.i/� O( %'Y�_
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Sedtion 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 maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
Y do hereby certify un e the ins andpenalties ofperyury that the informationprovided above is true and correct
Sigpature: Date: sh,
Phone#: f 7 Z
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
I
Contact Person: Phone#: f
• i
i
Information and Instructl®
n'
Massachusetts General Laws chapter hapter 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 aparhnents 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 i chapter 152,,§25C(6)also states that"ever state or y 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 our situation and,if
Pp Y to Y �
necessary,supply sub-contractors)name(s),address(es)and phone numbers)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 confinnation of insurance coverage. AIso be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the pen-nit or license is being requested,not the Department of
Industrial Accidents. Should you have any.questions regarding the law or ifyou 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 Deparhnent 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 pennit/Iieense number which will be used as a reference number. Irl 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 c'
» r or
tow in_(city
town)."Aco of affidavit avit
copy. 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 pen-nits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or pen-nit 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 iromrnonwealti of Massachusetts -
De,partmcut of Industrial Accidents
Office of Investigations
600 Washington Street
Foston,MA 02111
Tel.# 617-727-4900 ext 406 or 1-877-MASSAFE
Revised 5-26-05 Fax#617-727.7749
www.mass.gov/dia i
I
Massachusetts- Department of Public Safeth
Board of Building Regulations auul St:rridar(is
Construction Supervisor License
License: CS 104728
DAVID EDMUNDS .
P.O. BOX 2214
SALEM, NH 03079
_ J
c—
�"'G-'y�� Expiration: 10/3/2013
('ommis.iuncr Tr#: 104728
Office of Consumer Affairs&B siness Regulation
HOME,)MPROVEMENT.CONTRACTOR
W"Registration:_ 166661 Type:
Expiration: _612112012- Corporation
..E UNDS GENERAL`GO'NTRACTING, LLC.
DAVID EDMUNDS.
.•
1 SHAKER LN `-"
Y_ .•
HAMPSTEAD,NH 03841 : :". Undersecretary