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Home My WebLink AboutBuilding Permit #353-2017 - 140 MILL ROAD 10/3/2016 (3) NORTy .� BUILDING PERMIT O� TLEo �b 6 TOWN OF NORTH ANDOVER �� 6 so APPLICATION FOR PLAN EXAMINATION 1 Permit No#: Date Received ArEo gSSACHus Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER 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 ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic ❑Well 0 Floodplain D Wetlands ❑. Watershed District _-_0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: r Contractor Name: Phone: Email- Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: i 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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund liana �r of AaPnt/OwnerSignature of contractor 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 4 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 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 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 Doc:Building Permit Revised 2014 Plans Subrnitted': `2 Plans Waived ❑ Certified Plot Plan ❑ 8tarnped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/1V4assageBody Art ❑ Swnnming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ permanent Dwnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed OnSignature_ COMMENTS n IU IiJ ' wu - CONSERVATION Reviewed on S Siqnaturo)-- kAll C4 COMMENTS "U _qA (I k4D 0 A_Jr HEALTH Reviewed on Signature CGMMENTS -Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision. Comments Water& Sewer Connection/ Si nature� Date q Driveway Permit DPW Town Engineer: Signature: 4 Located 384 Osgood Street ;FIRE DEPARTME T Te�'mp Dumps_ter�dn;site yes Lrocateci at:124iMain#Str,et .:. �>� ' r .,..-.--e.�—.rte: a:3;.,.+c ♦... '4'�4•' S 53.,- ltt. ++��ir S' vZt 4 {Fire Department g:n r91.daste . ,`� `�;,'d�.{ ,,. <<�:.,�� n. +.-su,a� k t ,rs' 1. ��'.• 5 xni.' U�'�LL''> •,f y' ' y, . .a5�< >.t� r."i ..a._,:c��,� 'x � dirt-... ; �GOMMENTS�._ • l -�� :��.i � -ty .c E i , _' � L 'r� 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.$10041000 fine NOTES and DATA— (For department use) '6 " M, e V)AJ lb -?,-Cu) '17 &La 4. ® Notified for pickup Call Email Date Time Contact Name Doc.Bi lding Permit Revised 2014 Location /1-/0 W C L No. 35 3 a "� Date d " • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ f TOTAL $ V Check# f1YF _, Building Inspector 3095 tAORTiy q Town of 1 I, s ndover to No. h Co' h ver, Mass, /06 6i1 •♦ �i COCHICHRWICM ^' �•9 q°R^reo �Pa�,��5 S 11 BOARD OF HEALTH Food/Kitchen PERMIT T Septic System THIS CERTIFIES THAT ..�� .;,. /, .�..�,Q.I.�,H. .�I�. .,., ! ;f,•............. BUILDING INSPECTOR � ... has permission to erect .......................... buildings on ........1..'if.Q......�'.N�.�4�.. R ..... .... .................. Foundation Rough to be occupied as ......... flL......j��.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 IN 6 MONTHS ELECTRICAL INSPECTOR, UNLESS CONSTRUCT N STARTS 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 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.$10041000 fine NOTES and DATA— (For department use) U�(, 0 , I ,�: e� CPAW 7r�kLa 4-0 ® Notified for pickup Call Email t Date Time Contact Name = Doc.Buildinb Pennit Revised 2014 Plans Submitter Plans Waived Certified Plot Plan 11 ped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody 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 m U FORM PLANNING & DEVELOPMENT Reviewed On � Signature_ COMMENTS CONSERVATION Reviewed on .S Si iiro)— k11211 COMMENTS A PI HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Wafter& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FI E DEPARk MEN ,Temp Dumpster onLsite , rno j.Located at 124 Main Streets Fire Departmentsignatpu�rre/date - a �*� � LY aa ] 1'7t` . sr?� [ 4t ' -t 0— r" ° im { � n y � COMMENTS �"* '� ', Y: •- I�� COLONIAL RESTORATIONS, LLC Specializing in Structural Restoration/Repair Oof Post&Beam Homes and Barns since 1981 Homeowner Information Name/P one treet Address�� City/Town State 'p Code �P� O Contractor Information Company Name/Phone Number Colonial Restorations,LLC 508-735-9900 i Street Address 74 Dug Hill Rd. O City/Town State Zip Code Holland, MA 01521 Business Phone Federal Employer ID or S.S.Number: 042864184 Home Improvement Contractor Reg.Number: 108470 Expiration date: 8/18/16 (Describe in detail the work to completed.) � Q J o �t T f �S =(I N CZ c c e s S (Q C r em.✓ i S C,--V (-� a o 16 - Approximate date when contractor will begin contracted work. Approximate date when contracted work will be substantially completed. The nature of our work does not allow exact scheduling. Projects often grow in size once started if additional damage is found when the building is opened up. Weather, etc. can also cause delays. Q 74 Dug Hill Rd., Holland, MA 01521 (508) 735-9900 www cr]981.com email- infona,crl98Lcom r- r COLONIAL RESTORATIONS, LLC Specializing in Structural RestorationlRepair of Post&Beam Homes and Barns since 1981 10 Total Contract Price and Payment Schedule The Contractor agrees to perform the work specified above for the sum oft for labor(see estimate for possible additional charges). If any additional work is found,there will be additional charges. Material costs are additional and should be about 4 eba,00 . All conditions from estimate apply to this contract. A deposit of e 100.0 oC is required to be scheduled. Payment is to be in I parts with final payment due in full upon completion. Client agrees that deposit signifies their ownership of the property and responsibility for all bills. Property owner also signifies by deposit that property is residential,not commercial or industrial. When the estimate indicates payment to be in installments each installment is due after a proportionate amount of work is complete. Please have funds transferred to checking if necessary so payments can be made in a timely manner. Any payments significantly overdue will be subject to maximum interest rates allowable. Money for custom ordered materials is due prior to the order being placed. NOTES: (*)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. Subcontractors -The contractor agrees to be solely responsible for completion of the work described. If electricians,plumbers,or other contractors are needed for Colonial Restorations to perform their work, it is the responsibility of the homeowner to hire and pay other contractors. Colonial Restorations does not function as a general contractor. 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. Deposits are not refundable. Two identical copies of the contract must be completed and signed. One copy should go to the homeowner. The othfr copy should be kept by the contractor. llle7ll� aowZ) Homeo is i e/D toontra is Signature/Date 0 74 Dug Hill Rd., Holland, MA 01521 (508) 735-9900 wwwcrl981.com email- infona,cr198Lcom a�bjr pp � op ,0, rata O i � 1 e�. ta' r^ — f �p v n o S J{ ��'..!Y✓ S a �� ' �aS J�� S i\%� S �y �.:ZI r° C:a,Q�/'� �/ / ��` �! � � S/ J � 1 W�SOd�-%� ro, 0 1 Q The Commonwealth ofMassachusetts Department oflndustr•ialAccidents O1 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 ii Please Print Legibly Name (Business/Organization/Individual): 1 o n + (A2 e r L_cj c^ S Address: 142 2J City/State/Zip: C, 1f_2 / Phone#: S o 7 3 S^- 7!F 0- Are you an employer?Check the appropriate box: Type of project(required): 1.o I am a employer with employees(full and/or part-time).* 7. ❑New construction 2. am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 0 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.R I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.t p 6.R We are a corporation and its officers have exercised their right of exemption per MGL C. 14.0 ther �e S 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. 0 t Homeowners who submit this affidavit indicating they are 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer drat is providing iporlcers'compensation insuz'azce foz•nzy employees. Beloiv is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing tine policy number and expiratio;,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 DTA for insurance coverage verification. Ido hereby certify under the arns and enalties ofpeJuty that the inforination rovided above is true and correct. Si nature: Date: 8" a 3 I (o Phone#: 7 31- 7'tOO Official use only. Do not sprite 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 O6.Other Contact Person: Phone#: COL ONIAL RES TORA TIONS, LL C Specializing in Structural RestorataonlRepair Oof Post& Beam Homes and Barns since 1981 Massachusetts Department of Public Safety Board of Building Regulations and Standards MY " License: CS-078132 Colonial -� Construction Supervisor �l Restorations, LLC � Barn ? House ? Sills T BRADFORD GREEN 74 DUG HILL RD � Leaning Sagging - SPOTTED HOLLAND MA 01521 `� l BradGreen 508-735-9900 � I { ` ?om CJrecn nnvu,.cr1982.com mfoo-1981.com Expiration: Commissioner 08/22/2018 O p Office of Consumer Affairs&Busiess Regulation HOME IMPROVEMENT CONTRACTOR HOME IMPROVEMENT CONTRACTOR Registration: "1.08470 Type: COLONIAL RESTORATIONS Expiration 8/x8/2018 Partnership 74 Du Hill Rd _ g COL NIAL RESTORA% N�{' Holland,MA 01521 Thomas Green ` a, 74 DUG HILL RD. ` i� LIC./REG NO. EFFECTIVE EXPIRES HOLLAND,MA 01521 ~�:r -• ' "�' r- `" "� HIC.0606817 12/01/2015 11130/2016 Undersecretary SIGNED 74 Dug Hill Rd-Holland,MA 01521 (508) 735-9900 www.cr]981.com email-info@prl981.com