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HomeMy WebLinkAboutBuilding Permit #543 - 1492 GREAT POND ROAD 3/25/2008 NORTH BUILDING PERMIT 0 tuto 06 TOWN OF NORTH ANDOVER O L A APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received wran �SSACHUS�� Date Issued: ZSR o IMPORTANT: Applicant must complete all items on this page LOCATION044 `_ Pant _ Pft01'ERTY 0WIN: - _ Want MAP [ : PARCEL: Z NG f�STRtCT Histo rac 1��str ct yes =no Vlachfne Shops 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 Sep#ic ,1l :JJ 1=1adplai Wetlands ' -aterShedUstrict wat6r/,Sew ' - DESCRIPTION OF WORK TO BE PREFORMED: 71 �e c \i nn �4( v\AA Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRWCTOR Name: ILA � hor�e: f �. ` Address: Supermsor's Construction:License. � S Exp. .Date:. Home t a Tovernent Lrcense. Expo :Date. ' S ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.x$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ (D FEE: $ (;kq, Check No.: 41.)SL Receipt No.: Ol/O 7 NOTE: Persons contracting with istered contractors do not have access to the guaranty fund agnature of A ent/Own _ Signature of contracto �„ „ �, 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 Affida�vi ❑ Photo Copy Of. :C. And/Or C.S.L. Lic nses ❑ "Copy of Contrac ❑ 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/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 2.2007 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 2007 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS r Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes 4 Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature &Date Driveway Permit Located at 384 Osgood Street FIRE.DEP:ARTME'NT -TsmpDurn.pster:onsite yes no£ Located at 124 Main Street Fire Departrnentsignatureldate .77 ,� / COMMENTS Location No. d� Date MORTh TOWN OF NORTH ANDOVER 3? FEW O',(`•o •,h��L Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �1 Check 'A 2 , 0 ; 7A /Building Inspector NORTH Town of Andover 0 No.Sy 3 Z - over, Mass. �5A, �© d > D LA COCMIC ME WICK V Ao P"f\ 7�S RATED �C BOARD OF HEALTH i Food/Kitchen PERMI Septic System BUILDING INSPECTOR �e-"4. THIS CERTIFIES THAT.. .. .......................�...............................�.............:......................... Foundation ............................................ .. .. �/ < �--� �..... ..... ........................ Rough has permission to erect........................................ buildings on ........ 1 �' �/r� 7 Tirol�i .a d� Chimney tobe occupied as....... .L �: , ........!.. . . ..... ... .... ...............................:.....................//......//............::y...... provided that the person accepting this permit shall in every respect conform to the terms of the-41. he �ppli�ation 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 i VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough r�'� ��, r�--*^,...... Service G ........ BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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 Acadia Insurance Company Administered by Berkley Risk Administrators Company, LLC P.O. Box 939, Pierre, SD 57501-0939 2510 E. Irwin, Pierre, SD 57501 a Phone(605)945-2144 Fax(605)945-2048 Toll Free(800)634-4589 Acadia Insurance NCCI Carrier Code 33391 OFFER OF RENEWAL STATEMENT The Insured: WCIP Policy Number: WC-28-28-000455-01 Brian Smith Risk ID: dba: Brian Smith Carpentry Tax ID#: F 014528592 11 Pearson St Litchfield, NH 03052 Policy Period: From: 4/10/2008 To: 4/10/2009 Date of Mailing: 1/22/2008 Past Due Premium from audit for period 4/10/2006 to 4/10/2007. $0.00 Past Due Premium from Expiring Policy Period 4/10/2007 to 4/10/2008 $0.00 Net Deposit Premium for Renewal Period 4/10/2008 to 4/10/2009 $500.00 Amount necessary to renew $500.00 Total Premium: $1,000.00 The amount necessary to renew must be US postmarked or received prior to 4/10/2008. Timely payment of the necessary premium will assure you of continuous coverage. If your premium equals or exceeds$125,000 your payment of the renewal deposit constitutes knowledge and acceptance of the possible applicability of the LSRP to the policy. Please return the stub with your payment in the enclosed pre-addressed envelope to ensure proper credit. Make checks or money orders payable to Berkley Risk Administrators Company, LLC. Detach Stub Acadia Insurance Company Administered by Berkley Risk Administrators Company, LLC P.O. Box 939, Pierre, SD 57501-0939 2510 E. Irwin, Pierre, SD 57501 a Phone(605)945-2144 Fax(605)945-2048 Toll Free(800)634-4589 Acadia Insurance NCCI Carrier Code 33391 Date of Mailing: 1/22/2008 The Insured: WCIP Policy Number: WC-28-28-000455-01 Brian Smith Risk ID: dba: Brian Smith Carpentry Tax ID#: F 014528592 11 Pearson St Litchfield, NH 03052 Policy Period: From: 4/10/2008 To: 4/10/2009 Pay prior to 4/10/2008 Date of Mailing: 1/22/2008 Past Due Premium from audit for period 4/10/2006 to 4/10/2007 $0.00 Past Due Premium from Expiring Policy Period 4/10/2007 to 4/10/2008 $0.00 Net Deposit Premium for Renewal Period 4/10/2008 to 4/10/2009 $500.00 Amount necessary to renew $500.00 Total Premium: $1,000.00 Amount Enclosed: Indicate your policy number on your check or money order. BA 3510a (12/97) 8087 660589 The Commonwealth of Massachusetts Department Oflndus&W Accidents Office of Investigations 600 Washington Street .Boston, AL4 02111 www-mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le�bly Name(Business/Organization/Individual): LGA C Address: �. 12.0,\r-12.0,\r- S o',A � City/State/Zip:�J%�c Cn ►`,2� � � N s�� Phone.#._f��, u.��f -���� C�6o3 -Sb6 Tst-t� Are you an employer? Check the appropriate box: Type of project(required): 1.Q I am a employer with L ' 4• Q I am a general contractor and I employees (5Z and/or p . have hired the sub-contractors 6• ❑New construction 2.❑ I am a sole proprietor or partner_ listed on the attached sheet F7. Remodeling . ship and have no employees These sub-contractors have working forme in any capacity. employees and have workers' 8. ❑Demolition [No workers' comp,insurance comp• insurance.: ' 19• ❑Building-addition required.] 5. F-1 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11 Plumbing r ` myself. g epairs or additions y [No workers comp. right of exemption per MGL insurance required.]t c. 152, §1(4), and we have no 12.0 Roof repairs employees. [No workers' 13.2 Other 5 'a comm. insurance required] �ap r `Any applicant that checks box#1 must also fill out the section below showing their workers'compensation t Homeoa;ers who subant this affidavit indicatin;they are doing all work and then hir-outside policy information. 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-contractors have employees,they must provide their wor kers'comp:policy number. I am an employer that is providing workers'compensation insu information. rance for my employees. Below is the policy and job site Insurance Company Name: a Policy#or Self-ins. Lic.#:' '�1 ( _ �k'_� j Sk ` Expiration Date: Job Site Address:V4q* City/State/Zip:—No, 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 of MGL c. 152 can lead tothe imposition of criminal penalties o 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 --STOPforwared to the Office a Investi ations of the DIA for insurance covera a verification. I do hereby certify under the pains•and penalties of perjury that the information provided above is true and correct Si ature: Date: q —o Pbone#. - Offieial.use only. Do not write in this area, to be completedby city or town official. Cita or Town: Permit/License# Issuinb 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 as d 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 pe=rson in the service of another under any contract of hire, express or implied,oral or written." i 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"ever state or local licensing agency shall withhold the issuance or renewal of a license or permit to,bpera°tePa 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 1,52,§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 HE 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 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 youare 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 siuieto fill in the permittlicense 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 perxnits 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 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 6Q0�Jsshingaa Street Boston, MA 02111 Tel.#617-727-4900 ext.406 or 1-877-MASSAFE ` Fax # 617-727-7749 Revised 11-rt22-06 www.mass-gov/dia Thermal Performance Data ,it�--- - WINDOWS Harvey Replacement Windows & Patio Doors a Mr.& DOORS U-Factor in accordance with NFRC-100-2004,based on whole window value. To calculate R-value,divide 1 by the U-Factor(example:1 div.by.35=2.86 R-value).Test resultssubject to change due to periodic re-testing. Window Glazing U-Factor' SHGC Visible;Light ENERGY STAR® v� Transmittance Com'liance Classic Double Hung Clear 0.48 0.57 0.61 --- Welded sash &frame Low-E 0.35` 0.30 0.54 All Zones Low-E/Argon 0.32 0.30 0.54 All Zones 2X Low-E/Argon 0.31 0.28 0.48 All Zones "0.35 value for Classic DH w/Low-E Clear w/Contour Grid 0.48 0.51 0.55 --- effective for windows Low-E w/Contour Grid 0.35 0.27 0.48 All Zones manufactured after 12/01/06 Low-E/Argon w/Contour Grid 0.32 0.27 0.48 All Zones 2X Low-E/Argon w/Contour Grid 0.31 1 0.25 0.43 All Zones Slimline Double Hung Clear 0.49 0.59 0.63 --- -Welded sash&frame Low-E 0.36 0.30 0.52 NC, SC, S Low-E/Argon 0.32 0.30 0.52 All Zones 2X Low-E/Argon 0.32 0.28 0.50 All Zones Clear w/Contour Grid 0.49 0.53 0.56 --- Low-E w/Contour Grid 0.36 0.27 0.50 NC, SC, S Low-E/Argon w/Contour Grid 0.32 0.27 0.50 All Zones 2X Low-E/Argon w/Contour Grid 0.32 0.26 0.44 All Zones Slimline Single Hung Clear 0.49 0.59 0.63 --- -Welded sash &frame Low-E 0.36 0.30 0.52 NC, SC, S Low-E/Argon 0.32 0.30 0.52 All Zones 2X Low-E/Argon 0.32 0.28 0.50 All Zones Clear w/Contour Grid 0.49 0.53 0.56 --- Low-E w/Contour Grid 0.36 0.27 0.50 NC, SC, S Low-E/Argon w/Contour Grid 0.32 0.27 0.50 All Zones 2X Low-E/Argon w/Contour Grid 0.32 1 0.26 0.44 All Zones Signature Double Hung Clear 0.50 0.56 0.60 --- -Mechanical sash &frame Low-E 0.37 0.29 0.53 NC, SC, S Low-E/Argon 0.34 0.29 0.53 All Zones 2X Low-E/Argon 0.33 0.27 0.48 All Zones Clear w/Contour Grid 0.50 0.50 0.53 --- Low-E w/Contour Grid 0.37 0.26 0.47 NC, SC, S Low-E/Argon w/Contour Grid 0.34 0.26 0.47 All Zones 2X Low-E/Ar on w/Contour Grid 0.33 1 0.25 0.42 All Zones Vinyl Awning Clear 0.45 0.51 0.55 --- Low-E 0.34 0.26 0.48 All Zones Low-E/Argon 0.31 0.26 0.48 All Zones 2X Low-E/Argon 0.31 0.25 0.43 All Zones Clear w/Contour Grid 0.45 0.46 0.49 --- Low-E w/Contour Grid 0.34 0.24 0.44 All Zones Low-E/Argon w/Contour Grid 0.31 0.24 0.44 All Zones 2X Low-E/Ar on w/Contour Grid 0.31 0.22 0.39 All Zones Vinyl Casement Clear 0.45 0.51 0.55 --- Low-E 0.34 0.26 0.48 All Zones Low-E/Argon 0.31 0.26 0.48 All Zones 2X Low-E/Argon 0.31 0.25 0.43 All Zones Clear w/Contour Grid 0.45 0.46 0.49 --- Low-E w/Contour Grid 0.34 0.24 0.44 All Zones Low-E/Argon w/Contour Grid 0.31 0.24 0.44 All Zones 2X Low-E/Ar on w/Contour Grid 1 0.31 1 0.22 1 0.39 1 All Zones N=Northern,NC=North Central,SC=South Central,S=South Rev.7/07 T Brian Snaith Carpentry 11 Pearson Street Litchfield, NH 03052 603-424-0369 Jeff Doran 1492 Creat Pond Rd. No.Andover,MA. March 1, 2008 Windows/Doors/ Siding Windows: Replace eight double hung windows, seven @ 315/8" x 59" and one @ 30 %a"x 37" with Harvey"Classic" style replacement windows these units are all vinyl have low-e glass, double sash locks and will come with nine over nine grilles between the glass and have full fiberglass screens. The picture window 86" x 53" will be set up as a 1/4 'h 1/4 unit with the same features as the Classic units above, except for grille layout on the two flanker units which will be approximately 22" wide and unable to fit a nine over nine pattern. Doors: Replace front entrance 5'x 6'8" with a Smooth Star fiberglass unit having a 3' x 6'851 six panel door, bored for lock set and dead bolt with two 10" x 6'8" sidelites and have brickmould casing on the outside and a composite sill. Fire door 30" x 6'6" leading to the garage will be replaced with a six panel fire rated steel door and.bored for a lockset only. Siding: Remove and dispose of all existing siding and wood debris from soffits and corners,prior to siding a 3/8" rigid insulation will be applied to the entire house giving an R-Value of 1.5 .After insulating all accessories work such as soffit detail, inside and outside corners,j-channels around windows, doors and all termination points. Then the Mastic Sandtone Double 4" siding can be applied, all of the accessories will be the same color as the siding except for the soffit work done in white and all rake boards fascia boards and window trim being wrapped with white aluminum. Payments as follows: Advancement for material deposit----------------------------------$ 10,000.00 2nd installment at the start of the job-------------------------------$ 3,000.00 3rd installment after all windows and doors are installed--------$ 5,630.00 On completion---------------------------------------------------------$ 5,630.00 Total $ 241260.00 Homeowner=== Contract - - -------- Thank You 03/20/2008 08:27 5084327916 CAPE COD TECH PAGE 02/02 gar � Nord of AutldiriRAGRulago s antl Seindarda Con'struoNme 8upelrvlsot License UG9e\ CS 33806 12009 TrA 13288 i r y iy�t PAUL F SMITH , p 19 HEMLOCKH L 9REWS7ER.MA 02�3�'� '4 Comtnlaldnet i . � ,bel�pcwt�rorwwntrxlHc o�'./a�amac/rNe.� Board of Ruddialt Regulations and Standards HOME IMPROVEMENT CONTRACTOR RegistIM"n:,`.101007 Er __ 8/008 I r rrrV.Clr'` itl481 1.4 i PAUL F.SMITH Paul Smith :.-.;�.n i 19 Hemlock HallowD_'er' Brewster.MA 02631 Dcputy Administrator b