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HomeMy WebLinkAboutBuilding Permit #219 - 16 SILSBEE ROAD 9/22/2006 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION o�No or 6 gtio ? '6 0 H p Permit NO: �1 Date Received b �, fq0 Argo <OcwKwrK• ' �9S APP��� Date Issued: ' (i L�� s CH Us� IMPORTANT: Applicant must complete all items on this page LOCATION Pry PROPERTY OWNER /�lZl �n/ Al-W�G Print MAP NO.: PARCEL: 3 ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Repair, replacement ❑ Assessory Bldg ❑ Commercial ❑ Demolition ❑ Moving(relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED �q Identification Please Type or Frint Clearly) OWNER: Name: n',,/ A I'I USZ06%gl9 Phone:77?-aj� ; PM Address: J�a �'/r� �a�F Zd/,? 1:zz CONTRACTOR Name: Rete 'f '•� � e Phone: 7op-6?q`dP0®7 Address: 9 go V7-// SP0,NJWA Supervisor's Construction License: �0 O 5'3 a Exp. Date:/ Home Improvement License: zea D Exp. Date: ARCHITECT/ENGINEER�c o L • ��?-t S Name: Phone: 97? 6, Address: -5�0 1���"r2 /1l�W,�e A/ Al No. /9 l Zoe FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATR COST BASED ON$125.00 PER S.F. Total Project Cost :$ �,,6�3 FEES Check No.: Receipt No.: S Page 1 of 4 TYPE OF SEWERAGE DISPOS L Swimming Pools El Art E] Public Sewer Well F1Tobacco Sales ❑ Food Packaging/Sales 11- Permanent Dumpster on Site ❑ Private(septic tank,etc. Electric Meter location to proj ect NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Signature of Agent/Owner .SFr- , CO Signature of contractor . ❑ Plans Submitted ❑ Plans Waived El Certified Plot Plan Stamped ped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ � I j COMMENTS D JECTED DATE APPROVED CONSERVATION - o COMMENTS azi, too/ DATE REJECTED DATE APPROVED HEALTH ❑ ❑ ' COMMENTS FIRE DEPARTMENT - Temp Dumpster on site yes no Fire Department signature/date 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 Date Driveway Permit Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided- Dimension rovidedDimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA— For department use Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan.2006 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 Addition Or Decks ❑ Building Permit Application ❑ Surveyed Plot Plan ❑ Workers Comp Aff davit _ ❑ 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) 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 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:BPFORM05 Page 4 of 4 a, ) Location S� No. Date ,M TOWN OF NORTH ANDOVER a0 Certificate of Occupancy $ ,�' •O��nn��'.. �SsuMusE<�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 19605 Building Inspector k NORTty Town of t L over 0 No. dover, Mass., Q t- LAKE I� COCHICHEWICK 7�ADRATED PPS\ BOARD OF HEALTH Food/Kitchen Septic System PERMIT T D • BUILDING INSPECTOR THIS CERTIFIES THAT........J**r.,�1...AI.!t.......... . ..A�.............. ...�.w/.1/..o........................ .... ................ Foundation has permission to erect........... ........................... buildings on 104..........41./../J:..0190.4 ....��'.............. Rough tobe occupied as.... 04Vl r t..... �..*.j....41.......... ...................................................................................... Chimney thprovided that the person accepting this permit shall in every respect conform1h the terms of the application on file in Final is 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 '?j 3 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU= S Rough 1 ..................... Service SPECTOR 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. I SEE REVERSE SIDE smoke Det. i ✓176 C4d)9L'19209tCBUIL� A+y✓�Z.110:1CLt"10 10 BOARD OF BUILDING REGULATI-�OhIS License: CONSTRUCTION SUPERVISOR Number: CS 083818 Birthdate: 02/13/1958 — Expires: 02/13/2007 Tr.no: 83818 Restricted: 00 STEVEN E WHALEN 331 DW HIGHWAY#5 "'�' MERRIMACK, NH 03054 Administrator I f w PLAN OF PROPOSED POOL CONSTRUCTION LOCATED IN NORTH ANDOVER, MASS. SCALE.-I"=20' DATE.9/6/2006 Scott L. Giles R.P.L.S. Frank. S. Giles R.P.L.S. 50 Deer Meadow Road ' North Andover, Mass. LOT#5 67.11' LOT#16 LANDCOURT PLAN 88138 SHEET 2 36' PROP. POOL 20.5' ti M _ _�s. _ -- 4' LOT#15 LOT#17 15.5' 1 10.5' o 0i EXIST. HSE. FND. #16 OF 13.62' ., 3 n . 13972 d1 SIyTEug��� ow �'��L lGllil� 60.00' I CERTIFY THAT SI L SBEE ROAD THE OFFSETS SHOWN COMPLY OFFSETS SHOWN ARE FOR THE USE OF THE BUILDING INSPECTOR ONLY WITH THE ZONING AND SUCH USE IS FOR THE DETERMINATION OF ZONING CONFORMITY BY LAWS OF OR NON-CONFORMITY WHEN CONSTRUCTED. NORTH ANDOVER FAMILY POOLS&PATIOS,INC. �3 CSL#010330 d sales • service • supplies HIC#118204 D OA 70 South Broadway,Lawrence,MA 01843 WC#4951074 O Tel: (978)688-8307 • Fax:(978)688-1949 LIAB#01098398230 01 Name i"( u Q Date. f - 1 /0 Q Address -city--V,) Ancloyer State m4 zip_&L�L,5 Home phone_(_ fRo 1 q& Work phone Cell phone������� Add'1# Cross street/directions /G'de' /ca Zr,/t?�t'i'�✓ 7Z-7 P/GYex p Estimated start date &"e- Orc S�%•• f Estimated completion date L-�- cam �E=�a j,, 0�Z We propose to furnish and install one /6�se" �',e�{�/�pn/-� swimming pool for the.sum-of$. /7_700 THIS PRICE INCLUDES: •Manual vacuum cleaner kit •Leaf net •8 Ft Steps ��✓d/Z/ 1itdJV1 /�Pj r "` I'S •Wall brush -Handrail A101V& — /00 •Rope&Floats •Extension pole •Filter /yc1>d • ide •Initial balancing chemicals •Test Kit plumbed no more than 25ft fro pool •8 to 12 Wk supply of maintenance chemicals •Surface skimmer((s)eP •Pump&motor /5 (supply depends on.pool-size)- •Co in f_f /�Jt� Choice of-liner THS _? PRICE ALSO INCLUDES THE FOLLOWING WORK TO BE PERFORMED BY A LICENSED ELECTRICIAN: Bond and ground pool-wiring of a 220 volt filter pump-one 110 volt plug-wire and install one 220 volt indoor time clock-outside wiring to be done in PVC pipe-sixty feet of electrical run from service panel to filter (*note:nuns over sixty feet will be subject to an extra charge)_Initials IN ADDITION TO THIS PRICE,ADD ESTIMATED K HOURS OF MACHINE TIME AT$/5.0 PER HOUR=$ SZ/00 THIS PRICE DOES NOT INCLUDE: _Initials Any machine time in excess of that estimated above. Additional machine time to be billed at the same rate as above due with the second pool payment. All hours of trucking will be charged at$----,7 e2 per hour per truck due with the second pool payment. Any dumping costs incurred for disposal of ledge,large rocks,or soil-re-seeding of grass around pool- spreading of loam-bucked in water -patio or fence around pool or any accessories except as noted below-additional fill,if necessary,for-proper.backfilI.orreshaping of hole- dis- posal of large rocks-fuel connections-heater venting-fuel storage tanks-permits-repair of damage to sprinkler systems or any buried items(ex.dry well,electrical lines,cables,etc.)in the access and pool overdig areas-plumbing to filter in excess of 25 feet-stumping,and/or removal of stumps.brush or debris.gomeowner is responsible for repairs of damage to known or unknown buried items. Water or soil conditions(ex.clay,peat,live sand,excessive rock,etc.)requiring a stone pack of the hole will be subject to an extra charge of$ .fid minimum to$ ga o O maximum. Use of the above mentioned stone pack will be at the discretion-of the_job.supervisor. Customers must supply access for all tracks and equipment. It is the owner's responsibility to obtain the building and electrical permits or to assume the costs of necessary permits. _Initials Notes: — ",f/— ? _ OPTIONS TOTALSi2 f/1i�1oG/oall Diving board ( ) ...... Basic Pool Price $_ /7, -700 Main drain X 6V rx-Ap =-,v a Estimated Machine Time o 0,9 Solar cover ( ) Options 50 Pool light (5--,WS,"S" ) /©_- Heater a 3 o Subtotal- $------------- Environpool PluQ hea 5%Sales Tax -7 p Caretaker w/Electronic Valve, 16hd 5100 <od&,,e-t- Additional floor heads( ) `7'0 o Total .P/pI $ Polaris Vac-Sweep s L0.%.Deposit. r $o 0 Polaris retrofit only /7eria v . ::Z-"+(y . Balance of Contract $ $ t 7 mou wiuddy Seat v2a 11(X1 j- Sol/.se. PAYMENTS: 113 EXCAVATION 113 BA L+EXTRAS 3 SYSTEM STARTUP The buyer hereby agrees to pay,in full,the total amount of this transaction upon start-up of the installed pool.Your salesman or job super- visor will meet with you two to three weeks prior to excavation at which time all decisions including pool size,shape,liner print,and all options must be final. Changes after this date will be subject to extra charges where applicable. You,the Buyer,may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction.Credit card payments not accepted on contract amount. BUYER date q / 661- The Commonwealth of Alassachuselts Department of Industrial I ecitlents Office of Investigations 600 Washington Street •• !»'' Boston, MA 02111 4t ; www.inass.govldia Workers' Compensation Insurance affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name tt3usiness,UrganiiatiOMIIltlkidual): Address: — City;State;Zip:l,0 /1LC�/j?� Phone #• M' Are you an employer?Check the appropriate box: Type of project(required): 1.[]'I ata a employer with 4. ❑ I am a general contractor and I 6. New construction employees(Full and'or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. ' E] Remodeling ship and have no employees These sub-contractors have 3. ❑ Demolition working for me in any capacity. workers' comp. insurance. y. 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 1 1.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §I(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' 13.0 Other comp. insurance required.] `Any;applicant that checks box ?I must also fill out the section below showing their workers'compensation policy information. 'f lomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors most submit a new affidavit indicating such. Contractors that check this box nwst attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am tin employer that is prowling workers'compensation insurance fir my employees. Below is the policy and job site information. > Insurance Company Name:,&'/�►�T T�'3�ie%I MC'� � �' Policy f or Self-ins. Lic. .=E: G✓ �93i 7 _—_ Expiration Date: /Z 3J Az Job Site Address:16S it? AA"'� 6/o. �r✓l vt rrl,Q. City;'State'Zip:__ O/C?3�s__ 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 NIGL c. 152 can lead to the imposition of eriminal penalties of a tine up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP'iN ORK ORDER and a tine 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 ofthe DIA for insurance coverage verification. du hereby cerci%y render the pains andpenalties of perjury that the in/urmntion provided above is true and correct. �i ,nature: Date: Z �d d)lfichd use only. Do not;Trite in this area, to he�.wmpletetl by eii)-or town glacial. City or Town: Pi.,rmit/License# Issuing,Authority(circle one): I. Board of Health 2. Building Department 3.City/Town Cleric T. Electrical q>>spector 5. f lutrtbing Inspector 6.Other an4su t Per aan: Phone#: I`f 'It:t11E�ETt P-:-Mart, tt /itt:wuffiFttarnat[imai'Rfew- giafttt Fax[M:HUELIi tmationid-W T;:Famgy_:PudtL 216=810,01 3A-PM'PaW:30f=4 -0 T OF Ii V Il °"T><(►�eantr�srl - THI>€�I;ItT�FtGA?l .iZ#ISS11M-AB-A`,pIA�TER=fiF-1NFtTRTAA�ON_ ONLYMMIZONFER NO;RIGHUPON:THI CEf -T.RT1FIQUE= =8tieraat l iiTe9P miqlaudLEHOILDER TM&-CE"FICATE DOES=NOT MMlY;EX-TEND OR' B llardv$1e & .: AETEwTHE;GOvEFtA.GE-AFF(DRDrz a THE=pot IGiE86RL-ew.- rm 110:887= 91 6 7�57100 Fmc:WW-9.881-003R 'IN ERSAFFOROINe--COVERAGE- NA1G Maim INSJJREETA:.. Saftty= 3:us=anCi-- 8rams.l . E7]CY�S 16_ E� � IffC.: ;INSLIREFFC° Sceitedaie-Innuerios=Cp�ar� 70 S---. INSURER D'. TT S G QII I L fadSP�CIIC>�NJi!�. $��r = IN;lRER. TPET YCtES-OF-INSURANCE-LISTED BEEOW=•}KV I-3Ea'f3EL3:TOJHEINSUREDNANED-ABOVE-TDR'TAET?MACYTPERIDD-INDICATED NOTWRHvT1dd6)1NG r ANY=REQ.MEM€NT.TERAAyXC_rgVTTIT;fifi}.iFANY'CONTRACTOR,OTHER D€CUMRfWfrHREWEffTOLVMJCHTHIS=CERTIFICATE'-fsAyT.BEIM13Hit7tA: IMYF'EWN,THE]N5URAMCEAFFORDED fW-Tt LICIEE:TESLRIBMHFREIN1S-SLJBIECT:TOALTHETERRM.EY..lUsIO1WA CDNDPIONS:OFSUCH= PFA3CSE--AGSR-CATE_Lmn-sLsHQWN MAY,HAVEBEENREDUCEtI:BYiRA1acLAIMS. LTtfINSMJIMMY= T3TEGFINSURANEE POLICY-Nt &BW OA'TE3(Mf9ta0TYYI': LIMIT$ _ GENERAL.LABH lT7 EA0i OTMURRENCE- -4t1000 OV C 3r CNIVERCIALGENERAL.LIABI R'Y Hir${i0 (i14 /3g/i? ; /31/M-er PRUMSESJEaem.w:,n $-t0lf00( (d.LifMS-M90E- QOCCUR: �MED (Any-°^8"P�sonl_ i$•E9Lfi PFRs9NAL&ADVimaiRY-' $'.1f3:tI_QB Iit 8 -�IIkt?.' AI= GENETALAGIREGgkTE $-c�t3a7IIQLiII- C�ENT:AC-��l2EioATElIMir/N?PLIE PE1 iPRE3GjU!~t5=L9NF'/OP-HYi£# $_'�Y j�.OQj� PCItIev•� I?F� - :JECT LiEv s ;lmW BCI .: I€�t6fltltla z CCVBWEDSINGIELIMTT. ! _ ; AMf'AltTl1 39472 ALL OWNTn-AITOS> BODILY:INJLRY ,SCHEDULt DMHOS: tFrmpwsrn): H!REDYIUTCG E3OE31LY:IN:illRY - _ �� NON�3WNHZi4UTD.�: (P�-occidsFltl'• '$-' - PROPERTY DWAAGE Fj .-GARAGEII!>r$IL[fY' - 'AUTO ONLY-EAACCIDENT. ,$ ANY-A2-3TT,Ii - C7F-LFRTI#Alh' EZtA $: sMJTUONLY- - _E]tT:E88NTABIlELt:Lk-19.49)1"tT7 _ ;EACH-OMIRRENCE- !$ OCClR3= CLLSiPiS=flTfif} AZGRUINTF- F Q' _ L}H3E7C-G7IE3L;E - RETENTM,4 7 WS1,�1fER&Tt[t VENSAMONJIN6- :EMPLOYEWUMMv TORY,LIMTTE EF€ $ I.9MPROPRIESOHIRARINERIE)EGUTIVt C 7 ' x/31/8$ E.L.FACHACCIDDIT $ ,Q _ OFFICEWEMBER.EXCUJDECV. - Uycs,. itieucttle�:: - :El..DISEASE-FA--EMPtDY ,,;$'j;U= ff SPECIAL.PROVISIt3PFv".4elow- 'Eli.DISEASE POI�ICY:LUAfT: c - r I EI0PIY3F-0PERRi1T3NS=l:vOICATICIM--1 VEMLIE .i,a(CLUSIONAIFftLtl�:M10)l8KIW Mcm- :: 7 >S�vrenee :01� Lam I2=: 4S! RoutAw- 12----,; umi& 3„ :ton_NEE Q3ff V.. Jbbi1QC'atsOa PIeB'E,_ Ili C CIT MM HSI t3ER_ CANCEi 1 RTit3J1= blIDDLEW SHOULD-ANY-0 7SWOREIPEEXEENAT[W '- OA7Fx1F�tE6RTtEE3SfitESdfrvdNffiI��MLti.[3�1.Vf1Ff7YttTu4gl . 1Q' [EAYI�iNRB71�' TIS o� �ifsdd7eto NaTteFT� HTtE°E�t�AratEurulTutsasHeU. 9-78-7-74-Ofillt TI3YZ- Rv 1, IME!O9BEO: iiONt3A1lABEAY.UFNtiYHBJETUFC3N?At�NB;IRER,ET3Ati5T175t3R Widd Lantaw 1L aims RE PREMWMT VEs AC[1RQ- L(7DffiTO$) aAGGRU C-OftPGRAMON-19M mu rr FAM (ELT 497 &TST t as tX -Tm CMWR BENCH! a fi!v M ELLc UT LA- 1 1 sr f: — 7 ;7 Se _ �Fc'tR-TFf�It#IEE�4tf t3iG �A1f4M�rt„ Cit - �t N-THEY- k%TARac s� t '. r i; t ate.rtf at : t�fi StiOf 7ID TH=F�QEILS W1C ty .. r te�o: +�ar • ��TES nurta�n�,,5i>1s:AI�Li .�sf 8111t�1�1L�. �°j°�'3alr�x. dDT:rti '_ 1 _`�➢ f� r :- `d .moi :.arrir ausrntrrl;_ efffl5mow EZ_ wry EiL °-I ✓le '(�anr�rno�aurP� a�✓�aaaaofzu�e/� BOARD,OF BUILOIN REGULATIONS ense: LicCONSTRUCTION SUPERVISOR 5kl. Number GS 010330 Bitthflate= 0 /.h 911960 E VA Tr.no: 14273 ' } t _._.._. Re-if! t v,6 WILLIAM C POULCSx� E:,'" }.t - 70"S BROADWAY LAWRENCE, MA 01$ 3 �6mitiissioner � ' �fze p Board of Building ----- Regulations and Standards HOME IMPROVE CONTRACTOR License or registration valid for individul us Registra66ni before the ex i e only - 1,18204 P ration date. If found return to: Ex ,r an — 32007 g Board of Building Regulations and Standards - One Ashburton Place RM 1301 --Ff rete Corporation Boston, FAMILY POOLS$t ,41*j INO Ma.02108 r >i WILLIAM GIANORIOULIjSF r� a 70 S.BROADWAY ;.. LAWRENCE,MA 01843 Administrator Not valid Without - ., Wature