HomeMy WebLinkAboutBuilding Permit #404 - 1631 SALEM STREET 11/23/2009 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: 0
Date Received
Date Issued: '
IMPORTANT:Applicant must complete all items on this page
LOCATION S gSJGM c'f—MEX j
Print
PROPERTY
PROPERTY OWNER
Print
MAP NO/d L PARCEL ZONING DISTRICT: Historic District yes no
Machine Shop Village es no
p g - y
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
i
New Building One family
addition Two or more family Industrial
i
fA teration No. of units: Commercial
epair, replacement Assessory Bldg Others:
Demolition Other
Septic . Well- � , _. Floodplain Wetlands Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
(LS174LL_
lM OcSo,Qa.[ Sz-p5 .
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Identification Please Type or Print Clearly)
OWNER: Name: v� �„� �z7-5
A1C Phone: �l�
SAI&. Sr QD
Address: �
CONTRACTOR Narne: tu.c(q-i 6
Address: 0 4:�'4_s
Supervisor's Construction:License: � � Exp, Date: Z- 1
Home.Improvement'License: Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:.BULDING PERMIT.$12.000/PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ �(3b FEE: $ �~
—"C/-
Check No.: 1. Receipt No.: `{�
NOTE: Persons contracting wflth u gistered contractors do not have access to the guaranty fund
Signatureof Agent/Owner wre of contractor
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
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
�,o L
L'dMENTS
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 38 ood Street
FIRE DEPARTMENT - Temp Dumpster onsite yes no
,Located at 124 Main Street
Fire Department signature/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
I
NOTES and DATA— (For department use
❑ Notified for pickup - Date
Doc:.Building Permit Revised 2008
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
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
a 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: Doc.Building Permit Revised 2008
Location
No. o Date
NORTot TOWN OF NORTH ANDOVER
F o"
• i Certificate of Occupancy $
}
sS C14USEt� Building/Frame Permit Fee $ .
Foundation Permit Fee $
Other Permit Fee $
!' TOTAL $
Check #
22649 -----
Building Inspector
VAORTH
o" of Andover .
0 T
No.
0 LA dover, Mass
COC NIC H KE
EWICK
V-ATE 1�? Cl
% BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
BUILDING INSPECTOR
............. .......... ..Ce!kl::�AAe�.........................................................................
THIS CERTIFIES THAT ... ................... eA Foundation
has permission to erect........................................ buildings on
...................................... Rough
to be occupied as.... .. . .........A ..........r1"OP-1.1Y....I...........
Chimney
provided that the person accepting this permit shall in every.respe� to.i6 terms r-m- ...a.f.the e....application. . . .-. . ...o...n.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
Final
PERMIT EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION STARTS Rough
Service
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.
SEE REVERSE SIDE
Smoke Det.
EE
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, llLA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): c� (,.✓ G
Address:
City/State/Zip: M_e ( M M-- Phone#: Cr7V �)O
Are you an employer?Check the appropriate bog: Type of project(required):
1.❑ lam a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction
. employees(full and/or part-time).* have hired the sub-contractors
2 1 am a sole proprietor,or,partner- listed on the attached sheet. t 7• ❑ Remodeling
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 10. Electrical re
required.] officers have exercised their ❑ pairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions
myself. [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.].
*.;.;y 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 and their workers'comp.policy information.
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 Self4ns.Lic.#: 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 Section 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 may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
Sign l2 3102
�7Date:
Phone#: ci / � coo /93—
Official use only. Do not write in this area,to be completed by city or town offwiaL
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 Iicensing 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."
Additional) MGL chapter 152 25C 7 states"Neither th
Additionally, p , § ( ) a 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 c workers' compensation insurance. If an LLC or LLP does v
q carry pe have
employees,a policy is required.uired. Be advised that this affidavit
may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign anddate 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 permittlicense number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license application 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 location 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 bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigation would Iike 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 Accident
Office of Investigations
600 Washington Street
BEoston, MA 02111
Tel. # 617-7274900 ext 406 or 1-877-MASSAFE
Revised 5-26-05
Fax# 617-727-7749
vv ,.mass.gov/dia
Of µORTH TOWN OF NORTH ANDOVER
°O� OFFICE OF
0
BUILDING DEPARTMENT
1600 Osgood Street Building 20, Suite 2-36
"oq,ieD'pP",�5 North Andover Massachusetts 01845
\ / �SSgcHusE�
1 Gerald A.Brown Telephone(978)688-9545
Inspector of Buildings Fax (978) 688-9542
.HOMEOWNER LICENSE EXEMPTION
T BUIDING PERMIT APPLICATION
Please print
DATE: o
JOB LOCATION: �ta�� L
Number Street dre Map/Lot
c , ) 91M.
` "3HOMEOWNER
Name Home Phone Work Phone
PRESENT MAILING ADDRESS • +
01 P��57
City Town State Zip Code
The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and
to allow such homeowners to engage an individual for hire who does not possess a license,P rovided that the owner
acts as supervisor). State Building (Code Section 108.3.5.1)
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to
be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be
considered a homeowner.
The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other
Applicable codes,by-laws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Revised 7.2009
Form Homeowners Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
190 Haverhill Street Suite 122
Methuen MA 01844
978.794.0402
Home Improvement Contract
The following contract for landscaping services is
respectfully submitted to
Tim & Diana McEachern
For the property located at:
1631 Salem Street
North Andover MA 01845
t
November 19, 2009
Home Improvement
Supplemental Contract
Scope of the Work
Remove the hollow staircase and build a new set of stairs per customer supplied picture,
using new brick and 6' blue stone treads and a block foundation. The old set of stairs
will be removed and a new slab foundation will be installed for the new stairs. The top
landing will be Canal Street Brick,and extended to match the front of the porch.
The material to pave the farmer's porch and the bluestone nosing is in the contract.
Construct and install a rail and post system for the porch and stairs to match the picture.
The material will be FJP(Finger jointed and primed)wood, and all end cuts will be
primed, the two upper posts @ the steps will be full length the two posts @ the bottom of
the steps will be typical, and there will be 2 -half posts to anchor the rail to the house.
The posts will be fluted to match the picture. The balusters will be 2" turned balusters to
match picture. The railing rails will be made of cedar rail stock
Prime and paint the porch railings and balusters white(M&L)
Contractor will pick up permit for the homeowner, homeowner will be charged the cost
for the permit
The contract Price
The owner shall pay the contractor for the materials and labor to be performed
under this contract the sum of six thousand one hundred thirty six dollars
($6136.04) subject to any additions and subtractions pursuant to authorized change
orders.
Payment Schedule.-
1.
chedule:1. $2000.00 Deposit to order material for the steps, the special
order railing parts
2. $2000.00 Payment-Arrive to start work.
3. $2136.00 Payment- Completion of steps walkway, and gutters
(Note: Deposit for special order materials).
Time of Completion
The start date will need to be determined based on the signature date of contract; however
the job is expected to take 2-2 1/2 weeks and will be started within 3-5 days of signature
date of contract. Final payment is due same day as completion. No exceptions.
General Provisions
Any alteration or deviation of the above specifications,including but not limited to
any such alteration or deviation involving additional material and/or labor costs,will
be executed only upon a written order for same, signed by owner and contractor, and
if there is any charge for such alteration or deviation the additional charge will be
added to the original contract price of this contract Payment terms for additional work
will be identified prior to the commencement of the work. If any payment is not
made when due, contractor may suspend work on the job until such time as all
payments due have been made. A failure to make payments for a period in excess of
seven days from the due date of payment shall be deemed a material breech not this
contract. In addition the following general provisions apply:
1. All work shall be completed in a workman like manner
2. Contractor may at its discretion engage subcontractors to perform work
hereunder provided contractor fully pays said subcontractor and in all
instances remain responsible for the proper completion of this contract.
3. Contractor shall furnish owner appropriate releases or waivers of lien for all
work performed or materials provided at the time the next progress payment is
due, if required.
4. Contractor agrees to remove all construction related debris and leave the job
in a broom clean condition.
5. Contractor and homeowner mutually agrees in advance that in the event the
contractor has a dispute concerning this contract,the contractor may submit
such dispute to a private arbitration service which has been approved by the
Office of Consumer Affairs and Business Regulations
6. Contractor shall not be held liable for any delay due to circumstances beyond
its control including strikes, casualty or general unavailability of materials,or
weather.
7. One final punch list will be submitted,this will be the only list, once
complete, the contract is considered complete and final payment will be due.
8. Accounts 15 days past due will be subject to a$ 35.00 late fee each month
accounts over 30 days past due subject to interest @ 1.5%per month and will
go to collections. Homeowner and/or the undersigned will be liable for all
collection costs and the outstanding Balance.
Owner
-NO kil
Contractor Rolling Green Landscaping
Insurance
The contractor represents that it has purchased and agrees that it will keep in force
for the duration of the performance of the work or for such longer term as may be
required by this agreement,in a company or companies lawfully authorized to do
business in the state of Massachusetts. Such insurance as will protect Rolling
Green Landscaping LLC and the owner of the site, from claims for loss or injury
which might arise out of or result from the contractors operations under this
project,whether such operations be by the contractor or a subcontractor or its
subcontractors.
The contractor represents and agrees that said insurance is written for and shall be
maintained in an amount not less than the limits of the liability specified below or
required by law,which ever coverage is greater. The contractor certifies that
coverage written on claims made form will be maintained without interruption
from the commencement of work until the expiration of all statutes of limitation.
1. Workers Compensation 100000each accident/5000000 policy limit
2. Liability 100000each occurrence 2000000 aggregate
limit
3. Automobile Liability 100000each occurrence 2000000 aggregate
limit
Warranty
Rolling Green warrants for a period of 2 seasons all normal wear and tear on all materials
and labor supplied by Rolling Green or its subcontractors. Repair or replacement of
defective item is up to the discretion of Rolling Green,and material vendor. There is no
extended warranty on defective materials supplied by the home owners;repair or
replacement would be at owner's expense. If called to property for claims not covered by
warranty a$40.00 minimum service charge will be assessed. Warranty is Void if any
other person or entity works on,modifies,or moves any component of system other than
Rolling Green Landscaping LLC without prior consent and written approval.Not
Responsible for damage due to misuse, snow plows,or acts of god and nature, or
maintenance neglect.
*Workers comp insurance provided only if employees or subcontractors are
engaged in work activity Certificates will be provided upon request.
r
Home Improvement Contractor Law
All home improvement contractors shall be registered and that any
inquiries about a contractor or a subcontractor relating to a registration
should be directed to;
Office of Consumer Affairs and Business Regulation
Ten Park Plaza, Suite 5170
Boston, MA 02116
Phone: (617) 973-8700
Persons contracting with unregistered contractors do not have access to
the state guarantee fund
You may cancel this agreement if it has been signed by a party thereto at a place other
than an address of the seller,which may be his main office or branch thereof,provided
you notify the seller in writing at his main office or branch by ordinary mail posted,by
telegram sent or by delivery, not later than midnight of the third business day following
the signing of the agreement.
DO NOT SIGN THIS PROPOSAL IF THERE ARE ANY
BLANK SPACES
William Rowe
William Rowe Tim&Diana McEacli rm
President
Rolling Green Landscaping LLC