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Home My WebLink AboutBuilding Permit #87 - 164 MILL ROAD 7/29/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: ot IMPORTANT:A licant must complete all items on this page -Ra LOCATION Cf L] ISI 1 { 1 ock r Print PROPERTY OWNER Q I G�(1�(l� LQ,� S n Unit# Print MAP NO/PARCEL: ZONING DISTRICT: Historic District no Machine Shop Village es no 100 year-old structure y no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New BuildingOne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Wepair, replacement ❑Assessory Bldg ElOthers: ❑ Demolition ❑ Other D Septic D Well D Floodplain D Wetlands Watershed District 0 Water/Sewer DE$CRIpTION OF WORK TO BE��OR44EDD: I r — x r'S lJ f exp e -r- � /P 0y, (Identification Please ype or Print Clearly) OWNER: Name: ¢hone: � w Address: I p, CONTRACTOR Name: Phone: Address: Supervisor's Construction License: ' O a� a� Exp. Date: ` o Home Improvement License: D 0`1 Exp. Date: ARCHITECT/ENGINEER SPC Phone:_ Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. �� Total Project Cost: $_ � � , 0 00 FEE: $ Check No.: 11O +�— Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to t gua ty fund -_�_ .� _ �__. � ._ Si nature�af-AgPnt/Owner . Signature�of contraeto J - 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 ❑ 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 o 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 2008mi 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 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 I DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS i 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 I ❑ Notified for pickup - Date I Doc:.Building Permit Revised 2011 June/mi I Location Ll D� No. �—I�"1 Date r f NaRTM TOWN OF NORTH ANDOVER 9 � + ; ; Certificate of Occupancy $ cNuBuilding/Frame Permit Fee $ swst Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2449 Building Inspector V4 RTH TOANM Of y over .. No. OA r �. o , dover, lVlass., ' 0 �- LAKE 4 �A cOC MIC ME WICK\y X1,95 RATEP"? C2 V BOARD OF HEALTH Food/KitchenPERMIT T D Septic System BUILDING INSPECTOR � �N THIS CERTIFIES THAT.......... ..... ... . .....n�� ......L.......... ............................... .. ........... .:..... Foundation has permission to erect......... )bou'ldings on...... ....... ..... .�.......... . .. ...... .............. ........... Rough to be occupied as...... .......... ......lk� ........�.... ............ ..... ....... Chimney c provided that the person accepting this permit shall in eve respect conform to the terms of the applica on file iwoo nFinal this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Cons ruction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final G� PERMIT EXPIRES IN 6 M S UNLESS 7 �^ ELECTRICAL INSPECTOR �J d�LESS C®N S UC� � 1 S Rough .................................. Service BUILDING INSPECTOR Final Occupancy Permit Required t® 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 FIR_E-DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. f The Commonwealth of Massachusetts Board of Building Regulations and Standards Massachusetts State Building Code,780 CMR,7h edition Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised One-or Two-Family Dwelling Aril 15, 2009 This Section For Official Use Only Building Permit Number: Date Applied: Signature: Building Commissioner/Inspector of Buildings Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Reco d: car nP. O�naS icy M 1 I Cod ame(Print)' ` Address for Service: � g � ignature Telephone SECTION 3:DESCRIPTION OF PROPOSED WORKZ(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) X7 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work': Q ICS S + X . , �. 1 M e LAO 4�,e► f Ctn 5 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ 5 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ J ❑Standard City/Town Application Fpe ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ Check No, Check Amount: Cash Amount: 6.Total Project Cost: 6,0001 60 Check Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) 16 4 QQ 7 013 e License Number Expir tion D e Name of CSL-4,01der R List CSL Type(see below) Type Description U Unrestricted(up to 35,000 Cu.Ft. Restricted 1&2 Family Dwelling ��2 M Only —)8 Residential J RC Residential Roofm Covering Telephone WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 Registered Homme improvement dont ctor(HI HIC Company Nam o C Registrant ame Regis6ation Number 4Ades ^�� _�31 'c� Expi tion Date Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes .......... No...........❑ rt SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I; as Owner of the subject property hereby authorize ��' , to act on my behalf,in all matters relative to work aut rized y this building permit application. 10 /&//z- Si ature of er /ate IJ I SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION t. wnerr or Auth�ze Agent JMeeclare that the statements and infoUnation oA the foregoing application are true and accurate,to the best of my knowledge and behalf., / (_m S n r5 ffnfk Print N _ 2�d zffi�ignature of Oi4Vr or Authorized Age#f Date Si ed under the pains and penalties of a 'u NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.R5,respectively. 2. When substantial work is planned,provide the information below: Total floors area(Sq.Ft.) (including garage,finished basement/attics,decks or porch) Gross living area(Sq.Ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of halfibaths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"maybe substituted for"Total Project Cost' i 91te Office of Consumer Affairs and Efusiness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 159704 Type: DBA f— Expiration: 5/19/2012 Tr# 297563 MASONRY DOCTOR JEFFREY SMITH 4 LESLIE RD. =' ; IPSWICH, MA 01938 7tr a `¢Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card DPS-CA1 0 5OM-04/04-G101216 �l:rxsach(rx'th- Dclru'trncnt of Public -Sal*ejI 130: 111 of Buildin", Rc"elation. ; Construction Supervisor Specialty rn(I �t:rn(1;ir i1 License: CS SL,104227 I-icense Restricted to: JEFFREY SMITH 'I 4 LESLIE RD IPSWICH, MA 01938 Expiration: 12/20/2013 (,.unui....i�,r Tr-,: 104227 • Circle Insurance Fax:978-777-4899 Jul 25 2011 11:23am P002 002 ) ACCMa CERTIFICATE OF LIABILITY INSURANCE DATE(MM THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THS CERTIFICATE OF INSURANCE DOES NOT CONSTTME A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: 9 the certificate holder Is in ADDITIONAL IM—RED,the policyCies) must be endorsed. if SUBROGATION IS WAIVED,subject to the tams and condi60ns of the policy,0B1UI0 policies may require an ondorsement A eafamerlt on this eertlttcate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCtdi N T Circle Business Insurance Age PHONE g7g 777_5618 (978) 777-4898 247 Newbury Street AOAaj Pau laHalas@CiraleInsurance.net Danvers, MA 01923 P ° 1357 INURE AFFORDHO COVERAGE NAIC0 INSURED INSURERA:Scottsdale Insurance Co. Masonry Doctor Inc. maunaRa:Travelers iraeuranee 4 Lesley Road INSURERC:UtiCa Ipswich, MA 01938 INSUR D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANy CONTRACT OK OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.INS _ LTR TYPEOFINSURANCE POLICY M8E P AMDdYYYY LIMITS GENERAL LIAVILM EACH OCCURRENCE S 1 00O 000 DAMAGE RE 50000 A X COAMERCALGENERAL LIABIUTv CI.S1559325 1/24/11 1/24/12 P $ CLAIMS-MADE ®OCCUA MED EXP(A ors palm) $ 5 000 PEIRSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE S 2.0 0 000 %WL AGGREGATE LIMITAPPLIESPER PRODUCT$- OMP/OP G $ 1,000,000 X POLICY7L "E'C'T F7 LOC Is AUTOMOBILEUABIUTY COMBINED SINGLE LIMIT $ BODILY 4/28/11 4/28/12 d•�I) B ANrnum HA1A069057 HODILVINJURY(per pereort) s 250,000 ALLOWNEDAUTOS BODILY INJURY(Per awide)t) $ 500,000 X SCHEDULEDAUT06 I PROPERTY DAMAGE X HIRED AUTOS (Per sed") $ 100,000 X NONOWNEDAUTOS $ $ UMHREUA LIA6 OCCUR EACH OCCUR $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETIENTION $ $ C WORKERS COMPENSATION 4439225 6/10/11 6/10/12, X WG STnrV oA 12 rH- ANC EMPLOYERS'LIABILm ANY PROPRIEiORIPARTNERIEJEWTNE Y f N N 1 A EX-11—U-1 EACAT DE T :$ 100-000 O WwaloN-Ift N REXCLtAED7 E.L.DI5EASE-EA EMPLOYEES 100,000 QAmlOsgry to NH) — IFyes Cow be wider DESCRIPTION OF OPERATIONS below EL.DISEmE-POLICY LIMIT s 500,000 TIONS I V9MCLE9 A�rh CORD I(M ACK"Ofte)Rerwrks Sd%9dd9.RTrWespace isrespired) OE 9CRIP'PON OF OPERA710NS I LOCA ( A Job:Laagston 164 Mill Road North Andover, MA 01845 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE'ABOVB DESCRIBED POLICIES BE CANCELLED BEFORE YFIE EXPIRATION DATE THEREOF, TI BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROW 146 Main Street North Andover, MA 01845 AUIHOR¢ED REPUBMTATI�-4, �w Shelli Graves •®1988:2009 D TION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD i The Commonwealth of Massachusetts ( Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 `[i www.nzass. ov g /ria Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information �p Please Print Legibly Name(Business/OrganizatioMndividual): UtC�c) D Address: Ll RQ City/State/Zips (A-I, v P"P one #: . q Are you an employer?Check the appropriate box: Type of project(required): am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction rm mployees(full and/or part-time).* have hired the sub-contractors am a sole proprietor or partner- listed on the attached sheet.t �• E]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 repairs or additions required.] officers have exercised their 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑ Roof rep�,ir�s insurance required.]t .employees.[No workers' 1�1711Roof i r l comp. insurance required.] ''"`''"" *Any applicant that checks bo)C#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:__ _ co, Policy#or Self-ins.Lic.#: q q 29 a as 5- Expiration Date:—�O-o o I Sob Site Address: \I/ a T City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).0 1 b J 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 c ify under airs and aloes ffAerjury that the informadi n provided above is tr a and correct Si ature: InUDate: Phone i) " ! q, Offlcial 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 Contact Person: Phone#: pry Doctor Inc. 4 Leslie Road Ipswich,Ma. 01938 Cherith.smith@gmail.com www.masonrydoctor.com 978.312.1932 CUSTOMER SERVICE AGREEMENT AND WORK CONTRACT This is an agreement between Marianne Langston(customer) and The Masonry Doctor Inc.,4 Leslie Road,Ipswich, Ma. 01938. Under the terms set forth below, Customer agrees to purchase the services of The Masonry Doctor Inc.,in preparing and constructing the project as set forth in the Project Description, and The Masonry Doctor Inc. agrees to render such services. As consideration, Customer agrees to pay The Masonry Doctor Inc.,the amount shown as `Total' in the Project Description(`Contract Price') in exchange for performing the services described in the Contract Description. The parties further agree as follows: s PAYMENTS Customer will pay the Masonry Doctor Inc.a retainer fee of$1,868.00 with a signed contract on or before the start date of the project. The customer will pay the Masonry Doctor Inc.the remaining balance of$3,732.00 upon completion of the project. CHANGES The Masonry Doctor Inc.,will make reasonable efforts to complete the contract as designed. Circumstances may arise beyond the control of The Masonry Doctor Inc.,that may prevent construction of the Contract exactly as planned. The Masonry Doctor Inc., will make reasonable efforts to minimize this impact on the design and construction. Customer acknowledges this possibility and acc6pts the action The Masonry Doctor Inc., will take to minimize the potential change in design. If Customer wishes to change any part of the instillation after this agreement is signed,but prior to the commencement of installation,which results in additional material or labor costs for The Masonry Doctor Inc.,or results in delays of the completion of the Contract, said costs will be added to the remaining balance of the Contract and billed as part of the original Contract. Any changes in the design or Contract whether the changes result in,additional time cost or g � � , neither,must be made in writing and signed by both parties,using a Change Order Form. z LIABILITY The Masonry Doctor Inc.,is not liable for injuries of Customer or others on the Customer's property injured by or on machinery, supplies or work area constructed and used by The Masonry Doctor Inc. The Customer is not liable for injuries of Masons while working and completing the Project Description. PROJECT START AND COMPLETION An estimate of the number of days to complete the contracted work and expect start date are provided as a courtesy. There may be delays in the start date and completion date due to poor weather or other circumstances beyond the control of the Masonry Doctor Inc. Those delays will not alter or invalidate any part of this Contract,nor will they entitle the Costumer to additional rights under the contract. TERMINATION This agreement may be canceled by the Customer by mailing written notice to they. Masonry Doctor Inc., 3 business days prior to the Start Date of the Project, as stated in the Contract. JOB DESCRIPTION Job Site: Marianne Langston 164 Mill Road North Andover,Mass.01845 Total: $5,600.00 Anticipated Completion Timeline: 1 week Project Start Date: Wednesday,August 24,2011 at 9:00 am Project Description: (front entryway stairs) Remove'all railings on front entryway; Remove existing limestone; Widen existing stairs(by entry door)two risers @ 16"x6'w/granite treads/platform (existing width 4'8");(bottom stairs)Remove bottom set of stairs (5 risers); Rebuild bottom set of stairs to original footprint w/used brick/granite treads; (porch)Remove limestone edge on porch; Install granite edge on porch; Dispose of debris; Clean job site Please note that railing work is not included in this contract. u PAYMENTS I j $1,868.00 retainer fee due on/or before Wednesday, August 24, 2011 (with signed contract) $3,732.00 due upon Project Completion Make check payable to: Masonry Doctor 4 Leslie Road Ipswich, Mass. 01938 This agreement shall be interpreted and enforced in accordance with the laws of the State of Massachusetts. Customer(Print) Date 2-EW ustomer( ignature) Date Masonry Doctor I c. July 18, 2011 The Ma Doctor InQ./) Date 711 ov//� ./ f �; } (^ Vr/ � � ` i �� ,,� �� !� `` '/� ;,;� -,,, � ,� R �� '-�� i� ,�/f � �/ �\ 4, \ �/ ,�.�� ,_ !`� --._