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Home My WebLink AboutBuilding Permit #166 - 167 LANCASTER ROAD 8/31/2009 BUILDING PERMIT. 01* No D06, rH qti TOWN OF NORTH ANDOVER ►°3�;4 APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received �, oR,TlG IpP` Date Issued: �SSACHt15��'(`' IMPORTANT:Applicant must complete all items on this page LOCATION ��yy,,�� ,,rr Print' PROPERTY OWNER !"`r "� f Print MAP NO:/ j PARCEL• r ZONING DISTRICT: Historic District yesn Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Resi Non- Residential New Building e#amily Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION F WORK TO BE PREFORMED: �- STa rf vzo u-Ir. ��>�� p �o tS'T- �jl�r��1z.{ --S . /l,'�.�--i� �t•t/�.S 1--14 AlIdentification Please Type or Print Clearly) OWNER: Name: Al TE-4 - Phone: x Address: /(a '7 `i',-- F- (ZasS � �f oa Z Ga CONTRACTOR Name: '. 4— AasS vt Phone: 978 fi� GtZ `�Z V105Address:lid +�.4c� - GmN�, �w(cs f3 . Supervisor's Construction License: cs 8'`2 3�a Exp. Date: Zca/ Home Improvement License: < N05-2Exp. Date: V-04001 ARCHITECT/ENGINEER / 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. .y Total Project Cost: $ o FEE: $ 4� —ry Check No.: Z5_14�� Receipt No.: dd- NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fun � . ..T � Signature of Agent/Owner Signature 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 i 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 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 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 2009 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 Li Workers Comp Affidavit o .Photo Copy Of H.I.C. And/Or C.S.L. Licenses o 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 o Building Permit Application ❑ Certified Surveyed Plot Plan o 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 L3 Certified Proposed Plot Plan .❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o 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:Building Permit Revised 2008 DATE(MMIDD/YY) Tl .15 OFLIAS ACORD PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE PAYCHEX AGENCY INC. HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR WEST HENRIETTA NY 14586 ALTER COMPANIES AFFORDING COVERAGE BELOW. COMPANY A GUARDINSURANCE INSUIRED COMPANY PL ROSS BUILDERS LLC e 120 LUMBER LANE UNIT 9 COMPANY TEWKSBURY,MA 01876- COMPANY • ............................................... .............•...•......................................................................................... .... ... 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 OR 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. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MM/DD/YY) DATE(MM/DD/YY) GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG $ =�LAIMS MADE[OCCUR PERSONAL&ADV INJURY $ OWNERS&CONTRACTOR'S PROT EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) $ MED EXP(Anyone person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ pUMBRELLA FORM AGGREGATE $ =OTHER THAN UMBRELLA FORM $ WORKER'S COMPENSATION AND X WC STATU- OTH- ER A EMPLOYERS'LIABILITY RY EL EACH ACCIDENT $ 100,000.00 THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE PLWC013248 02/15/09 02/15/10 EL DISEASE-POLICY LIMIT $ 500,000.00 OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE $ 100,000.00 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS <:.:..`•:.:.:;.:.:;� :�..... ....... . . . SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CITY OF MEDFORD EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL BUILDING DEPARTMENT 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 85 JUDGE P HASSETT DRIVE MEDFORD, MA 02155 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUT ED REPRESENTATIVE .............:..:.:..,......::::::.•:.•::. .:.•..-::...:•.•.:•:::::•:::. ::•::•:.•:::. :::•::::::.:•:. ::•:•::':•:: .. :::::::.•::::. ::::•.: :..•::::.•::::.::.::•:::.•::..;.........;............:.......;....:::.•: RR:2'5�5:: :::':':'::':': :':':':: ::::::::::::::: ': ::: ::• ::::::.:::::: :: .::@AC{3F3D:13C)RPC!#i#1 ACit3 .:::.:......:...:::::::............................... �AORTH Town of Andover . O .��-,ems m" yo I� •Sti M . C A E a dower, Mass., '��' COCHICHEW11 K 7d ADRATED S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.....A*,�k..... ....... %� Foundation has permission to erect........................................ buildings on ................ ��'+.............. .�q ,..Ifl.e ...... Rough to be occupied as.........1%.......... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final �— PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRU STARTS ELECTRICAL INSPECTOR 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. �usine��t►t°n Offi�f� omh �arts& n' nsumerCONTRACTOR HOME IMPROVEMENT Registratio \56652 Tr# 287031 Expiration.'--- 11 Corporation Ltd Liabdi Type* d} �� LLG , E P.L.ROSS BUILDRS µ, PAUL ROSS 120 LUMBER LANE Bl DG 1 , T I EWKSBURY,MA`,p18Y Undersecretary e"t of Public Sutct` setts- DcPutn'' una St<<ntlurd` 1Vlas,uchu' ,s Rculution ildin', License gourd of Bu ervisor Construction Sup License. CS 82898 Restricted to: 00 PAUL L ROSS JR HILL RD TLESt4 118 RAT p1810 ArIpOVER,MA EXpir ation: 711912010 Tr##: 117 ('a mniissl;�n�r The Commonwealth of Massachusetts Department of Industrial Accidents 2 Uf Office of Investigations 600 Washington Street Boston, MA 02111 www,mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information �tt Please Print Legibly Name (Bus iness/Organization/tndividual): �_ +`�' 5 601 L43-eZ5 Address: `.�v t %µ Q- t - �� 1)N1 i City/State/Zip I lwks.-G r l 0076 Phone #: C/ 0 800 2 Are yo n employer?Check the appropriate box: Type of project(required): I. I am 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.E] 1 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.E] l am a homeowner doing all work 8 P per right of exemption r MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.j t employees. [No workers' 13.[1 Other comp. insurance required.) *Any applicant that checks box M 1 must also fill out the section below showing their workers'compensation policy information. ' Homeowners who submit this affidavit indicating1ky amdoing 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-contnetors and their workers'comp.policy infomution. I am an employer that is providing workers'eompensedon insurance for my employees. Below is the polity and job site information. f Insurance Company Name: 6 VPfZ0 T J_SL �C,9__ Policy#or Self-ins. Lic.#: �L;.w c 80 rj / 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 S 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 ce • under the pains and pe Rtes of perjury that the information provided above is true and correct Signature. 1 V"I D4vy Date: Phone# Official 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#: i P.L. Ross Builders 120 Lumber Lane, Bldg 1, Unit 9, Tewksbury, MA 01876 (978) 851-0026 fax: (978)851-0028 Abbreviated Construction Contract The Parties: Contractor: P.L. Ross Builders, by Paul L. Ross, Jr., President. Owner(s): Mark Thayer, 167 Lancaster Road,North Andover, MA 01803 The Proiect• Location: 167 Lancaster Road,North Andover, MA Scope of Work: The Contractor shall provide all the necessary labor, materials, and supervision to complete all the following work, except as noted otherwise: Rafter repair: This repair will require removing the ceiling sheetrock from the top of ceiling down to the wall to provide access to both rafters and to allow staggering of the cuts in the strapping above the sheetrock. We will install the two sister rafters and the two double headers,replace the strapping and sheetrock and then finish with joint compound. We will alse install the extr- studs in the wall to those new"after-leads. We will also patch the cracks in the ceiling caused by the cut rafter. We will patch,prime and paint the affected ceilings and walls. Considering that we will have to cut the ceiling sheetrock at the top of the gable end wall,we will repair the gable end wall as well as the ceiling. We will also obtain the building permit and all inspections by the Building Inspector as viell as the Stfuettir^' Vie• Wood Molding at Hearth Extension: Assuming this work is done in conjunction with the above rafter repair,we will install new molding around the perimeter of the hearth and support for the HVAC vent. Project Cost: The Owner(s) agree to compensate the Contractor the $3,000. Payments as follows: 30% on contract signing and balance on completion. Any unpaid amounts shall accrue interest at the rate of%12 per year. The Owner(s) agree to pay all reasonable costs of collecting any overdue amounts, including attorneys' fees. Schedule The Project will begin approximately 1 week after contract signing or as mutually scheduled by Owner and Contractor. All work on site will be completed within two weeks of start of construction. Insurance The Owner shall be responsible for obtaining and/or maintaining Owner's property and casualty insurance written on an all risk basis. The Contractor shall be responsible for providing Commercial General Liability, Workmen's Compensation and Automobile Insurance to protect against liability arising from the Contractor's operations. Owners' Covenant not to Hire Contractor's Subcontractors The Contractor will introduce Owner to several of Contractor's subcontractor who may provide design assistance, advance price quotations and possibly construction services for the A I x Project. The Owners agree and covenant not to separately approach or contract with any of these subcontractors for a period to conclude the later of one year after the completion of all construction work on the Project or a period of two years from the date of this agreement. The Owners agree that any breach of this covenant shall be a material breach of this agreement and entitle Contractor to its 25% overhead and profit markup on those services plus all reasonable attorneys' fees and costs incurred in enforcing this covenant. Extent of AEreement This Contract and the documents incorporated by reference herein constitute the entire agreement between the parties. It supersedes all prior and contemporaneous agreements, whether oral or written, and may only be altered by written change order signed by both the Owner and Contractor. Dispute Resolution All claims or disputes between the Contractor and Owner(s) arising out of or related to this Agreement, or the alleged breach thereof, shall be decided by arbitration in accordance with the Construction Industry Arbitration Rules of the American Arbitration Association currently in effect unless the parties mutually agree otherwise. Notice of the demand for arbitration shall be filed in writing with the other party to this Agreement and shall be made within a reasonable time after the dispute has arisen. A single arbitrator shall be mutually selected by the parties or in the event of no agreement on an arbitrator the matter shall be submitted to the American Arbitration Association. The award rendered by the arbitrator shall be final, and judgment may be entered upon it in accordance with applicable law in any court having jurisdiction thereof. Contractor's Initials ; Owners' Initials The above agreement is entered into under seal on lJ , 2009. - Do not sign this Agreement if there are any blank spaces. - Included addenda or additional documents: Contract Addendum–Massachusetts Home Improvement Contractors Regulations; Owner's Statutory Cancellation Rights; P.L. RoA Builder By: Paul L. oss, Jr., President O r: Mak Thayer— Owner: Owners'Statutory Right ht to Cancel this Contract You may cancel this agreement if it has been signed by a party thereto ataP lace other than the address of the contractor,which may be his main office or branch thereof,provided you notify the contractor 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 this agreement. Locatio f Gsh��Lf� No. Date 6� f MaRTN TOWN OF NORTH ANDOVER 0� .•o ,•,tib 3? • OL Certificate of Occupancy $ sACM�s<� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 22Y/ 5 Building Inspector