HomeMy WebLinkAboutBuilding Permit #610 - 168 BERKELEY ROAD 5/12/2009Permit NO:
Date Issued:
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION. FO.R PLAN E3CAMINATION
Date Received
I IIMPORTANT: Applicant must complete all items on this page
LOCATIO
M
PROPERTY OWNER l
MAP NO: Ltj PARCEL ZONING DISTRICT: tE Historic District
Machine Shop
yes.
D��TilD �6• NC
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
One family
Addition -- 2-5&4
Two or more family
Industrial
Alteration
No. of units:
Commercial
Repair, replacement L)ex-
Assessory Bldg
Others:
Demolition
Other
Septic Well
Floodplain Wetlands
Watershed District
Water/Sewer
C+
DESCRIPTION OF WORK TO BE PREFORMED:
Identification Please Type or Print Clearly) n c+�
OWNER: Name: meq/ ��4e.0 iV F�-e b Phone�Z 7N S��7'� �d
Address: N
CONTRACTOR Name. a( W14x 4tAV' Phone: ec? 13 ;9L)1,S
Address: �" L c.s G Uv9 rtt 3 c5 Y
Supervisor's Construction License: OQ0 Exp. Date: -7 1
Home Improvement License: / Exp.. Date: l 2- 1.2 0
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
r
Total Project Cost: $ ov�% 3 d C- Z � FEE: $ �
Check No.: y� 57 Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
+Lc -
Location
Date
TOWN
�� 9
No. ,
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check,,
J
22U�44
Btfifdin( Inspector
R
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 o
COMMENTS
HEALTH
COMMENTS
re
on ISignature
Zoning Board of Appeals: Variance, Petition No:
Planning Board Decision:
Comments
Zoning Decision/receipt submitted yes
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Durnpster 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 21 A —F and G min.$100-$1000 fine
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
o 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
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
❑ 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. Building Permit Application
Revised 2.2008
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GERTIF?ED PLOT PLAN
PREPARED FOR:
KAREN GREENFIELD
AT
168 BERKEL Y ROAD
NORTH ANDOVER, MA.
NORTH ESSEX REGISTRY OF DEEDS: BK. 4467 PG. 252
�z ASSESSOR'S MAP: 47, LOT 85 ZONING: R-4
o SCALE: 1'=30' DATE.• MARCH 16, 2009
NOTE' EXIS77NG DIMENSIONS TAKEN TO CORNERBOARD.
S572252T
,(�/7311.7'
63.540 31.8' 32.3'
_XISTING/,%
STORY; /
)WELLING j,
IVO. 168 /%
///12
32.7' 32.6'
107.93'
N57'22 35 "W
FOSS ROAD
15.5'
PROPOSED 16'x12.2' PORCH
70 BE BUILT OPFR PGR7J0N
OF E)MING 31.3'x12.2' DECK.
5.6'
]� 9.7" :Zt
Q)
Q)
N �
19.7'
REMAINDER OF
EX/SANG DECK.
P�ZH OF Alys�
Q N
421 -GIS
N0. 35773
tl LAW
PREPARED BY.•
JOHN ABAGLS & ASSOCIATE PROMSIONAL LAND SURVEYORS
9 BARTLETT STREET, NO. 252, ANDOVER, MA. (978)-688-4899
JOB NO. 5651
Town of North Andover
QI Base Map 11 Zoning 11 2005 Aerials Watershed Zone Utilities V SizeoUU
0u u u u u u u u u u( Help Scale 1" = 16 ft
047.0-0055
047.04054
too we 077.0-0084
047.0-0085
047.0-0086
f^�8•
047.0-0093 bee
0472-0092 047.0-0087
91 -,� ,.� .
Get Pictometry Image= Go Save Map Image -
v2.5 [beta 2] AppGeo .s
Page 1 of 1
Selection 11 L
Select
(show all)
Owner
SAMOST, TOD[
1 selected R
Ownerl
0wner2
Address
Map/Lot
Lot Size
Fiscal Year
Land Use
Code
Last Sale
http://maps.mvpc.org/NorthAndovertnimapNiewer.aspx 5/4/2009
BILL CONATON BUILDING & REMODELING, LLC
121 LO WELL ROAD
WINDHAM, N.H. 03087
TEL: (603) 898-7155
bcbuild@comcast.net
Mass. HIC Reg # 1.57195
PROPOSAL
Todd Samost & Karen Greenfield
168 Berkley Road
North Andover, MA 01845
978-557-1080
NOTICE: All home improvement contractors and subcontractors engaged in home improvement,
unless specifically exempt from registration by provisions of Chapter 142A of the General Laws, me be
registered with the Commonwealth of Massachusetts.
Thank you for allowing us to quote your project. We propose to furnish all material and perform
all labor necessary to complete the following:
Project Description:
12X32 Deck with 12X16 Two Season Enclosure
Equator Latitudes Walnut Composite Decking
Material Description: See attached
Starting and Completion Provisions:
The work will begin in May 2009 and will be complete absent of unusual circumstances in 35 days.
Any changes made must be in writing and may change the completion date.
This proposal does not include any hidden damages that are uncovered over the course of the job
and additional work required by local building inspectors.
PRICE:
B.C. Building and remodeling agrees to do all work described above for the total price of
$27,301.28
Payments to be made as follows:
Deposit $8-,001):00 51000 07
Ist payment of $7,000.00 when framing and decking is complete
Stn payment of $7,000.00 when windows, siding & roof are complete
payment $4,000.00 when plastering is completed
Balance of $1,301.28 substantial completion of work
Contractor's Signature: Date: U
Acceptance of Proposal
The above price, specifications, and conditions are satisfactory and are hereby accepted. Bill Conaton
Building & Remodeling, LLC is authorized to do the work as specified. Payment will be made as stated
above.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
t
Owner's Signature: Date:
Owner's Rights and Benefits:
The owner may have 3 -day cancellation rights under one or more of Mass. Gen. Law Chapter 93,
Section 48; Chap. 1401), Section 10; Chapter 2551), Section 14. '
All warranties on the owners rights under the provision of 780 CMR R6 and MGL c 142A
L
I
E
I
�lussachusetts -Department of Public Safety
1 Board of Building: Regulations and Sruulards
Construction Supervisor License
License: CS 49000
Restricted to: 00
WILLIAM A CONATON
121 LOWELL RD
WINDHAM, NH 03087
('ununis�ciuncr
Expiration: 7/31/2010
T r#t: 28402
Board of -_'
Build �g Re og i� 4 nd Sta
"4E IMPROVE CONTFZgCTOR
Registration: 157195
EXAiration ; 9/12/2009
Tri
rYpQ Indi" .,a
WILLIAM q Widual �!
CONATI 6
WILLIAM QN •
CONAT`(�N
121 LOWELL RD
WINDHAM, NH 0308' ".
*Any applicant that checks box # 1,m= also fill our the seenon below ahowi qutr ]
+ Homcowuera who submit. c n€th--ir workers' compensation pofic} inioimatioa.
iltis affidavit inuicatitt Ute ,ere uoi&l u1 "Irk astd then hi � ou side coniraciore roust submit a new anitfavit
4Contractors that chccl: ibis box must atracheti an additional shit showing the name of t e ss
tnd:=ting such,
b-c--naactors and their workers' com
I atr, vtJ employer sisal is providing workers' co ensafiort � p. Poiie}, inionnation.
utfnrmatiort,
►nP assurance for n9employees. Below is the policy and job site
Insurance Company
Poiicy # or Self .ins. Lic. #:
Expiration Date:
Job Site Address:
City/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showin; the policy number and expiration slate),
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 i a STOP WORK ORDER and a fine
of up to .1250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office a
Investigations of.the DIA for insurance coverage verification.
I do hereb under th pains er u
l rithat the information provided ab ve true and correct
Si�natur� %
Dat".
QTJ'Cial use only. Do not write in. this area to be completed by city or to offtcfaL
City or Town:
Issuing Authority (circle one): Permit/License #
_
1. Board of Hr-alth 2. Building Department 3. City/Town Cl
6. Other erk 4. Electrical inspector S. Plumbing Inspector
Contact Person-
Phone #.
The Conumorawealth of Mass chusetZ+
f '" ilG
IK : �l7jl
art
Depment of Industrial Accidents
Office of Investigations
W o
600 ash in Ion Street
reet
Bostopt,
MA 02111
www.m"S.e ov/dia
Workers' Compensation Insurance .Affidavit: g
A _ h mat Information
�uilders/Contractors/Electricians/Pl�cffibers
��7
1VMne (Business/OrganiztbonM�l dividual): R CJrt',f eya
�� � ��
Please Print tenthly
�.
�
1
Address: (1, t LsW i -L
a 1 V LLC—
),j MAA L,.
A J IA 01®
Phone #:5-�--
Are you an employer? Check the appropriate box:
1, ❑ Ian, a employer with
4. ❑ I am a general cont
f protect (required):
TY71N
employees (Hill andlor part-time).*
2,1 am a sole proprietor or partner-
a^tor and I
have hired the sub -contractors
listed oni the
ew construction
hip and have no employees
working for me in any
attached sheet $Remodeling
These sul>-contractors have
8. ❑ Demolition
capacity.
[No workers' comp. insurance
workers' comp. insurance.
5.. ❑ We are a corporation and its
9 ❑Building addition
3. ❑required ]
I am a homeowner doing all work
officers have exercised. their
right of exemption
.1 OC Electrical repairs or additions
myself. [No.workers' c omp,
per MGL
c 152. § 1(4); and we have no
1 l.❑ Plumbing repairs or additions
insurance required.] t
'employees. [No workers
12❑ Roof repairs
comp, insurance re • Pd
13.[] Other
*Any applicant that checks box # 1,m= also fill our the seenon below ahowi qutr ]
+ Homcowuera who submit. c n€th--ir workers' compensation pofic} inioimatioa.
iltis affidavit inuicatitt Ute ,ere uoi&l u1 "Irk astd then hi � ou side coniraciore roust submit a new anitfavit
4Contractors that chccl: ibis box must atracheti an additional shit showing the name of t e ss
tnd:=ting such,
b-c--naactors and their workers' com
I atr, vtJ employer sisal is providing workers' co ensafiort � p. Poiie}, inionnation.
utfnrmatiort,
►nP assurance for n9employees. Below is the policy and job site
Insurance Company
Poiicy # or Self .ins. Lic. #:
Expiration Date:
Job Site Address:
City/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showin; the policy number and expiration slate),
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 i a STOP WORK ORDER and a fine
of up to .1250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office a
Investigations of.the DIA for insurance coverage verification.
I do hereb under th pains er u
l rithat the information provided ab ve true and correct
Si�natur� %
Dat".
QTJ'Cial use only. Do not write in. this area to be completed by city or to offtcfaL
City or Town:
Issuing Authority (circle one): Permit/License #
_
1. Board of Hr-alth 2. Building Department 3. City/Town Cl
6. Other erk 4. Electrical inspector S. Plumbing Inspector
Contact Person-
Phone #.
Information and Instructions
Massachusetts General Laws chapter l52 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 `pan individual, partnership, as, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and includirtg the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, associafi on 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 maim., -dance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall nort because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also stares that "every state a r local licensing agency shall withhoid 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 acceptablie evidence Mf compliance with the insurance coverage required."
Additionally, MGL chapter 152, §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 contrating authority."
Appiicauts
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to yoiu situation and, if
necessary; supply sub -contractors) name(s), address(es) and phone number(s) along with their certincate(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 may .be submitrEd to .the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. Theaffidavit 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 re "aLrdirg the tau or if you are required to obtain a workers'
compensation policy; please call the Department at the nriusrebcr listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officiais
Please be sure that theafFidak is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit foryou to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permitTicense number which will be used as a reference number. In addition, an applicant
that must submit multiple pertnitfiicense applications in arty 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 permits or licenses. A new affidavit must be filled out each
year. Vdhere a home owner or citiz„-ri is obtaining a licenses 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 Ofn"ce of Investigations 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 Commonwtalth of Mamsachusetts
Dtpartment of L-ndustrial Accid pts.
Office of Envestigations
600 Wasltirtgton Street
Boston; MA 02111
Tel. # 617-727-4900 c)zt 406 or 1-877-M, . SAFE
Revised 5-26=05
Fax # 617-72.7-7749
v^mmass.gov/dia