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HomeMy WebLinkAboutBuilding Permit #Exception - 17 MABLIN AVENUE 5/1/2018 TOWN OF NORTH ANDOVER b APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page -,,.-w.�--_.......iwyw........,.:�w...,rirt;•= 'w._ a� y-..._.a..{c-. __Lr .. 3`' L . L®CATIONI_ n 100 Year OldrSt ucfure�`r es no.r .' Print, y - .T Y0 0. u MAPNO ' PARCEL w ZONINGDISTRIC�T HistoncDstnct yes) no7 w _els age �YeS ':- t � ar chin hopyVil TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition El Two or more family El Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other �Floodplain] (ENve lands `� WatershediDist'rict�� ,F. t o�$eptic Well x F ®Vllater/Sewerw DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address . war « { ; .! "� ^ ';* t•e' ... «- :' a5F^'.,� , -r-s +. _ � YU'�, y<;4 r � s C®,NiTRACTORI"Name t , Address Date. r, ._ �p�..-_x.Y4 k?-.�,, +.-.rc,-. ...,„—.•cy �,...`:� ..... ,,` - — s.. _ _ .. d=_r'.q`_. ..,:-y.. - .i�� �.. !ExpDatea 4F k t y g*}t°a 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. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 'Signature�of Agent/Ovvner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Building Department The folowing is a list of the required forms to be filled out for the appropriate.permit to be obtained. Roofirig, Siding, Interior Rehabilitation Permits o Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work Li- Engineering Affidavits for Engineered products DOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) D Engineering Affidavits for Engineered products ®TE. All dumpster permits require sign offrom Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products 40TE: 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 subm;tted with the building application Doc: Doc.Buil,ding Permit Revised 2012 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 0 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 i CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS L 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 Tow Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMEI�9T - Temp Dumpster on site yes no Located at•124 Main Street Fire Department signatdre/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, roast 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 de artment use I B Notified for pickup - Date Doc.Building Permit Revised 2010 PAYET-1 OP ID: DF CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDDIYYYY) Q412312013 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. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Phone: NAM: Appleby&Wyman Ins Svc Ctr Main Street America Group-NE PHONE New England Region Fax: Arc No Ext:866 253 0293 arc No): 866-332-4776 Ke Box H 0 EMAIL ss:ServiceCenter MSAGrou .com Keene,NH 03431 Appleby&Wyman Ins Agency INSURER(S)AFFORDING COVERAGE NAIC A INSURERA:Main Street America Assurance 29939 INSURED Roger Payette INSURER B: Payette Construction 17 Milton Street INSURER C: Dracut,MA 01826 INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFYTHAT 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 WffH 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR OLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDDIYYYY MMIDDNYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY MSI6540F 03/16/2013 03/16/2014 PREMISES Ea occurrence $ 50,000 CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Perattident $ $ UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WCSTATU- OTH- AND EMPLOYERS'LIABILITY YIN Y I ANY PROPRIETORIPARTNERIEXECUTIVEE.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? 1-1 N 1 A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under - T DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) 127 Mablin AVe i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE North Andover Building Dept. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g p ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street North Andover, MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD NORTH oven of _ Andover O z "t No. LAK, h ver, Mass, �3 13 COCHICM.WICN S U BOARD OF HEALTH PERMIT T L D Food/Kitchen Septic System \_ BUILDING INSPECTOR THISCERTIFIES THAT ................... ...a."4.`�r........... ...t.........�................................................. has permission to erect ........................... buildings on ..... � .......:.Vv\-:a ... bA.h,....... .......... .....•...• Foundation s� Rough to be occupied as .... .5, .....Ii.. .....1., .i!: .C�Q.!l.?5... .... ��....Uln-.(,...Cc�U:Gc.. .► •�' Chimney provided that the person accepting this permit shall in every respect 4nform to the terms of the applicatti Final p on file in 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 01 UNLESS CONSTRUCTI ST RTS Rough Service ................................................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. SEE REVERSE SIDE y 4 PAYETTE CONSTRUCTION CO. AGREEMENT Homes&Additions of Distinction 17 Milton Street Dracut,Massachusetts 01826 OFFICE(978)454-5223 License No.021304 FAX(877)314 0108 Reg.No.101841 www.payetteconstruction.com roger(i�pavetteconstructionxom TO: Mr.John Pirrotta DATE: 4/10/2013 17 Mablin Ave. JOB NAME: Siding and windows No.Andover,MA 01963 TELEPHONE: FILE NAME: 13pirrottacontract EMAIL ADDRESS: DESCRIPTION: PRICE: $18,520.00 ------------------------------------------------------------------------------------------------------------------------------------------------------------- JOB TO INCLUDE PLANS: All plans,if any,necessary to obtain a building permit. PERMIT: Builder to obtain building permit. Owner to pay permit fee. SURVEY: No survey work is included. DEMOLITION: Price includes removal of all siding and any decayed material. SIDING: House is to be re-sided with Certainteed Monogram®double 4" rough cedar finish vinyl siding. Al surfaces will be wrapped in Tyvek®and siding will a backed with 1" high-R sheathing to add R-7 to sidewall. ELECTRICAL WORK: Owner to secure electrician. WINDOWS AND DOORS: All windows will be removed and replaced with Harvey Classic® new construction windows with low-e package. Windows will have integrated exterior casing and J-channel. WALL FINISHES: Walls are to be V2" blueboard with thin-coat plaster. Ceilings are to be thin-coat [plaster, texture finish. Smooth ceilings may be done at extra cost. PAINT/ STAIN: None included. SUNDECKS AND PORCHES: None included. FINISH WORK: Windows will be trimmed to match existing as closely as possible. RUBBISH REMOVAL: Builder to remove all debris generated during construction only. Rubbish containers are not for homeowner use unless otherwise agreed upon by both parties. DRIVEWAY: None included. PAYETTE CONST. CO. JOB NAME: PIRROTTA SUBMITTED ACCEPTED BY: R R P ETTE DATE: April 10,2013 DATE:T` aOC('`j PAGE: 1 OF: 3 i PAYMENT SCHEDULE : PERCENT PMT.: UPON COMPLETION OF: AMOUNT: 5% SIGNING OF THIS AGREEMENT 925.00 10% OBTAINING BUILDING PERMIT 1,850.00 35% DEPOSIT FOR WINDOWS 6,500.00 10% START OF WORK 1,850.00 20% SIDING/WINDOWS,2 SIDES 3,700.00 15% BALANCE OF SIDING AND WINDOWS 2,775.00 5% SATISFACTORY COMPLETION 920.00 100% 18,520.00 AMENDMENTS: This section to be used to list any changes to this agreement. PAYETTE CONST. CO. JOB NAME: PIRROTTA SUBMITTED BY: A0 ACCEPTED BY: ROGER PAYETTE DATE: April 10,2013 DATE: PAGE: 2 OF: 3 TERMS OF AGREEMENT (Not all will apply to all projects) 1. Both parties must agree to any changes. Initialing said changes shall indicate such agreement. 2. Payment for each phase of construction must be made before the start of the next phase. Such payment indicates owner's satisfaction with that phase. 3. Owner agrees to immediately notify builder of any situation that might cause a work delay or stoppage so as to minimize losses to the builder. 4. Satisfactory completion: If dispute arises over satisfactory completion,work will be determined to be satisfactory or unsatisfactory by an impartial third party in the building trades. Such third party is to be mutually acceptable by both parties. 5. When a second floor is to be added to an existing home,the builder will take all reasonable precautions to prevent water damage due to rain. NO GUARANTEE,however is either expressed or implied that,if such damage occurs, repair is the responsibility of the builder. 6. The builder assumes no responsibility for any thing encountered during excavation that is beyond the builder's control,such as, BUT NOT LIMITED TO,ledge,excess concrete from other building projects,high water table or any other obstacles which would cause a work delay. 7. Unless otherwise previously stated in the specification sheets the following items are NOT INCLUDED: Finished ed landscaping (shrubs,raking,seeding,mulch,etc.),gutters and downspouts,storm windows and doors,floor coverings(rugs,inlaid,tile etc.), dryer vents,microwave oven vents to outside,towel racks,toilet tissue holders,door stops. 8. Builder to provide proof of contractor liability and worker's compensation insurance before start of work,however,owner is responsible for providing hazard insurance for the structure as it is completed. This may be obtained as a rider to the existing homeowner's policy. 9. When remodeling or adding to an existing house,owner is to provide builder with access to the house for the purpose of resetting circuit breakers and for bathroom use. If owner wishes,arrangements could be made for electrical generators and chemical toilets to be used at the owner's expense. 10. It is understood that heavy equipment will be needed to perform different functions during construction. All reasonable precautions will be taken to prevent driveway or lawn damage,however,repair of such damage,if it occurs,is not the responsibility of the builder unless otherwise described in the specifications of this agreement. 11. When a flat or nearly flat rubber roof is installed,it is common for rain or melting snow to puddle in low spots. This is common and has no adverse effect on the roofing material and is not indicative of poor workmanship or structural flaw. 12. It is common for concrete to crack,pit or flake. This is not an indication of defective material or workmanship. Cracks will be filled if they occur within the one-year warranty period. No other consideration will be given. 13. All work is guaranteed for one year from the date of completion. Completion is defined as the date that the occupancy permit is secured,or when all final inspections are signed off. Any"punch list"items will be dealt with separately from guarantee items. 14. Extras: Any work beyond the scope of this agreement will be performed for the cost of materials and labor rates of /hr for a lead man and /hr for an assistant. PAYETTE CONST. CO. JOB NAME: PIRROTTA SUBMITTED BY: ACCEPTED BY: ROGER PAYETTE DATE: April 10,2013 DATE:RO ki aG I PAGE: 3 OF: 3 r I �{ TV The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington St. Boston, MA 02111 www.mass.gov/dia Worker's Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Application Information-Please Print Legibly i Name(Business/Organization/Individual/Owner: WA, ge_ 1 054 IS Address: /a %L'T1J d!- City/State/Zip: _ ��' _�1/�,fit}-- Phone#:^ �! • �Z 23 Are you an employer? Are you the homeowner? Check the appropriate number: 1. I am an employer withJ employees(full and/or part-time: 2. _ I am a sole proprietor or partnership&have no employees working for me in any capacity. 3. _ I am a homeowner doing all work myself. (No workers compensation insurance required.) 4. _ I am a general contractor&I have hired the sub-contractors listed on the attached sheet. (These contractors have workers comp.insurance and I have attached a cony of their ins.) 5. _ We are a corporation and its officers have exercised their right of exemption per MGL c.152§1 (4),and we have no employees.(No workers comp.insurance required.) • Any applicant that checks box#1 must also fill out the section below showing their workers'comp.policy information. • 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 attach an additional sheet showing the name of the sub-contractors and their workers' compensation policy information. Type of project(required): Check appropriate# 6. New Construction 7.X Remodeling 8._Demolition 9. Building addition 10. Electrical 11. Plumb. 12. Roof 13._Other I am an employer that is providing workers'co pensation insurance for my employees. Below is the policy&job site info. Insurance company Name: bt,7- Afto Policy#or self-ins. Lic.#WAF 7 �gq,<,-f-03/ Expiration Date: ► L1 Job Site Address: T— Dracut,MA 01826. Attach a copy of worker's compensation policy declaration page(showing the policy number and expiration date. Failure to secure coverage as required under Section 25A of MFLc. 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$250.00 a day against the violation. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby ce ' y and the pain and pe hies f,perjury that the information provided above is true and correct. Signature: Date: Phone# Official use only: Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority (check one) I.—Board of Health 2. Building Dept. 3.—City/Town Clerk 4.—Electrical Insp. 5._Plumb&Gas 6.— Other-Contact Person: (print) Phone# i Office of Consumer Affairs&Busiesd s Regulation b OME IMPROVEMENT CONTRACTOR. egistration: 1_01_841 q Type: Expiration: 6/29!2014;- Rrivatd Cotporatioi PAYETTE CON$TRU6TION CO.,tNC: / Roger Payette 17 MILTON ST. Dracut,MA 01826 _ Underseetary Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Super%isur License:CS-02S304 # ROGER G PAV TTE r` 17 MI&TON ST DRACUT M Oi82t; Expiration Commissioner 01/20/2014