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Home My WebLink AboutBuilding Permit #439 - 171 LACONIA CIRCLE 11/30/2006 TOWN OF NORTH ANDOVER NORTN APPLICATION FOR PLAN EXAMINATION of,<��' a��o 0 A s ► Permit NO: 3 Date Received Date Issued: �SSgcHus�� IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print MAP NO.: / PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Repair, replacement ❑ Assessory Bldg ❑ Commercial ❑ Demolition ❑ Moving(relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTR OF WO TO BE PREFORMED Identification Please Type or Print Clearly) j OWNER: Name: i'11 �� U -5 h a t-N�zA K Phonez��o�y t Address: f 71 1kzPA1%A CONTRACTOR Name: .0 /'ZnR T x of 11 c1 QRS Phone:Of 78- 9/5-7 973'0 Address: �f&y J&,Uel f 72( ll/tf-w Ir U P,1/Pod T i�/� � ( �1 ST) Supervisor's Construction License: Exp. Date: Home Improvement License: `,/7 7 Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULD/NG PERMIT.-$12.00 PER$1000.00 OF THE TOTAL EST/MATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ 1 FEE:$ Check No.: .2�%®7 Receipt No.: Page I of 4 TYPE OF SEWERAGE DISPOSAL Public Sewer 11Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ ❑ Permanent Dumpster on Site ❑ Private(septic tank,etc. Electric Meter location to roject _NOTE:. Persons contrdlct' g,with unregiste ed ontra ors.do not have access to the gua anty fund Signature of Agent/Owner nature of contractor Plans Submitted ❑ P aiv t ��errt`jfie Plot Plan ❑ amped Plans ElIto THE FOLLOWING SECTI NS OR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS FIRE DEPARTMENT - Temp Dumpster on site yes no Fire Department signature/date COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Si nature& Date Driveway Permit Building Setback(ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA— For department use i a 1 Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan.2006 r Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. I 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 Addition Or Decks ❑ Building Permit Application ❑ 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) 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 j Hydraulic Calculations (If Applicable) j ❑ Copy of Contract ❑ Mass check Energy Compliance Report E 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Page 4 U4 Location No. �%��9 Date zAfm 1-4e NORTH TOWN OF NORTH ANDOVER 16.. y ` Certificate of Occupancy $ JACHUSEt� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL Check 607 19843 ,, Building Inspector NORTH Town of _ 4 over No. q3 * _ // 4V A Ags LA E dover, Mass., GOCKICMEWICK 7,9 A0 ATED PQa\ �y `s BOARD OF HEALTH Food/Kitchen Septic System PERMIT T D • BUILDING INSPECTOR THIS CERTIFIES THAT.............. ..;..O ...Q. K-a-T. .N ..fto-06:................................. Foundation has permission to erect........................................ buildings on .. 7�..�i4 i► 40./!&4.....� ��... Rough 4Chimney to be occupied as ♦.. �Q.. provided that the persona ng his perm*d,sshall 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 PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTI STARTS ELECTRICAL INSPECTOR Rough .. ..... ... : /i64JIING Service CTOR 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. NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accorda ce with the provision of MGL c 40 S 54, a condition of Building Permit at: /7/ AAe, is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. Also, note Permits are required under Fire Prevention laws.Chapter 148 Section 10A. The debris will be disposed of in: (Location of Facili ) Signature of Permit Applicant Fire Department Sign off: Dumpster Permit A 0 a D to �o LLC Quality Construction and Project Management Services CONSTRUCTION AGREEMENT/CONTRACT Liberty Bell Builders 5 Roosevelt Place Newbur-)port.MA 01950 HIC 147768 (978)255-1281—(978)255-1351 I November 2, 2006 Bhatnagar 171 Laconia Circle North Andover, MA 01845 I I I CONTRACT November 2, 2006 Between the Owner: Divya Bhatnagar 171 Laconia Circle North Andover,MA 01845 And the Contractor: Liberty Belt Builders RIC 147768 5 Roosevelt Place Newbuiyport,MA 01950 (978)255-1281 For the Project: Bhatnagar 171 Laconia Circle North Andover,MA 01.845 SCOPE OF WORK New Roof for existing main house to include the following: Remove all shingles,nails and old drip edge from the existing main house. Clean area of all debris removed from existing roof and dispose. Install ice&water to the first three feet of roof Install new drip edge,tar paper the balance of the roof Install new shingles to match existing shingles and install ridge vents where needed Includes all labor and materials TOTAL BASE PRICE $4,800000 WORK TO BEGIN FOLLOWING/2 DOWN AND AGREED START DATE BALANCE DUE UPON COMPLETION BASE PRICE INCLUDES: Limited Warranty- Contractor-tvarrants against leaking roofs by reason of defects in material or workmanship for a period of five years from completion date. It is the responsibility of the homeowner to insure free passage in gutters and downspouts at all times. Damage, if any, caused by windblown rain or snow through gables soffit vents or louvers into attic space is excepted from the provisions of this '%arranty-, as is damage or defect caused by snow, ice back-up or natural causes. This warranty excludes remedy for damage or defect caused by abuse, modification or repair not performed by the contractor, improper or insufficient maintenance, improper operation,or wear and tear from normal usage. i The contractor and the homeowner hereby- mutually- agree in advance that in the event that 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 Regulation and the consumer shall be required to submit to such arbitration as provided in MGL c 142A. OPTIONAL CONTRACT ApIDITIONS: NONE AT THIS TIME OWNER: CONTRACTOR: i I i I ✓lie Pan„naauoeaLt� o� Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR License or regi&tration valid for individul use only Registration:. 147768 before the expiration date. If found return to: Board of Building Ezplratiori .8/8/2007 Ong Regulations and Standards One Ashburton Place Rm 1301 Type Ltd Liability Corporation Boston,Ma.02108 `. f.., LIBERTY BELL BUILDERS LLC. JAMES BELL 5 ROOSEVELT PL _ NEWBURYPORT,MA 01950 `` Administrator - out signature Not valid with � _ I j . I i _ i The Commonwealth of Alassachusetts Department of Industrial:Iceidents Office of Investigations t 600 Washington Street I's Boston, AM 02111 ' www.mass.agov/dia t Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers \pplicant Information Please Print Legibly �iifl7te ll)usinessl)rganiialitmilndivi�luall: ,� Address: cS R=UeIn — of�sa City.State Zip: Phone #: 2e—S/5—D 730 ;kre you an employer?Check the appropriate box: Type of project(required): 1. am a employer with C� 4• ❑ 1 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. ' E] Remodeling ship and have no employees These sub-contractors have 3. ❑ Demolition working for me in any capacity. workers' comp. insurance. y• ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions required.] 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.] — •Any,applicant that checks box; I must also lilt out the section below showing their workers'compensation 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 attached an:additional sheet showing the name of the suh-contractors and their workers'comp.policy information. I um tin employer that is providing workers'compensation insurance for my employees. Below is file policy and job site information. Insurance Company Name:_-._ Policy 't or Self-ins. Lic. 4:—_----_ Expiration Date:____ .lob Site address:. Z 7� r"n/v�r►tit—!� ��[.r�� e /i �,State,1ZlPA: 1$" -- — — 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 NAGL 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 its civil penalties in the form of STOP WORK ORDER and a tine 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 Invcstigations of the DIA for insurance coverage verification. lilt)hereby certify oder the pains and penulfies of perjury that the in/ormution provided above is true and correct. y_i�i,ttnre: � � Date: 07 O �._ I'h�,tie----- A.—tel—�=0-- �--- --------------- -- ------ f?fichd a,e only. !?u;tut trrile in tltis nr•_�a, ro he .nmplelcd by cel) ur rnwn,,lfic iul. City+►r T,)wn: %,n-reit/License# !ssuing•Authority(circle one): I. al;oard of Health 2. Building Department 3.City/T�)wn C!erk 4. E'ectric.al laspector _•'. Flumbing Inspector 6.Other Phone#: