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Home My WebLink AboutBuilding Permit #602-14 - 22 MIFFLIN DRIVE 2/20/2014 i TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION f Permit N0: �� Date Received Date Issued: 2-0 L IMPORTANT:Applicant must complete all items on this page LOCATION a' AIM Print, PROPERTY OWNER tAOWA _ PrWCS1hrt.f__= - -- Print -1-bo-Year-Old Structure yes no MAP{NQ PARCEL: ZONING DISTRICT —_,Historic District yes no _ Machine Shop Village yes n TYPE OF IMPROVEMENT. PROPOSED USE Residential Non- Residential ❑ New Building .eine family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ,2<epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septle [],Well,, 4. O Floodplain 0 Wetlands ❑ Watershed pisteidV ,Water-/:Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name'Ach to e m'0s4 'f i ft, Phone: W1 S' Address:- A CONTRACTOR Name: -,Phone:71_y Address: 73__.�vtps _ Supervisor's Construction License _ __.Oy 3f�2? � . __T� Exp. Date:, Sh �► Home Improvement License: f�- wl4�____ � -Y ;Exp. Date; ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ 7-B k FEE: $ . �d Check No.: �/L/2 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the aranty fund Si naturetof A en Si 00ature of`cont P racto . Plans Submitted l.� Plans Waived El []/S,6)Certified Plot Planmped 1 Building Department The fol;,)wing is&li'st of-the required.forms to be filled out for the appropriate.permit to.be obtained. Roofivg, Siding, Interior Rehabilitation Permits ❑ Ruilding 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 ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cans if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the ape).al 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.Building permit Revised 2012 i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TWE:OF-SEWERAGE_MSPOSAL Public Sewer ❑ Tanning/Massage/BodyArt ❑ Swimming Pools ❑ Well ❑ Tobacco.Sales ❑ . .ToodPackaging/Sales ❑ Private{septic tank,etc._ ❑. _ Permanent Dimpster on Site ❑ THE_FOLLOWING SECTIONS FOROFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING &DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS i HEALTH Reviewed on Signature COMMENTS i. z 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 Tovv;! Engineer: Signature: Located 384 Osgood Street (FIRE-DEPART- M,ENT Temp Dumpster on site yes no Located-at 124iMair Street Fire Departme"'i signature/date ' ''' x 4 `• n COMMENTS , Number of Stories: Total square feet of floor area, based on Exterior dimensions._ Total-land-area, sq. ft.: 4 ELECTRICAL: Movement of Meter location, rust 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 2010 Location �2 No. � OA �y Date a 20 /� i . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ da Foundation Permit Fee $ �. Other Permit Fee $ TOTAL $ Check# 27311 - (30-166g Inspector NORTH own of E : Andover a No. h , ver, Mass, coc.41c.uw.C" y1. 0R4TED U BOARD OF HEALTH Food/Kitchen PERMIT T LD` Septic System THIS CERTIFIES THAT ...... ii BUILDING INSPECTOR ............................................................................................. ^ Foundation has permission to erect ... g .. �' ... ... . .;/. �i'Y.... .............. ......... buildings .� .�',lr ........ ..�:................................. Rough to be occupied as ........... .. c:.. !? �c%.. �' ../�r :t-f�?:"1.�:�r.(f. . ................................................ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final 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 UNLESS CONSTRUCTION TARTS Rough .................... Service ........... ...... . .......... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinm 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 about:blank NATIONAI II ADQUAPIrRS MichelleProvost-,fne 1soI se;4port Orm?,Custer,@l 19013 rW 30-97245 January 23,20i4 ' .�.. - rte.,fie i-• .r�l("c�.i;T�jiiiP. .n w,:a�'°�"-... CUSTOM REMODELING AND IMPROVEMENT AGREEMENT BuyeYa Information Project Number.30-97245 January 23,2014 Michelle Provost-Tine OWD0A9MW,-t 22 Mifflin Dr (978)376.6465(hlrchnife's Cnf) mprorast•tine@msn.com North Andover,MA,01645 (878)739.6641(A4cimfle's V✓or4,) e..emr aan nu: County:Essex Township: Buyer(s)listed above hereby jointly and severally agrees to purchase the goods and/or services of Power Home Remodeling Group{"Contractor")In accordance with the prices and terms described on the front and the following four pages of this agreement and any specification sheets,which are Incorporated as part of the Agreement(collectively,this "Agreement").This Agreement represents a cash sale of goods and services,Buyer(s)agrees to pay the cost of the goods and services purchased as described herein,regardless of timing or approval of any financing Buyer(s)may seek for their purchase.Problems and Inquiries regarding this Agreement should be directed to the Contractor at 1-888-736-6335. Purchase Price: $7,358.03 1 Pre Installation Inspection Date: Drnvn Payment: $0.00 Qur PRA alt arrive an Fn 1/31 trixeen 9 45a and 10 45a Balance Due on $7,358.03 Estimated Project Start:6 to 7 weeks Substantial Completion, Estimated Project Completion:1 to 2 days Method of Payment: Other uamnia cmtvieadn axle is not at the essence Uetaa-s aayond Corrtracrars=110 not Mte.Nded to coicosting ame tmmes See Dewfunknovn conalhons on reveme Buyer(s)hereby acknowledges receipt of a copy of the pamphlet,"The Lead-Safe Certified Guide to Renovate Right", Informing Buyer(s)of the potential risk of lead hazard exposure from renovation activity to be performed in Buyer's home, at the addres written above.Buyers)received this pamphlet on the date of this Agreement,before commencement of work."b�`'`-t, (Buyer's initials{. It is agreed and understood by and between lite parties that this Agreement constitutes the entire understanding between the parties,and there are no verbal understandings changing or modifying any of the terms of this Agreement.Buyer(s) hereby acknowledges that Buyers)11 has read the entire Agreement and has received a completed,signed,and dated copy of this Agreement,including the two accompanying Notice of Cancellation forms,on the date first written above and 2)was orally Informed of his/her right to cancel this transaction.DO NOT SIGN THIS AGREEMENT IF THERE ARE ANY BLANK SPACES. Future promotions not applicable. I have read and received each page of this 5 page agreement. ��IQV231U up Buy. s /01/23114 Sig gture of Renmdel'irig'Consultant Stgnat Harold Short Michelle Provost-Tine YOU,THE t3UYER(5),MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, SEE THE NOTICH OF CANCLrLLATION FORM FOR AN EXPLANATION OF THIs R1aHt January 23,2014 20:17 IIIINIIIllll111l11118111111111111111111111h1{ Page 1 of 5 I z�z` The Commonwealth of Massachusetts Department of Industrial Accidents Offwe of Investigations 600 Washington street Boston,MA 02111 www,mass gov1dia Workers' Compensation insurance Afidairit: Buiidetrs/ContractorslEiectricians/Plumbers Applicant Information Please Print'ielriblY Name(Bwio inessrganiz&nowudividual): P-OWC-CAOME EC_M01DF4_JiJ4 0 2U+2 - Address: sv! B!l FS'r126± 19013 City/State/Zip: Phone#: Are an employer?Check the appropriate box: Type of project(required): 4. ❑ 1 am a enera!contractor and 1 ]. 1 am a employer with g 6. ❑New construction employees(full and/or part-time).* have hired the'sub-contractors 2.C3 am a sole proprietor or partner- listed on the attached sheet.: 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 arc a corporation and its required.] Officers have exercised their 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work right of exemption per MGL11.0 Plumbing repairs or additions myself.[No workers'comp. c.152,§1(4),and we have no 12.oRoof repairs insurance required]t employees.(No workers' comp.insurance required] 13.( Outer •Any applicant that checks box 91 must also fill out the section below showing theirworkers*eompea ation policy h t armee. t Homeowners who submit this affidavit indicating they are doing all work and then hie outside cowrarxots must submit a Dew at£davit halicadog rich. lContractm that check this box amst attached an additional sheet slowing dee name of the sub-coouacxocs and their wotkcn*comp.policy Wormedam I am an employer that is providing workirs'compensation insurance for my employees. Retaw is the pollcy and f ob site injorrnaiton. Insurance Company Name ria ys j t.i/e,2�c T �� 1/V� Q�ica ?95 Policy# ns or Self-i .Lic.#- Expiration Date: 10 it - Job Site Addres 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 tinder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to 81,50 .00 and/or one- car imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00;a y gaiast a lator. Be advised drat a copy of this statement may be forwarded to the Office of Investigations othe D for cer ooverage verification. I do herebyc un er hep and ahles of perjury that the Information provided above is true and comet. SiRMstart' Ojficibl use only. Do not write in this area,to be completed by city or town ofliciaL City or Town: Permit/License it Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: du Bate`. Crdet�., Ig acok areatEamoeffant '— ' K anstnitta a onde�nsaEioit a t'a ce H r `"'y;3,,' f+ i a{g,ffi .f4,!=s �t $ r w. 'S� 'k a , I.sr- r- Sa? n ..s"�. 5e �� x� �� a r�.�,Fr•,r dim-v.F.m r�is'"�',�`'"�'.;�'��,�•,��ar�•'�� t.J"" �`s}"'�� Mar+ 1 :s• 4 ,{fL �•• • �+ r�16�inRx. MaYrl�.. wim. _ � .. - •rr--a--mn-wwn'r-dw-v«*+w..�...r.rw.svv-v+�—zr-wM1. t,4�•�+r�r'X^�.-yq':..,rY+X•n-!'f^�"N_rat�.'ns (tF{ a tai "` r+,{ i- "" "'j�" �'' .y , �Ssr.. ' O,' a'�'E7*' yjy '� t MOM e RNA;, i c�z �. � ,�sF°�" . ' "I"„'11:. �.'"..'�« �..t''f;.lt�?r:.;.�$ !'�,'ea'�'�i"a'i.ei5..r •£� � -�•` '�i.u��a � ��' .n �.+�.'l*•fe+ww...+.',vs•sw.e..n'.+tMn amrvE+src.va�+.ue ."S�^A.:.=- .WR!s+re!!mci'na+�sa�.Y._.... _.�-rW^u'z,+v.^.+n*'P'!w:�Rf+�M:��_..r �� a �� 4UE.,;y .3 ��*�,-.N�e✓ar�c,,T.#r �f�tfit{ �y5��^ � r • �' `r '�- 'a a' 3 ar,...,,�rr.Wase.m^r.-*r,m•-r..,r_..>e.«r,•..os-k �...,..y-+_�.-mss»-....,.°. -;�-n•,e«.,,.n+,a�4a<-.-...�,.. ,...-,.,:,,a.-.. ; i ry x �,,,t»i"F•yC f4 3+ f ��,�a t t�k�'�c» -� �+ �� t�',. f may'' >• 33•".p" &�t�� `a'A ,r'"'w�°�r��`4'r`,�'9`+`g��'�'R. �}�'�''�� '�^'��`"�{��x �� a r E.�,. �q ;�w.� g, � ""a`5''��-�`�•�i�'i�a�y�l��xf' �i c�t�� tx f1�,ffF � � � tr Office of Consumer Affairs and Business Regulation a 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement; ontractor Registration Registration: 168616 Type: Supplement Card Expiration: 3/18/2015 POWER HOME REMODELING GROUP;LLC',;, .. , JUSTIN SMITH 2501 SEAPORT DRIVE STE 13110 ;` - CHESTER, PA 19013 Update Address and return card.Mark reason for change. SCA 1 i, 20M-05/11 Address ❑ Renewal E] Employment Lost Card CJ�2e�o7rurr�aiur�ecr,�a�C%UGaaaac�,ccael� _ f lice of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration x1(78618 Type: 10 Park Plaza-Suite 5170 Expiraiun 3f1'$/2D96 4 Supplement Card Boston,MA 02116 POWER HOME RE;Nfb EilUP LLC. I:.. JUSTIN SMITH 2501 SEAPORT DRIV8�STE S 110 CHESTER,PA 19013 Undersecretary Not valid without signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supenrisor I License: CS-093980 1 JUSTIN W SMITI 399 E Hartford Afenus Uxbridge MA 01569 Expiration Commissioner 01105/2016 t