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HomeMy WebLinkAboutBuilding Permit #356-15 - 234 BRENTWOOD CIRCLE 10/14/2014 NORT►I BUILDING PERMIT O��IUSO 16 TOWN OF NORTH ANDOVER o� APPLICATION FOR PLAN EXAMINATION � 2 ax Permit No#: V// Date Received:*4— 'q g7E° Date Issued: IMPORTANT:Applicant must complete all items on this page F=v c_ YPs PROPERTY O_WNEF;L�,�Sm 501L41-all Pnrit 100 YearaStructure ryes tno : IMAP. aPARCELr 'ZONING'D:I-STiRICT -�, Hstoncistncf ayes ono . •Machine Shop Villa TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ZRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other �. �, �. ^` z P_ ❑:Flootlpla nw E®Webb ds � I®§Watershed,Dlstricts , ❑iSeptic 0 Well a ❑EWater/SOver. J D CR TI N OF WORK T B PERFORM D: j/ Gs 34� Identi icati9n- Please Type or Print Clearly OWNER: Name: 6 �hh/y Phone: _ _ Address 3 —,��en1irmo°c� Cil'C G �;,+. _y d" r 4. �� a�ujllNll; �� CR:�' 'd,.,i 4 � J4�A Jy..,::fi^ri'-z.�t�� �.� .'..� �-_' i`a-•� L -.rs g.. .J-f!.- eL"�7 t v,,/ c ,. [�/P y; „w 'n a u•+ .F =ContractoriName -� a lPhone� l V_ a � tiE�ti - -s. -_,.�.�....-«-w. .w.—r nom• G�' ,� �._,W +! ', �'f ..- y'.. Add gess — s aFSpervisgr sConstruct on-bLcense � �6vU Exp r j " 6 IlomeImpro�ernentLicense.tel©��< - _ ' . IExpD tem=- .,-= -- - . 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: $ , ©yIX FEE: $ Check No.: 1 Receipt No.: �l NOTE: Persons contracting w'h U, r gist ed cqfitractors do not have access to the g a an f nd Signature of Agent/Owner _. Signature of contractor , Location No. �? Date • • TOWN OF NORTH ANDOVER S�fTL'ED646` . Certificate of Occupancy $ Building/Frame Permit Fee $ 12 -k, .: . V w Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 'Building Inspector 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on 10 IID)lq IID)/qSi nature l-i L�— I (( Com COMMENTS 5� ,,,� ltd l U l l �{ 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 f J��"s_ �3 z"u 'kf �' #^[z i 5.`{',�`�*F-" � �'"?-..'" 3�FIRE,DEPAR ;Temp Dumpster onsite;*yes L �Rnor TMENT� Fire Depair413 tmerit�signature/date -COMNIENTS� t 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.$10041000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 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 ❑ 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/Cross Section/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 a 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 Revised 2014 pORTIy Town ® _ ndover ver, Mass, 241 �A Cocru[r�t U BOARD OF HEALTH Food/Kitchen PER I T L D Septic System ,: h '�""i7�4 waA*U BUILDING INSPECTOR THISCERTIFIES THAT ......... ................................................................................................................ has permission to erect .......................... buildings on 2.5.4.... t^l� r.lvv 6%t . � '`` - 1 s` - ...• �1 � Rough �f to be occupied as .. �Aukv*! �1...-!. .... ��� ...................... ...... c provided that the person accepting this permit shall in every respect conform to the terms of the application nal on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration an 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 STARTS Rough Service .......... ............................. 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. L ttO R TJI Town ofTE .. : _ :.��. , Andover No. 6 h ver, Mass, qA111 v - 7S LI BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .... �.�1 n'!S!'.vI.......................... BUILDING INSPECTOR . .................................................. ' has permission to erect .......................... buildings on .. �1... q�:f�•�'a(. %:w Z:.....•,....., Foundation f Rough to be occupied as ...................& ?70. �/.., �':(. f�:y ..��� ''.4 G. ....................................... Chimney provided that the person accepting this permit shall in every res ct 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 CONSTRUCTIONS ARTS Rough Service .......... .......C`�C��� .. ................................ / B ING INSPECTOR- Final 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. NORTH Town oE : � . ndover O t% ..tr. No. ' �� �` -*M"- 0, b h ver, Mass, &,— 1114 cocNic«ew�cw y1. �,9 A�RwTED ►.P���S S U BOARD OF HEALTH PER ITc LD Food/Kitchen Septic System THIS CERTIFIES THAT ....... BUILDING INSPECTOR ... .. ...................................Z........ .. ................. ..... ..... .... has permission to erect y,, � vv Foundation .......................... buildings on .......... .....................�............ \ l L Rough to be occupied as .,v .. TV�►!�!r .. .f .........� .........T.��. ...�........ 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 an Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR ' UNLESS CONSTRUCTION STARTS Rough Service .... ........ ... .........ti.... ..,2 ........ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildin 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. Maten'ailWork Order Order Number: C07527S 7 RED ROOF LANE,UNIT 1 Customer Name: William Hannum III and Sara Schwartz SALEM,NH 03079 Address. 234 Brentwood Cir PH: 603.898.0868 City/State/Zip: North Andover, MA 01845 FX: 603.898*0821 W1MN.BLACKDOGBUILDERS.COM o Phone Number: (978)686-2838 Job No: HANNU-12157 ❑ Kitchen & Bath Change &Builders Change ❑Plumbing Description Price Total GARAGE - Remove concrete blocks used as supports between garage doors-2 EA 02.099. -2"x +"framed temp wall for support during excavation - 120 SF Build temporary 2x4 wall for use during excavation EXCAVATION 03.101. - Machine excavation PLUS per CF-72 CF This item covers the volume of material being excavated. 03.110. - Machine excavation-remove material - 1 EA Excavate area per plan with track mounted excavator. Excavator includes machine and operator and is used for work . such as foundations, septic systems, trenching, rough grading and general site work. This spec. is for the machine and the operator only. See additional specs for trucking or materials.Note: On a finished lawn this machine will cause damage( ruts and/or rips). Unless included in the specs there is no cost for loam and reseed. Repair, landscape and reseed work are the responsibility of the client. CONCRETE 04.003-3000#concrete delivered on redi mix truck-5 CY Provide concrete for foundation work that has a 3,000#PSI compresive strength after 28 days of curing. See minimum delivery fee if qty is under 6 cuyd. 04.009. -Concrete wall 10"thick 48" high - 30 LF Form and pour continuous concrete wall. Set wall forming to include windows,cutouts, beam pockets and crawl holes. All forming shall be oiled with form release oil.Anchor bolts as required by plan. Wall shall be 10"thick. Concrete shall be 3000 PSI mix, poured continuously, take ACI recommended weather precautions as needed. 04.401. - 10" x 20"continuous footings-30 LF Continuous concrete footings for concrete wall for full basement or crawl space. In existing excavation Build level forms for footings with 2 x lumber(one use) Pour from chute direct into footing forms Strip forms Size of footing WALL FRAMING - Plumb and reframe a portion of the wall sections between garage bays. -2 EA (No return of materials after 30 days--Installed items Subtotal $10,043.17 andspecial orders are not returnable) MA Sales Tax (if applicable) $0.00 Balance: $10,043.17 *Total Due $10,043.17 10/9/2014 2:11 PM Page 1 of 2 Willikm Hannum III and Sara Date Mike Livingston Date Schwartz Production Department Manager Upon signing, l agree to pay for the above stated additional work, which is to be performed under the same conditions as specified in the original contract unless otherwise stipulated. (Nor[:This revision becomes Part of and in conformance with,the existing contract.) m4 y 4 /understand that this additional work will add fiedays to the completion date of my job. (initiq *Payment is to be made as follows: ❑ Upon Receipt 0 With next progress payment 0 Upon Order 0 50% Deposit/50% on Receipt 10/9/2014 2:11 PM Page 2 of 2 " _ `i 11 . TSy r I +�"��•� ��C�' �,� �;R�l ,. GG e -__�—_— -_. •4�\� l�r•.. _ it � �} �t r � i W 1 y r a/� G✓i��r� — �al � !S6 - 36�� 1 � °� $�rrrn,nrurr� �r1�A19,5 �S � 40„ YP "cal rw ale Unit Price Total Cost i 162.75 $0.00 $X3.25 $0.00 - - $28 501 $0.001 $220.6Q $0.001 $383.25 $0.00 $93.71 $0.00 $173.25 $173.25; $220.501 $0.00 $87.50 $0.00 $0.00 $0.00 Residential Template-Blackdog Mullenix-9358 Page 10 0611812014, 8:53 AM License or registration valid for individul use only before the expiration date_ 111found return to: , �e• (Parrtmzovrcuenl(.�r.��i�%�>`r:r7crc�ratrf/J office of Consumer affairs and Business Regulation �_ ffice of Consumer Affairs 8z Business Regulation 10 Park Plaza-Suite 5170 ,ard 'Boston,MA 02146 11 ME IMPROVEMENT CONTRACTOR egistratton 1:06877._. Type: i o Expiration -7%28/2016,.. Supplement( BLACKDOG BUILDERS. Not valid without signature MICHAEL LIVINGSTON 7 RED ROOF LN.#1 %� — Salem,NH 03079 Undersecretary Restricted -one-and two-farmly dwellings or any accessory building thereto, irrespective of size. 9 ? Massachusetts -Depart ;eni of Public S iety L IMF`--° Board of Building Regulations and Star da,d!s Const:•nction supervisor-I & 2 FantilY icense: CSFA-075668 MICHAEL ID LIVI NGSTON.. Failure to possess a current edition of the Massachusetts 57 HOOK RID State Building Code is cause for revocation of this license. Auburn NH 03032 For DPS Licensing information visit: www.Mass.Gov/DPS Ccrnm ssioner 04/29/2015 BLACK-1 OP Ila:BB /`•1i��nPA,4✓• 0-TE(MM1DD/YYYY) s,..... - CERTIFICATE OF LIABILITY INSU RACE 07/08/2014 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 ondorsement s. PRODUCER CONTACT Merrimack Fax:866-848-1223 E-MAIL (Merrimack) one 603-424-9801 Brown&Brown 309 Daniel Webster H Highway Chris McPhail _..__._,_.._.....___—.. INSURERS AFFORDIN,._._._..._—_GE.-._.—___.....--- ---NAIC G _ INSURER A;Peerless Indemnity Ins Co 18333 INSURED Slackdog Builders,Inc. ..._.., ._-..—___._.__._._,.,.,..... ..,..,„.-INSURER0:Peerless Indemnity Ing Co 18333•,_..-� Slackdog Builders - _ INSURER C: Investment Holdings,LLC INSURER O y �.• _ v — ��� m �-_—. _, 7 Red Roof Lane Unit#1 Salem,NH 03079.2984 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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, INSR I00rYYYY1 fD01Y Y TR 'TYPE OF INSURANCE POLICY NUMBER MMI D MMlpp(YYYY LIMITS GENERAL LIABILITY300,000 OCCURRENCE (S 1,000,000 -- T A X COMMERCIALGENERALLIABILITY BICS55511514 07/01/2014 07/0112015 DA1v0iGE'rtsRTEtS ”- "" ----— I I (�Y PREMISEsjE�ocburronpa,�•_£_s�..____..._._300,000 •,J CLAIMS-MADE I X• OCCUR MED EXP(Any one person> S 15,00 .,-._..._,......._....__.________...._ PE_RSONAL&ADV f NJDRS 1,000,000 _ GENERAL AGGREGATE M Is 2,000,00 GEWLACGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG I5 2,000,00 POLICY 7 PRO• LOC 17 S AUTOMOBILE LIABILITY COMBINEOSINGLE LIMIT 1,00000 ••(Ea,arc cWnt)_ •�,y,.� _S A X ANY AUTO BA$55511514 0710112014 07/01/2015 BODILY INJURY(PerPoreon) S _ ALL OS AUTOSSCHEDLED �( i BODILY INJURY(Poraccidenl) S AUTOS I .. NON OWNED X HIREDAUTOS 4 X AUTOS �( UMBREtJAL1AB X OCCUR ERCHOCCURRENCE 5 1,000,00 B EXCESSLtAB Y CLAIMS MADE US055511514 07/0112014 07101/2015 AG_CREGA_TE T ^'S — DED 1 X I RETENTIONS 10000 Is WOAXERSCOMPENSATION WCSTATU- OTtf AND EMPLOYERS'LIABILITY _.—TQRY LIM_Q ___...E.@_....__.._.__—..�„.,� B ANY PRDPRIETORIPARTNER/EXECUTWEYIN XWO55511514 07/01/2014 0710112015 E.LEACHACCIDENT _ $ _ _500,0_0 OFnCER/MEMEEREXCLUDED? Q NIA I ..,...._,_...._.......__....._..... (Mandatory In NH) E.L,DISEASE-EA EMPLOYE S w 500,000 It yes,describe under �_._._.- _ ,. DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT l S 500,00 DESCFJPnONOF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Romarks Srhodute,It more spar®tc ragnlrad) *David Bryan is oxeluded Prow Worker's Compensation Coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE; EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �",�, � Y' ©1988-2010 ACORD CORPORATION, All rights reserved. ACORD 26(2010105) The ACORD name and logo are registered marks of ACORD i T'he Co,mmonveaM o,fffaswh eus Qfflce r�,fffive fl9a lows ' 609 Wass~mgton,S'treet Roston,.M 02111 w�vwrncrssgovlcfza . W4rkex,%'Compensation JG axance Affidavit: pp 'Namo(Businesslorgauizationlfndivzdaa): Address: � be �� r Cztyf S�af�l.��: s�i�� N (l �.%�� Phony�; �o•�� g°JQ –0 g�� • ,Are yorx m employer Geek then appropxiate loox: Typo of project(reluired): am a e 10 x 4, [(I am.a general confractox and T 6, New cbnoftac im f employees( zltand(oxpax�timed T havoUedthe sub-confractoxs 2.[l T ama sr�lepropxietoxorpatfaez listed on.the attached sheet. 7. �4ROWCdeling sMp and`liaveno.ernployces 'Ibese suT�conEraetoxcJxave 8. [(Deritolitzon working forme inany capacity. workers'comp.iusmance, 9, [l Building addition PTO workers'comp.insurance 5• ❑We are a corporation and its 10.[I Electrical repairs or additions xaquixed.] oisixcers?ave exexeased.their S-[] Z am a homeowner doing allwork right of exemptionperMCL II.0 p1 mbiingxepairs ox additions myselr.pro WoAawl comp. c.152,§1(4),andwehaveno 12.E1R.,00fxePairs it uxanc€;xerluzxed.�i employees,(No workers, 1311 Otliex comp.assurance required.] AYryapplicanttbaicfieeksbox Imusiaisa�ItouctheseOtionbeldwshowingtheirworkmecomp amationpolicyinformafion. 7gameownemwho sabmitIfizaifldayitind catijthey9edpingallworl£andthenhireoutsidecontraaorsmus'csubmitamwaffidayitindica5ngsdA UnracfDig thatcheekthisbo mist attachedwadditionalsheetshowingthe,=0ofthesub.-contractorsand theirworkers'comp.poffoyinfomlation. Ict�nImern�rayeNthatis�Yovic�ir�gT�Q��eP�'eo�nperavationinsU anceforrye�loyees Belor�isz`hepaticyanal hsite iI2fD;�YlZatr072. � L`�surance CornpartyName;_ �-�r�e�S �n��jh�ly /af C� /0 . II Policy#ox Sem.ins.�ic.#: 3�WD S.S�ll�f�j ExpzrationDate: �/'�0'r . rob Site.Address; � y � °�� V�'v� City/Stateizip; mvh AA,,� /— /W A ffaeln,a copy oTtewoxkexs,com)?cniation-polzeydeclaxatioitpage(pliowing-Me policy nmuber an(I expiration£date�. Failure to secnxe coverage as xecTuixedunder Section 25.A oflV OL o.152 can lead to the imp osxtiext of criminalVMalties of free up to$1,500,00 andfox civil penalties in the form of STOP WORK ORDER and a fine ofup to$250.00 a day agaimtthe=violator 13a advised that a copy oftI6 stateMentmay be folwaxdedto tTie 0:90,Of Investigations o£the DTA for ii tsuravca covexage verif[CatiOn. T do lie�eliy certEjy uric e 72e1ic�i dvenartieg of,�rgi,ny tiiai Etta ire,formation providedabove is itac wdeoaavet Si afire• Date: Phon #: v�) ��' –0��3 e OfjI-eiaZ t,tge o try, vo notTrite in AN area,to be emyleted iay city or town official. City or Town: Pexmit/Liceme# fming.Anthority(circle orae): 1.Board of Health.,%Building Department I CRYIT- om Clerk 4.Bloctxzcal Ti�spector �.�°lunal�ingTnspecton- 6.Other